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World J Hepatol. Oct 18, 2016; 8(29): 1205-1211
Published online Oct 18, 2016. doi: 10.4254/wjh.v8.i29.1205
Nutritional evaluation in cirrhosis: Emphasis on the phase angle
Sabrina Alves Fernandes, Angelo Alves de Mattos, Cristiane Valle Tovo, Claudio Augusto Marroni
Sabrina Alves Fernandes, Angelo Alves de Mattos, Cristiane Valle Tovo, Claudio Augusto Marroni, Postgraduate Program at Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS 90420-060, Brazil
Sabrina Alves Fernandes, Post Graduation Program in Bioscience and Rehabilitation and the Post Graduation Program in Rehabilitation and Inclusion, Methodist University - IPA, Porto Alegre, RS 90420-060, Brazil
Author contributions: Fernandes SA and Tovo CV performed the data collection; all the authors wrote the paper and approved the final version.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Sabrina Alves Fernandes, PhD, Postgraduate Program at Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Professor Duplan 72/01, Porto Alegre, RS 90420-060, Brazil. sabrinaafernandes@gmail.com
Telephone: +55-51-33038795 Fax: +55-51-33038795
Received: March 11, 2016
Peer-review started: March 14, 2016
First decision: April 20, 2016
Revised: August 2, 2016
Accepted: August 17, 2016
Article in press: August 18, 2016
Published online: October 18, 2016
Abstract

Protein-calorie malnutrition (PCM) is a common condition in cirrhotic patients, leading to a worse prognosis, complications, poor quality of life and lower survival rates. Among ways of assessing nutritional status, there are anthropometric methods such as the evaluation of the triceps skinfold, the arm circumference, the arm muscle circumference and the body mass index, and non-anthropometric methods such as the subjective global assessment, the handgrip strength of non-dominant hand, and the bioelectrical impedance analysis (BIA). PCM is frequently under-diagnosed in clinical settings in patients with cirrhosis due to the limitations of nutritional evaluation methods in this population. BIA is a useful method, but cannot be indicated in patients with abnormal body composition. In these situations, the phase angle (PA) has been used, and can become an important tool in assessing nutritional status in any situation. The PA is superior to anthropometric methods and might be considered as a nutritional indicator in cirrhosis. The early characterization of the nutritional status in patients with cirrhosis means an early nutritional intervention, with a positive impact on patients’ overall prognosis. Among the usually accepted methods for nutritional diagnosis, the PA provides information in a quick and objective manner.

Keywords: Malnutrition, Bioelectrical impedance, Phase angle, Sarcopenia, Nutrition

Core tip: Malnutrition in cirrhotic patients is a common clinical condition, but there is currently no nutritional diagnosis method defined as the gold standard. Presently, the only nutritional indicator compatible with the clinical condition through the Child-Pugh score in cirrhosis is the phase angle (PA). The PA has been a reliable method and is free of influences regarding changes in body composition of cirrhotic patients at an advanced stage. The PA measured by bioelectrical impedance analysis promises to be a significant parameter for early nutritional intervention in patients with chronic liver disease.