Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 27, 2020; 12(12): 1276-1288
Published online Dec 27, 2020. doi: 10.4254/wjh.v12.i12.1276
Bioelectrical impedance vector analysis evaluates cellularity and hydration in cirrhotic patients
Sabrina Alves Fernandes, Lara Rigon Leonhardt, Daniella Miranda da Silva, Fernanda Donner Alves, Cláudio Augusto Marroni
Sabrina Alves Fernandes, Department of Nutrition, Centro Universitário Metodista IPA, Porto Alegre 90420-060, RS, Brazil
Lara Rigon Leonhardt, Cláudio Augusto Marroni, Gastroenterology and Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 91760-470, RS, Brazil
Daniella Miranda da Silva, Postgraduate Program in Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-170, RS, Brazil
Fernanda Donner Alves, Department of Nutrition, Centro Universitário Ritter dos Reis - Uniritter, Porto Alegre 90840-440, Rio Grande do Sul, Brazil
Author contributions: Fernandes SA contributed to the writing of the research project, data collection and writing and reviewing the scientific article; Leonhardt LR participated in the data collection, tabulation, statistical analysis and writing of the scientific article; da Silva DM assisted in data collection; Alves FD and Marroni CA contributed to writing and reviewing the scientific article.
Institutional review board statement: This project was approved by the Research Ethics Committee of the Federal University of Health Sciences of Porto Alegre, No. 398/08.
Informed consent statement: Patients who participated in the study signed an informed consent form.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Sabrina Alves Fernandes, PhD, Research Scientist, Teacher, Department of Nutrition, Centro Universitário Metodista IPA, Porto Alegre, Porto Alegre 90420-060, RS, Brazil. sabrinaafernandes@gmail.com
Received: July 28, 2020
Peer-review started: July 28, 2020
First decision: August 22, 2020
Revised: September 7, 2020
Accepted: November 5, 2020
Article in press: November 5, 2020
Published online: December 27, 2020
Abstract
BACKGROUND

Malnutrition in cirrhotic patients is correlated with mortality and a better response to liver transplantation. However, recovery of the nutritional status in these patients is a challenge due to the difficulty in establishing a reliable nutritional diagnosis. The bioelectrical impedance vector analysis (BIVA) method appears as a feasible tool in clinical practice to define the physiological state of cirrhotic patients by assessing hydration and body cellularity.

AIM

To evaluate body composition in cirrhotic patients using BIVA.

METHODS

This retrospective cross-sectional study was carried out by following cirrhotic outpatients at a hospital in Porto Alegre, Brazil. A tetrapolar bioelectrical impedance analysis device was used to evaluate cellularity and hydration and to perform the BIVA. The BIVA graphic was elaborated by software and for statistical analysis a significance level of 5% (P ≤ 0.05) was considered.

RESULTS

One hundred and ninety patients, 61.1% males, with a mean age of 56.6 ± 11.0 years, were evaluated. Of these, 56.3% had Child-Turcotte-Pugh (CTP) A score, and the prevalent etiology was hepatitis C virus (47.4%). The patients were classified according to cellularity and hydration by the quadrants and ellipses of the BIVA method, quadrant 1 (47.9%); quadrant 2 (18.9%); quadrant 3 (14.2%); and quadrant 4 (18.9%). Those classified in quadrant 1 and 2 had a higher phase angle compared to those in quadrants 3 and 4 (P < 0.001). Quadrant 2 patients had a lower average age than the other groups. The association with CTP score showed that patients in quadrant 2 had a higher proportion of CTP A, and those in quadrant 4 had a higher proportion of CTP C (P < 0.052).

CONCLUSION

The BIVA method allows identification of the cellularity and hydration status of cirrhotic patients, and its association with clinical factors determines the disease severity, age and prognostic index.

Keywords: Body composition, Hydration, Cellularity, Hepatic cirrhosis, Electrical Bioimpedance, Bioelectrical impedance vector analysis

Core Tip: Using the bioelectrical impedance vector analysis method, it is feasible in clinical practice to identify hydration and cellularity status in patients with liver cirrhosis, regardless of their etiology. This tool allows health professionals to establish an effective treatment for these patients with the objectives of clinical improvement, a better quality of life and better response to orthotopic liver transplantation.