Phase angle as a predictor of malnutrition, sarcopenia, and adverse clinical outcomes in hospitalized patients with ulcerative colitis

doi:10.3748/wjg.121556

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World Journal of Gastroenterology

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1007-9327

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World J Gastroenterol. Nov 14, 2026; 32(42): 121556
Published online Nov 14, 2026. doi: 10.3748/wjg.121556

Table 1 Demographic, anthropometric, and clinical data of patients with ulcerative colitis, mean ± SD/n (%)/median (Q1, Q3)

	Total (n = 122)	Female (n = 48)	Male (n = 74)	P value
Age (years)	46.11 ± 14.08	44.77 ± 13.24	46.99 ± 14.62	0.398
BMI (kg/m²)	21.79 ± 3.35	21.12 ± 3.51	22.23 ± 3.19	0.074
SMI (kg/m²)	6.98 ± 1.36	6.14 ± 1.12	7.52 ± 1.23	< 0.001^a
HGS (kg)	29.35 ± 8.48	22.11 ± 5.39	34.04 ± 6.62	< 0.001^a
PhA (°)	5.17 ± 1.04	4.59 ± 0.97	5.55 ± 0.90	< 0.001^a
NRS 2002				0.008^a
≥ 3 score	53 (43.44)	28 (58.33)	25 (33.78)
< 3 score	69 (56.56)	20 (41.67)	49 (66.22)
Malnutrition	40 (32.79)	21 (43.75)	19 (25.68)	0.038^a
Sarcopenia	25 (20.49)	13 (27.08)	12 (16.22)	0.146
Smoking history	18 (14.75)	2 (4.17)	16 (21.62)	0.008^a
Alcohol consumption history	29 (23.77)	10 (20.83)	19 (25.8)	0.539
Clinical type				0.717
Initial onset	21 (17.21)	9 (18.75)	12 (16.22)
Chronic recurrent type	94 (82.79)	39 (81.25)	55 (83.78)
Disease activity				0.258
Activity	100 (81.97)	37 (77.08)	63 (85.14)
Remission	22 (18.03)	11 (22.92)	11 (14.86)
Severity of illness				0.617
Mild	14 (14.00)	5 (13.51)	9 (14.29)
Moderate	27 (27.00)	9 (24.33)	18 (28.57)
Severe	59 (59.00)	23 (61.16)	36 (57.14)
The Modified Mayo scores	8.00 (5.00, 10.00)	8.00 (6.00, 10.00)	7.00 (5.00, 9.25)	0.236
Gastrointestinal surgery history	17 (13.93)	7 (14.58)	10 (13.51)	0.868
Parenteral manifestations	30 (24.59)	14 (29.17)	16 (21.62)	0.344
IBD-related complications	24 (19.67)	12 (25.00)	12 (16.22)	0.233

^aP < 0.05.

BMI: Body mass index; SMI: Skeletal muscle index; PhA: Phase angle; HGS: Handgrip strength; NRS: Nutritional risk screening; IBD: Inflammatory bowel disease.

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Table 2 Comparison of patient characteristics in ulcerative colitis, mean ± SD/n (%)/median (Q1, Q3)

Factors	Low PhA (n = 42)	Normal PhA (n = 80)	P value
Age (years)	46.93 ± 16.67	45.69 ± 12.60	0.673
BMI (kg/m²)	20.04 ± 3.45	22.71 ± 2.92	< 0.001^a
NRS 2002			< 0.001^a
≥ 3 score	31 (73.81)	22 (27.50)
< 3 score	11 (26.19)	58 (72.50)
Malnutrition	28 (66.67)	12 (15.00)	< 0.001^a
Sarcopenia	20 (47.62)	5 (6.25)	< 0.001^a
Severity of illness			< 0.001^a
Mild	2 (5.56)	12 (18.75)
Moderate	2 (5.56)	25 (39.06)
Severe	32 (88.88)	27 (42.19)
Modified Mayo scores	9.00 (6.75, 11.25)	6.00 (5.00, 8.00)	0.002^a

^aP < 0.05.

PhA: Phase angle; BMI: Body mass index; NRS: Nutritional risk screening.

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Table 3 Comparison of patient clinical data, and body composition between low and normal phase angle status in ulcerative colitis, mean ± SD/median (Q1, Q3)

Factors	Low PhA (n = 42)	Normal PhA (n = 80)	P value
CRP (mg/L)	10.21 (2.63, 24.86)	2.63 (1.29, 9.00)	< 0.001^a
ESR (mm/60 minutes)	20.00 (13.00, 30.25)	10.00 (5.00, 15.75)	< 0.001^a
Alb (g/L)	33.20 ± 8.17	38.51 ± 5.01	< 0.001^a
PAB (mg/L)	199.42 ± 89.34	241.50 ± 51.40	0.007^a
TBIL (μmol/L)	9.07 ± 5.16	10.53 ± 3.68	0.108
Hb (g/L)	101.91 ± 22.19	122.16 ± 22.17	< 0.001^a
FFM (kg)	41.50 ± 8.13	48.88 ± 8.47	< 0.001^a
SMM (kg)	23.09 ± 4.32	27.25 ± 5.15	< 0.001^a
SMI (kg/m²)	6.28 ± 1.39	7.34 ± 1.20	< 0.001^a
BMC (kg)	2.43 ± 0.38	2.76 ± 0.41	< 0.001^a
HGS (kg)	23.41 ± 7.55	32.47 ± 7.22	< 0.001^a

^aP < 0.05.

CRP: C-reactive protein; ESR: Erythrocyte sedimentation rate; Alb: Albumin; PAB: Prealbumin; TBIL: Total bilirubin; Hb: Hemoglobin; FFM: Fat-free mass; SMM: Skeletal muscle mass; SMI: Skeletal muscle index; BMC: Bone mineral content; HGS: Handgrip strength; PhA: Phase angle.

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Table 4 Comparison of clinical data and body composition in ulcerative colitis, mean ± SD/n (%)/median (Q1, Q3)

Factors	No malnutrition (n = 82)	Malnutrition (n = 40)	P value	No sarcopenia (n = 97)	Sarcopenia (n = 25)	P value
Age (years)	46.78 ± 13.94	44.75 ± 14.42	0.457	45.80 ± 13.35	47.32 ± 16.87	0.633
BMI (kg/m²)	22.98 ± 2.80	19.36 ± 3.10	< 0.001^a	22.64 ± 2.99	18.49 ± 2.59	< 0.001^a
Modified Mayo scores	7.00 (5.00, 9.00)	8.50 (6.00, 11.00)	0.012^a	7.00 (5.00, 8.50)	10.00 (8.00, 12.00)	< 0.001^a
Gastrointestinal surgery history	10 (12.20)	7 (17.50)	0.427	15 (15.46)	2 (8.00)	0.524
Parenteral manifestations	13 (15.85)	17 (42.50)	0.001^a	18 (18.56)	12 (48.00)	0.002^a
IBD-related complications	9 (10.98)	15 (37.50)	< 0.001^a	13 (13.40)	11 (44.00)	< 0.001^a
CRP (mg/L)	2.74 (1.43, 9.75)	9.30 (2.34, 26.57)	0.003^a	3.28 (1.32, 9.92)	10.50 (2.58, 30.27)	< 0.001^a
ESR (mm/60 minutes)	10.50 (5.00, 16.00)	19.00 (12.25, 34.75)	< 0.001^a	11.00 (5.00, 18.00)	23.00 (14.00, 34.50)	< 0.001^a
Alb (g/L)	38.67 ± 6.11	32.62 ± 6.18	< 0.001^a	38.15 ± 6.05	31.01 ± 6.38	< 0.001^a
PAB (mg/L)	241.37 ± 52.64	197.59 ± 88.97	0.006^a	244.69 ± 58.57	158.41 ± 66.92	< 0.001^a
TBIL (μmol/L)	10.58 ± 3.77	8.91 ± 5.05	0.068	10.60 ± 4.08	7.81 ± 4.43	0.003^a
Hb (g/L)	121.27 ± 23.15	102.73 ± 21.27	< 0.001^a	119.47 ± 23.46	98.56 ± 19.15	< 0.001^a
FFM (kg)	49.13 ± 8.26	40.61 ± 7.84	< 0.001^a	48.45 ± 8.36	38.16 ± 6.63	< 0.001^a
SMM (kg)	27.23 ± 5.06	22.92 ± 4.43	< 0.001^a	27.19 ± 4.84	20.50 ± 2.92	< 0.001^a
BMC (kg)	2.77 ± 0.40	2.38 ± 0.37	< 0.001^a	2.73 ± 0.40	2.29 ± 0.38	< 0.001^a
PhA (°)	5.59 ± 0.76	4.32 ± 1.01	< 0.001^a	5.45 ± 0.86	4.09 ± 0.97	< 0.001^a

^aP < 0.05.

BMI: Body mass index; IBD: Inflammatory bowel disease; CRP: C-reactive protein; ESR: Erythrocyte sedimentation rate; Alb: Albumin; PAB: Prealbumin; Hb: Hemoglobin; TBIL: Total bilirubin; FFM: Fat-free mass; SMM: Skeletal muscle mass; BMC: Bone mineral content; PhA: Phase angle.

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Table 5 Correlation between phase angle and individual characteristics/bioelectrical impedance analysis parameters

Parameters	R	95%CI	P value
NRS2002	-0.522	-0.644 to -0.375	< 0.001^a
GLIM	-0.578	-0.685 to -0.445	< 0.001^a
AWGS2019	-0.532	-0.649 to -0.391	< 0.001^a
Alb	0.455	0.302-0.585	< 0.001^a
PAB	0.365	0.200-0.509	< 0.001^a
CRP	-0.303	-0.465 to -0.121	0.001^a
ESR	-0.512	-0.640 to -0.355	< 0.001^a
FFM	0.549	0.412-0.662	< 0.001^a
BMC	0.537	0.397-0.653	< 0.001^a
SMM	0.586	0.456-0.692	< 0.001^a
Modified Mayo scores	-0.263	-0.425 to -0.084	0.003^a

^aP < 0.05.

NRS: Nutritional risk screening; GLIM: Global leadership initiative on malnutrition; AWGS: Asian Working Group for Sarcopenia; Alb: Albumin; PAB: Prealbumin; CRP: C-reactive protein; ESR: Erythrocyte sedimentation rate; FFM: Fat-free mass; BMC: Bone mineral content; SMM: Skeletal muscle mass; CI: Confidence interval.

Full Size Table

Table 6 Risk factors for malnutrition in patients with ulcerative colitis

Factors	Univariate logistic regression			Multivariate logistic regression
Factors	OR	95%CI	P value	OR	95%CI	P value
Sex	0.444	0.205-0.962	0.040^a	2.707	0.590-12.425	0.200
BMI (kg/m²)	0.666	0.567-0.783	< 0.001^a	0.836	0.642-1.090	0.186
Modified Mayo scores	1.200	1.040-1.384	0.013^a	0.950	0.762-1.185	0.652
Parenteral manifestations	3.923	1.656-9.295	0.002^a	1.317	0.241-7.204	0.751
IBD-related complications	4.867	1.895-12.496	0.001^a	1.240	0.197-7.784	0.819
CRP (mg/L)	1.053	1.016-1.090	0.004^a	1.006	0.958-1.055	0.821
ESR (mm/60 minutes)	1.045	1.017-1.074	0.001^a	1.016	0.980-1.053	0.384
Alb (g/L)	0.833	0.767-0.905	< 0.001^a	0.917	0.799-1.053	0.218
PAB (mg/L)	0.990	0.984-0.996	0.002^a	1.005	0.994-1.015	0.396
Hb (g/L)	0.966	0.949-0.983	< 0.001^a	0.995	0.963-1.028	0.762
FFM (kg)	0.872	0.820-0.927	< 0.001^a	0.970	0.848-1.111	0.662
SMM (kg)	0.828	0.754-0.909	< 0.001^a	1.089	0.834-1.422	0.533
BMC (kg)	0.079	0.025-0.253	< 0.001^a	0.201	0.012-3.298	0.261
PhA (°)	0.179	0.093-0.343	< 0.001^a	0.276	0.109-0.698	0.007^a

^aP < 0.05.

BMI: Body mass index; IBD: Inflammatory bowel disease; CRP: C-reactive protein; ESR: Erythrocyte sedimentation rate; Alb: Albumin; PAB: Prealbumin; Hb: Hemoglobin; FFM: Fat-free mass; SMM: Skeletal muscle mass; BMC: Bone mineral content; PhA: Phase angle; OR: Odds ratio; CI: Confidence interval.

Full Size Table

Table 7 Risk factors for sarcopenia in patients with ulcerative colitis

Factors	Univariate logistic regression			Multivariate logistic regression
Factors	OR	95%CI	P value	OR	95%CI	P value
BMI (kg/m²)	0.609	0.493-0.752	< 0.001^a	0.794	0.552-1.141	0.212
Modified Mayo scores	1.520	1.234-1.872	< 0.001^a	1.363	0.942-1.972	0.100
Parenteral manifestations	4.051	1.588-10.338	0.003^a	1.139	0.138-9.392	0.904
IBD-related complications	5.077	1.901-13.558	0.001^a	0.521	0.052-5.252	0.580
CRP (mg/L)	1.039	1.013-1.065	0.003^a	0.963	0.911-1.019	0.194
ESR (mm/60 minutes)	1.027	1.005-1.048	0.014^a	0.979	0.933-1.027	0.388
Alb (g/L)	0.814	0.743-0.892	< 0.001^a	1.002	0.868-1.156	0.978
PAB (mg/L)	0.979	0.970-0.988	< 0.001^a	0.970	0.950-0.991	0.005^a
Hb (g/L)	0.962	0.943-0.982	< 0.001^a	1.022	0.974-1.073	0.374
TBIL (μmol/L)	0.832	0.733-0.946	0.005^a	0.816	0.630-1.059	0.126
BMC (kg)	0.052	0.013-0.217	< 0.001^a	0.342	0.036-3.290	0.353
PhA (°)	0.192	0.097-0.383	< 0.001^a	0.270	0.098-0.744	0.011^a

^aP < 0.05.

BMI: Body mass index; IBD: Inflammatory bowel disease; CRP: C-reactive protein; ESR: Erythrocyte sedimentation rate; Alb: Albumin; PAB: Prealbumin; TBIL: Total bilirubin; Hb: Hemoglobin; BMC: Bone mineral content; PhA: Phase angle; OR: Odds ratio; CI: Confidence interval.

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Table 8 Bootstrap internal validation results for phase angle, prealbumin, and combined model

Model	Original AUC	Bootstrap mean AUC	Optimism	Corrected AUC	95%CI
PhA	0.856	0.855	0.001	0.855	0.758-0.934
PAB	0.835	0.835	0.001	0.835	0.747-0.912
PhA + PAB	0.922	0.923	-0.002	0.923	0.859-0.973

AUC: Area under the curve; PhA: Phase angle; PAB: Prealbumin; CI: Confidence interval.

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Table 9 Comparison of clinical outcomes between low and normal groups under Kyle criteria, n (%)

Characteristics	12 weeks clinical outcomes			54 weeks clinical outcomes
Characteristics	Low PhA (n = 42)	Normal PhA (n = 80)	P value	Low PhA (n = 35)	Normal PhA (n = 53)	P value
Medication therapeutic escalation/switching	21 (50.00)	14 (17.50)	< 0.001^a	24 (68.57)	13 (24.53)	< 0.001^a
Readmission	27 (64.29)	12 (15.00)	< 0.001^a	28 (80.00)	24 (45.28)	0.001^a
Surgical intervention	4 (9.52)	1 (1.25)	0.047^a	7 (20.00)	1 (1.89)	0.006^a

^aP < 0.05.

PhA: Phase angle.

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Citation: Wang HY, Liu RJ, Wang YY, Wang DD, Zhang H, Zhang LJ, Jing X, Guo YJ, Li HQ, Liu AL, Ding XL. Phase angle as a predictor of malnutrition, sarcopenia, and adverse clinical outcomes in hospitalized patients with ulcerative colitis. World J Gastroenterol 2026; 32(42): 121556
URL: https://www.wjgnet.com/1007-9327/full/v32/i42/121556.htm
DOI: https://dx.doi.org/10.3748/wjg.121556

Wang HY, Liu RJ, Wang YY, Wang DD, Zhang H, Zhang LJ, Jing X, Guo YJ, Li HQ, Liu AL, Ding XL. Phase angle as a predictor of malnutrition, sarcopenia, and adverse clinical outcomes in hospitalized patients with ulcerative colitis. World J Gastroenterol 2026; 32(42): 121556 [DOI: 10.3748/wjg.121556]

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