1
|
Kawata S, Booka E, Honke J, Haneda R, Soneda W, Murakami T, Matsumoto T, Morita Y, Kikuchi H, Hiramatsu Y, Takeuchi H. Relationship of phase angle with postoperative pneumonia and survival prognosis in patients with esophageal cancer: A retrospective cohort study. Nutrition 2025; 135:112743. [PMID: 40203785 DOI: 10.1016/j.nut.2025.112743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2024] [Revised: 02/17/2025] [Accepted: 03/05/2025] [Indexed: 04/11/2025]
Abstract
OBJECTIVES Phase angle (PhA), derived from bioelectrical impedance analysis (BIA), is an indicator of cell membrane health. Low PhA values reflect poor cellular function and low muscle mass. However, consensus regarding the appropriate cutoff value of PhA remains insufficient, and its impact on outcomes after esophagectomy in patients with esophageal malignancies is not well studied. We aimed to investigate whether preoperative PhA is associated with postoperative complication risk and survival prognosis and whether PhA decrease during the surgical preparation period is a prognostic factor in patients with esophageal cancer. METHODS This retrospective cohort study analyzed data from 194 patients who had undergone esophagectomy for esophageal malignancies. A PhA measured several days before surgery, with cutoff values of 5.0° for men and 4.2° for women, was used. The relationship between postoperative pneumonia and clinicopathological factors and between low PhA and postoperative outcomes and survival prognosis was investigated. The preoperative PhA decline and survival prognosis were analyzed in 134 patients whose PhA was measured twice before surgery. RESULTS Overall, 93 and 101 patients were classified into the low and high PhA groups, respectively. A multivariate analysis showed that a serum albumin level lower than 3.5 g/dL and low PhA were independent risk factors for pneumonia (odds ratio [OR] = 3.40, P = 0.03; OR = 3.42, P = 0.03, respectively). The low PhA group exhibited significantly higher intraoperative fluid balance (6.7 versus 6.0 mL/kg/h, P = 0.01) and a higher proportion of patients who failed to achieve early mobilization on the first postoperative day (46 versus 32%, P = 0.04) than did the high PhA group. Multivariate analysis using a Cox proportional hazards model revealed that low PhA was a poor survival prognostic factor, independent of the clinical stage of esophageal cancer (hazard ratio = 2.61, P < 0.01). In patients whose PhA was measured twice preoperatively, a decrease in PhA during the preoperative period was a significant indicator of poor survival (hazard ratio = 2.59, P < 0.01). The group with a decrease in PhA during the preoperative period had significantly fewer steps than the group with an increase in PhA (6220 ± 2880 versus 8200 ± 2850, P < 0.01). CONCLUSIONS Low PhA was a risk factor for postoperative pneumonia in patients who had undergone esophagectomy and was associated with poor survival prognosis. A decrease in PhA during the preoperative period was a significant poor prognostic factor. Increasing physical activity before surgery may lead to an increase in PhA. Thus, it is important to measure and evaluate PhA changes sequentially in patients with esophageal cancer.
Collapse
Affiliation(s)
- Sanshiro Kawata
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Eisuke Booka
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
| | - Junko Honke
- Department of Perioperative Functioning Care and Support, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Ryoma Haneda
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Wataru Soneda
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiro Murakami
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiro Matsumoto
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yoshifumi Morita
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hirotoshi Kikuchi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yoshihiro Hiramatsu
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan; Department of Perioperative Functioning Care and Support, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| |
Collapse
|
2
|
González-Gutiérrez J, López-Gómez JJ, Primo-Martín D, Izaola-Jauregui O, Ramos-Bachiller B, Jiménez-Sahagún R, De Luis-Román DA. Relationship between body composition parameters and quality of life in patients with obesity and osteoarthritis. Nutrition 2025; 135:112765. [PMID: 40222206 DOI: 10.1016/j.nut.2025.112765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Revised: 02/28/2025] [Accepted: 03/10/2025] [Indexed: 04/15/2025]
Abstract
BACKGROUND AND AIMS The aim of this study was to evaluate the relationship between body composition determined by bioimpedanciometry (BIA) with quality of life (QoL) and functional capacity in patients with obesity and chronic osteoarthritis. METHODS The design was a descriptive cross-sectional study in a sample of 467 patients (350 women and 117 men) with obesity and chronic osteoarthritis. Age, sex, body mass index (BMI), QoL WOMAC test (expressed as a percentage from total score) and BIA parameters (muscle mass index (MMI), fat mass index (FMI), phase angle (PA), BMI-adjusted PA, reactance (Xc) and resistance (RZ)) were recorded. Patients were divided according to total WOMAC score in four quartiles. RESULTS The mean age of the patients was 60.12 (10.87) years and 74.9% of the patients were women. The mean BMI was 40.14 (5.39) kg/m2 (M: 39.74 (5.52) vs. W: 40.27 (5.35) kg/m2, P = 0.36). Total WOMAC scores were 49.12 (22.15) % (M: 46.40 (21.58) vs. W: 51.10 (22.25)%, P < 0.05); for stiffness, the score was 47.73% (M: 44.35 (30.36) vs. W: 48.85 (28.45)%, P = 0.15); for pain, it was 52.26 (25.34)% (M: 50.73 (32.68) vs. W: 52.77 (22.39)%, P = 0.45); and for functional capacity, it was 49.07 (23.38)% (M: 45.48 (23.18) vs. W: 50.27 (23.35)%, P = 0.06). MMI and BMI-adjusted PA were negatively correlated with WOMAC functional capacity score (r = -0.16, P < 0.05 for both sexes). CONCLUSIONS In patients with obesity and chronic osteoarthritis, muscle mass determined by bioimpedanciometry could have a relationship with quality of life determined by the WOMAC test. The decrease in the phase angle adjusted by BMI was related to a slightly decrease in the quality of life.
Collapse
Affiliation(s)
- Jaime González-Gutiérrez
- Endocrinology and Nutrition Department, Clinic University Hospital of Valladolid, Valladolid, Spain; Endocrinology and Nutrition Investigation Centre, University of Valladolid, Valladolid, Spain
| | - Juan José López-Gómez
- Endocrinology and Nutrition Department, Clinic University Hospital of Valladolid, Valladolid, Spain; Endocrinology and Nutrition Investigation Centre, University of Valladolid, Valladolid, Spain.
| | - David Primo-Martín
- Endocrinology and Nutrition Department, Clinic University Hospital of Valladolid, Valladolid, Spain; Endocrinology and Nutrition Investigation Centre, University of Valladolid, Valladolid, Spain
| | - Olatz Izaola-Jauregui
- Endocrinology and Nutrition Department, Clinic University Hospital of Valladolid, Valladolid, Spain; Endocrinology and Nutrition Investigation Centre, University of Valladolid, Valladolid, Spain
| | - Beatriz Ramos-Bachiller
- Endocrinology and Nutrition Department, Clinic University Hospital of Valladolid, Valladolid, Spain; Endocrinology and Nutrition Investigation Centre, University of Valladolid, Valladolid, Spain
| | - Rebeca Jiménez-Sahagún
- Endocrinology and Nutrition Department, Clinic University Hospital of Valladolid, Valladolid, Spain; Endocrinology and Nutrition Investigation Centre, University of Valladolid, Valladolid, Spain
| | - Daniel A De Luis-Román
- Endocrinology and Nutrition Department, Clinic University Hospital of Valladolid, Valladolid, Spain; Endocrinology and Nutrition Investigation Centre, University of Valladolid, Valladolid, Spain
| |
Collapse
|
3
|
Knoll-Pientka N, Schils D, Pasternak K, Czarnetzky S, Jansen C, Gradl-Dietsch G, Seitz J, Skoda EM, Libuda L, Schweda A, Teufel M. Can bioelectrical impedance analysis be used to identify water loading in patients with anorexia nervosa?- Implications from experimental measurements in young, healthy, and normal weight women. J Eat Disord 2025; 13:87. [PMID: 40390023 PMCID: PMC12090468 DOI: 10.1186/s40337-025-01285-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Accepted: 05/07/2025] [Indexed: 05/21/2025] Open
Abstract
Anorexia nervosa (AN) is a severe mental disorder, and patients with AN are characterized by a low body weight and a fear of gaining weight. Restoration of body weight to the normal range is one major treatment aim, which can be a challenging process for the patients. Hence, as a psychopathological symptom of AN, weight manipulations such as water loading before weighing are commonly observed in clinical routine. Biological impedance analysis (BIA) is a helpful tool in routinely visualizing changes in body composition during the refeeding process. Here, we targeted the question whether BIA could potentially detect water loading in healthy, young and normal weight women serving as a preclinical model for patients with AN.Sixty-one women (mean ± SD, 22.2 ± 2.2 years, 20.4 ± 1.0 kg/m2) were included in the analyses. We used a full experimental setting with a cross-over design on two consecutive days. On both days, all participants underwent a baseline BIA in the fasting state (t0). Directly thereafter, participants either consumed 1000 ml of tap water (intervention-condition) or waited for the second BIA measurement 20 min (t1) after baseline (control-condition), and vice versa the subsequent day. Two further BIA measurements took place at 40 (t2) and 60 min (t3) after baseline.After water consumption, we found increases in derived fat mass (FM) and phase angle at t1 to t3, decreases at t1 and subsequent increases at t2 and t3 in extracellular water (ECW) and total body water (TBW). In contrast, skeletal muscle mass (SMM) and ECW/TBW remained rather stable. In the control-condition, most parameters remained constant.Our study provided insight into the changes of impedance raw data and derived body compartments after water consumption among young, healthy and normal weight women. Although the considerable increase of FM in combination with a rather stable course of SMM, as found in our experiment after the consumption of water, could be a potential hint for water loading, further investigation considering the limitations of the present study as for instance the different metabolisms of patients with AN vs. healthy women is required, before transferability to the clinical setting will be given.
Collapse
Affiliation(s)
- Nadja Knoll-Pientka
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, Essen, Germany.
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany.
| | - Dorina Schils
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Katrin Pasternak
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Sandra Czarnetzky
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Christoph Jansen
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Gertraud Gradl-Dietsch
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, Essen, Germany
| | - Jochen Seitz
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, Essen, Germany
| | - Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Lars Libuda
- Faculty of Natural Sciences, Institute of Nutrition, Consumption and Health, Paderborn University, Paderborn, Germany
| | - Adam Schweda
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
4
|
Kameyama Y, Ashizawa R, Honda H, Fujishima I, Ohno T, Kunieda K, Yoshimoto Y. Effects of Paralyzed, Nonparalyzed, and Whole-Body Phase Angle on Physical Performance in Older Patients with Stroke. J Am Med Dir Assoc 2025; 26:105607. [PMID: 40280177 DOI: 10.1016/j.jamda.2025.105607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Revised: 03/11/2025] [Accepted: 03/11/2025] [Indexed: 04/29/2025]
Abstract
OBJECTIVES This study investigated the association between phase angle (PhA) and physical performance in older patients with stroke, focusing on lower-limb PhA and predicting rehabilitation outcomes. DESIGN A retrospective cohort study. SETTING AND PARTICIPANTS Seventy-one patients with stroke aged ≥65 years at a Japanese rehabilitation hospital. METHODS Bioelectrical impedance analysis was used to measure whole-body PhA, paralyzed side lower-limb PhA, and nonparalyzed side lower-limb PhA. Physical performance was assessed using the Short Physical Performance Battery (SPPB) test at admission and discharge, with subdomains including balance, gait speed, and chair-rise performance. Multiple regression analysis was performed to determine whether different PhAs affected SPPB scores at discharge after adjusting for various potential confounders. RESULTS Higher nonparalyzed side lower-limb PhA were significantly associated with better SPPB scores at discharge (β = 0.313, P = .004), and improved balance (β = 0.281, P = .016) and chair-rise performance (β = 0.388, P = .004). Paralyzed side lower-limb PhA was a predictor of total SPPB (β = 0.290, P = .020), but nonparalyzed side lower-limb PhA was more associated with total SPPB. Whole-body PhA was not associated with either total SPPB or any of the SPPB subitems. CONCLUSIONS AND IMPLICATIONS Lower-limb PhA, particularly on the nonparalyzed side, is a significant predictor of physical performance in older patients with stroke. Paralyzed side lower-limb PhA plays a role, particularly in predicting walking ability. These findings suggest that site-specific PhA may represent valuable biomarkers for rehabilitation planning and prognostic assessment in patients recovering from subacute stroke events.
Collapse
Affiliation(s)
- Yuto Kameyama
- Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Shizuoka, Japan; Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu, Shizuoka, Japan.
| | - Ryota Ashizawa
- Department of Rehabilitation, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Hiroya Honda
- Department of Physical Therapy, Biwako Professional University of Rehabilitation, Higashiomi, Shiga, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Shizuoka, Japan
| | - Tomohisa Ohno
- Department of Dentistry, Ryohoku Hospital, Hachioji, Tokyo, Japan
| | - Kenjiro Kunieda
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Shizuoka, Japan; Department of Neurology, Gifu University Graduate School of Medicine, Yanagido, Gifu, Japan
| | - Yoshinobu Yoshimoto
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu, Shizuoka, Japan
| |
Collapse
|
5
|
Wasilewska A, Tomasik P, Gałaś A, Stochel-Gaudyn A, Drożdż D, Fyderek K, Sładek M. Bioimpedance Phase Angle as a Diagnostic Tool of Nutritional Status in Children with Crohn's Disease on Exclusive Enteral Nutrition Therapy: One-Year Follow-Up Study. J Med Food 2025; 28:501-507. [PMID: 40178970 DOI: 10.1089/jmf.2023.0242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2025] Open
Abstract
Exclusive enteral nutrition (EEN) is highly effective in achieving remission and improving nutritional status in pediatric Crohn's disease (CD), commonly associated with altered body mass composition (BC). Bioimpedance analysis (BIA) with phase angle (PA) assessment is a noninvasive, reliable tool in screening for BC alterations. In the present study we aimed to assess the PA's usefulness in the detection of malnutrition in newly diagnosed pediatric CD, ongoing EEN treatment, and during 1-year follow-up. Patients and study design: Fourty-three patients with CD, qualified for EEN, were enrolled in the study. Additionally, 22 healthy children, being in the same age category, served as controls. Fat-free mass (FFM), fat-free mass index (FFMI), and BIA-derived PA were assessed at diagnosis, after EEN completion, and at week 52. The same parameters were obtained in the control group once. The majority of patients presented with normal body mass index at diagnosis. PA values were lower than 5 degrees in 65% of the study group. FFMI deficiencies were observed in 74% of patients. After EEN completion, an increase in FFM (P < .001) was observed. The highest mean of FFM (P < .001) and PA (P < .001) were observed at week 52. A strong correlation between PA and FFM at CD diagnosis (Spearman's rho = 0.671, r = 0.702, P < .001), after EEN completion (Spearman's rho = 0.781, P < .00) and at week 52 (Spearman's rho = 0.657, P < .001) was present. PA has been observed as positively associated with albumin concentrations both at diagnosis and after EEN. Our study provides some support that PA may be a reliable tool for screening alteration in BC, especially FFM and lean tissue mass (LTM). Moreover, PA has been observed as positively associated with albumin levels at CD diagnosis, which provides some evidence that it may be considered as a risk indicator of malnutrition and protein deficiency in newly diagnosed CD pediatric patients.
Collapse
Affiliation(s)
- Agata Wasilewska
- Department of Pediatrics, Gastroenterology and Nutrition, University Children's Hospital in Cracow, Jagiellonian University Medical College, Cracow Poland
| | - Przemysław Tomasik
- Department of Clinical Biochemistry University Children's Hospital in Cracow, Jagiellonian University Medical College, Cracow, Poland
| | - Aleksander Gałaś
- Department of Epidemiology and Preventive Medicine, Faculty of Epidemiology, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Stochel-Gaudyn
- Department of Pediatrics, Gastroenterology and Nutrition, University Children's Hospital in Cracow, Jagiellonian University Medical College, Cracow Poland
| | - Dorota Drożdż
- Department of Pediatric Nephrology and Hypertension, University Children's Hospital in Cracow, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof Fyderek
- Department of Pediatrics, Gastroenterology and Nutrition, University Children's Hospital in Cracow, Jagiellonian University Medical College, Cracow Poland
| | - Małgorzata Sładek
- Department of Pediatrics, Gastroenterology and Nutrition, University Children's Hospital in Cracow, Jagiellonian University Medical College, Cracow Poland
| |
Collapse
|
6
|
Porciello G, Di Lauro T, Luongo A, Coluccia S, Prete M, Abbadessa L, Coppola E, Di Martino A, Mozzillo AL, Racca E, Piccirillo A, Di Giacomo V, Fontana M, D’Amico M, Palumbo E, Vitale S, D’Errico D, Turrà V, Parascandolo I, Stallone T, Augustin LSA, Crispo A, Celentano E, Pignata S. Optimizing Nutritional Care with Machine Learning: Identifying Sarcopenia Risk Through Body Composition Parameters in Cancer Patients-Insights from the NUTritional and Sarcopenia RIsk SCREENing Project (NUTRISCREEN). Nutrients 2025; 17:1376. [PMID: 40284239 PMCID: PMC12030622 DOI: 10.3390/nu17081376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2025] [Revised: 04/11/2025] [Accepted: 04/15/2025] [Indexed: 04/29/2025] Open
Abstract
Background/Objectives: Cancer and related treatments can impair body composition (BC), increasing the risk of malnutrition and sarcopenia, poor prognosis, and Health-Related Quality of Life (HRQoL). To enhance BC parameter interpretation through Bioelectrical Impedance Analysis (BIA), we developed a predictive model based on unsupervised approaches including Principal Component Analysis (PCA) and k-means clustering for sarcopenia risk in cancer patients at the Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale" (Naples). Methods: Sarcopenia and malnutrition risks were assessed using the NRS-2002 and SARC-F questionnaires, anthropometric measurements, and BIA. HRQoL was evaluated with the EORTC QLQ-C30 questionnaire. PCA and clustering analysis were performed to identify different BC profiles. Results: Data from 879 cancer patients (mean age: 63 ± 12.5 years) were collected: 117 patients (13%) and 128 (15%) were at risk of malnutrition and sarcopenia, respectively. PCA analysis identified three main components, and k-means determined three clusters, namely HMP (High Muscle Profile), MMP (Moderate Muscle Profile), and LMP (Low Muscle Profile). Patients in LMP were older, with a higher prevalence of comorbidities, malnutrition, and sarcopenia. In the multivariable analysis, age, lung cancer site, diabetes, and malnutrition risk were significantly associated with an increased risk of sarcopenia; among the clusters, patients in LMP had an increased risk of sarcopenia (+62%, p = 0.006). Conclusions: The NUTRISCREEN project, part of the ONCOCAMP study (ClinicalTrials.gov ID: NCT06270602), provides a personalized nutritional pathway for early screening of malnutrition and sarcopenia. Using an unsupervised approach, we provide distinct BC profiles and valuable insights into the factors associated with sarcopenia risk. This approach in clinical practice could help define risk categories, ensure the most appropriate nutritional strategies, and improve patient outcomes by providing data-driven care.
Collapse
Affiliation(s)
- Giuseppe Porciello
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (G.P.); (M.P.); (E.P.); (S.V.); (L.S.A.A.); (A.C.); (E.C.)
| | - Teresa Di Lauro
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (T.D.L.); (E.C.); (D.D.); (S.P.)
| | - Assunta Luongo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (G.P.); (M.P.); (E.P.); (S.V.); (L.S.A.A.); (A.C.); (E.C.)
| | - Sergio Coluccia
- Branch of Medical Statistics, Biometry and Epidemiology “G. A. Maccacaro”, Department of Clinical Sciences and Community Health, Dipartimento di Eccellenza 2023–2027, Università degli Studi di Milano, 20133 Milan, Italy; (S.C.)
| | - Melania Prete
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (G.P.); (M.P.); (E.P.); (S.V.); (L.S.A.A.); (A.C.); (E.C.)
| | - Ludovica Abbadessa
- Dietetics and Artificial Nutrition, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (L.A.); (A.D.M.); (V.D.G.); (M.F.); (V.T.); (I.P.)
| | - Elisabetta Coppola
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (T.D.L.); (E.C.); (D.D.); (S.P.)
| | - Annabella Di Martino
- Dietetics and Artificial Nutrition, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (L.A.); (A.D.M.); (V.D.G.); (M.F.); (V.T.); (I.P.)
| | - Anna Licia Mozzillo
- Melanoma Cancer Immunotherapy and Innovative Therapy Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (A.L.M.)
| | - Emanuela Racca
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (E.R.)
| | - Arianna Piccirillo
- Otolaryngology and Maxillo-Facial Surgery Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (A.P.)
| | - Vittoria Di Giacomo
- Dietetics and Artificial Nutrition, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (L.A.); (A.D.M.); (V.D.G.); (M.F.); (V.T.); (I.P.)
| | - Martina Fontana
- Dietetics and Artificial Nutrition, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (L.A.); (A.D.M.); (V.D.G.); (M.F.); (V.T.); (I.P.)
| | - Maria D’Amico
- Colorectal Surgical Oncology Abdominal Oncology Department, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (M.D.)
| | - Elvira Palumbo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (G.P.); (M.P.); (E.P.); (S.V.); (L.S.A.A.); (A.C.); (E.C.)
| | - Sara Vitale
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (G.P.); (M.P.); (E.P.); (S.V.); (L.S.A.A.); (A.C.); (E.C.)
| | - Davide D’Errico
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (T.D.L.); (E.C.); (D.D.); (S.P.)
| | - Valeria Turrà
- Dietetics and Artificial Nutrition, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (L.A.); (A.D.M.); (V.D.G.); (M.F.); (V.T.); (I.P.)
| | - Ileana Parascandolo
- Dietetics and Artificial Nutrition, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (L.A.); (A.D.M.); (V.D.G.); (M.F.); (V.T.); (I.P.)
| | - Tiziana Stallone
- Ente Nazionale di Previdenza e Assistenza a Favore dei Biologi (ENPAB), 00153 Rome, Italy; (T.S.)
| | - Livia S. A. Augustin
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (G.P.); (M.P.); (E.P.); (S.V.); (L.S.A.A.); (A.C.); (E.C.)
| | - Anna Crispo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (G.P.); (M.P.); (E.P.); (S.V.); (L.S.A.A.); (A.C.); (E.C.)
| | - Egidio Celentano
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (G.P.); (M.P.); (E.P.); (S.V.); (L.S.A.A.); (A.C.); (E.C.)
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (T.D.L.); (E.C.); (D.D.); (S.P.)
| |
Collapse
|
7
|
Kekez D, Prejac J, Adžić G, Librenjak N, Goršić I, Jonjić D, Krznarić Ž, Augustin G, Pleština S. Phase angle as a prognostic biomarker in metastatic colorectal cancer: A prospective trial. World J Gastrointest Oncol 2025; 17:103029. [PMID: 40235903 PMCID: PMC11995349 DOI: 10.4251/wjgo.v17.i4.103029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2024] [Revised: 12/29/2024] [Accepted: 01/20/2025] [Indexed: 03/25/2025] Open
Abstract
BACKGROUND Colorectal cancer (CRC) represents a major global public health issue, ranking as the third most common cancer worldwide. Given the substantial prevalence of CRC, there is a critical need to identify precise prognostic and predictive biomarker tools for better treatment outcomes. Phase angle (PA) has been proposed as a prognostic marker in various non-malignant and malignant clinical conditions. AIM To investigate the relationship between PA and survival outcomes in the first-line treatment of metastatic CRC (mCRC). METHODS In this prospective observational study, we obtained data on patients who started first-line systemic chemotherapy from the beginning of 2020 until the end of 2022. The PA, assessed by the bioelectrical impedance analysis scale, was evaluated as a possible prognostic factor for treatment outcomes, which were measured as progression-free survival (PFS) and objective response rate (ORR). RESULTS Using the cut-point value for PA set at 4.60°, 144 patients were divided into two cohorts. The high PA group of patients exhibited a significantly longer median PFS than the low PA group, 14.8 vs 10.5 months, respectively. No difference in ORR was observed. However, patients with PA ≥ 4.60° had a higher disease control rate. CONCLUSION PA represents a novel and objective pre-chemotherapy prognostic factor to identify mCRC patients who are at increased risk of a worse survival outcome.
Collapse
Affiliation(s)
- Domina Kekez
- Department of Oncology, University Hospital Centre Zagreb, Zagreb 10000, Grad Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, Zagreb 10000, Grad Zagreb, Croatia
| | - Juraj Prejac
- Department of Oncology, University Hospital Centre Zagreb, Zagreb 10000, Grad Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, Zagreb 10000, Grad Zagreb, Croatia
| | - Gordan Adžić
- Department of Oncology, University Hospital Centre Zagreb, Zagreb 10000, Grad Zagreb, Croatia
| | - Nikša Librenjak
- Department of Oncology, University Hospital Centre Zagreb, Zagreb 10000, Grad Zagreb, Croatia
| | - Irma Goršić
- Department of Oncology, University Hospital Centre Zagreb, Zagreb 10000, Grad Zagreb, Croatia
| | - Danijela Jonjić
- Department of Oncology, University Hospital Centre Zagreb, Zagreb 10000, Grad Zagreb, Croatia
| | - Željko Krznarić
- Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb 10000, Grad Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb 10000, Grad Zagreb, Croatia
| | - Goran Augustin
- Department of Surgery, University Hospital Centre Zagreb, Zagreb 10000, Grad Zagreb, Croatia
| | - Stjepko Pleština
- Department of Oncology, University Hospital Centre Zagreb, Zagreb 10000, Grad Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb 10000, Grad Zagreb, Croatia
| |
Collapse
|
8
|
Rosa GB, Lukaski HC, Sardinha LB. The science of bioelectrical impedance-derived phase angle: insights from body composition in youth. Rev Endocr Metab Disord 2025:10.1007/s11154-025-09964-7. [PMID: 40208410 DOI: 10.1007/s11154-025-09964-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2025] [Indexed: 04/11/2025]
Abstract
Despite bioelectrical impedance analysis (BIA)-derived phase angle (PhA) being recognized as a global marker of health, reflecting both cellular integrity and fluid distribution, its biological determinants still need to be described in youth. This narrative review provides a comprehensive framework examining to what extent dielectric properties shaping PhA are influenced by qualitative and quantitative determinants at multiple levels of body composition in healthy and clinical pediatric populations. At the atomic-molecular level, water content, glycogen, lipids, and ionic concentrations are expected to influence PhA by affecting electrical conductivity and/or capacitance. While the increase in the absolute values of intracellular (ICW) and extracellular water (ECW) enhances electric conductivity, an increase in the relative portion of ECW is expected to reflect hydration imbalances with an impact on electrical pathways. At the cellular level, body cell mass is a key determinant of PhA, mainly due to the presence of skeletal muscle cells favoring conductive and capacitive properties. At the tissue level, skeletal muscle architecture and orientation strongly influence conductivity, while increases in skeletal muscle mass positively impact PhA by enhancing electric conductivity and capacitance. Beyond the theoretical insights presented in this review, careful interpretation of dielectric data remains crucial due to the lack of methodological standardization. Future research should prioritize validated reference methods, investigate longitudinal changes, integrate localized BIA, and explore additional BIA models to refine the interpretation of PhA.
Collapse
Affiliation(s)
- Gil B Rosa
- Exercise and Health Laboratory, Faculdade de Motricidade Humana, CIPER, Universidade de Lisboa, Cruz-Quebrada, Portugal.
| | - Henry C Lukaski
- Department of Kinesiology and Public Health Education, Hyslop Sports Center, University of North Dakota, Grand Forks, ND, USA
| | - Luís B Sardinha
- Exercise and Health Laboratory, Faculdade de Motricidade Humana, CIPER, Universidade de Lisboa, Cruz-Quebrada, Portugal
| |
Collapse
|
9
|
Gabiatti MP, Longo GZ, Hauschild DB, Pinto LG, Hansen F. Phase angle is associated with inflammatory parameters in young adults and adults with metabolic syndrome in a population-based study. Nutr Metab Cardiovasc Dis 2025:104028. [PMID: 40199706 DOI: 10.1016/j.numecd.2025.104028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 03/03/2025] [Accepted: 03/25/2025] [Indexed: 04/10/2025]
Abstract
BACKGROUND AND AIMS Phase angle (PhA) is suggested to reflect cell health. PhA association with inflammation and adiposity in metabolic syndrome (MetS) presence or absence, remains unclear. In the general population, PhA association with C-reactive protein (CRP) is controversial, and studies on PhA with other inflammatory markers are a literature gap. This study aims to evaluate the association of PhA with inflammatory and adiposity-related parameters in males and females with and without MetS. METHODS AND RESULTS Cross-sectional study with 597 adults (38.4 years; CI95 % 36.35-40.45) categorized into MetS (n = 126, 57.9 % female) and non-MetS (n = 471, 55.2 % female). Single-frequency bioimpedance analysis evaluated PhA. Adiposity-related (BMI, visceral adiposity index, and body fat percentage (%BF) by dual-energy x-ray emission) and serum inflammatory parameters (CRP, TNF-α, IL-6, IL-10, IL-1β, IL-8, IL-12p70) were evaluated. Regression analyses adjusted by age, and physical activity level, with or without %BF, evaluated the associations. In males MetS, PhA was negatively associated with %BF, IL-6, IL-10, IL-1β, and IL-12p70 (β = -0.07, p = 0.005, β = -0.03, p = 0.035, β = -0.06, p = 0.006, β = -0.03, p = 0.048, β = -0.02, p = 0.038, respectively) and positively associated with BMI (β = 0.07, p = 0.003) in non-MetS. In females MetS, PhA was negatively associated with TNF-α and IL-12p70 (β = -0.02, p = 0.048, β = -0.01, p = 0.016, respectively) and positively with IMC, %BF, TNF-α and IL-8 (β = 0.07, p < 0.001, β = 0.02, p = 0.021, β = 0.02, p = 0.011, β = 0.01, p = 0.035, respectively) in non-MetS. CONCLUSION In MetS individuals, higher PhA values are associated with lower inflammatory parameters in both sexes and %BF in males. The different behavior of PhA in females, suggests caution when interpreting PhA in this population.
Collapse
Affiliation(s)
- Mariana P Gabiatti
- Department of Nutrition, Health Sciences Center - CCS, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
| | - Giana Z Longo
- Department of Nutrition, Health Sciences Center - CCS, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Daniela B Hauschild
- Department of Nutrition, Health Sciences Center - CCS, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Luiza G Pinto
- Department of Nutrition, Health Sciences Center - CCS, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Fernanda Hansen
- Department of Nutrition, Health Sciences Center - CCS, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| |
Collapse
|
10
|
Oshita K, Hikita A, Myotsuzono R, Ishihara Y. Relationship between age and various muscle quality indices in Japanese individuals via bioelectrical impedance analysis (BIA). J Physiol Anthropol 2025; 44:8. [PMID: 40045346 PMCID: PMC11881323 DOI: 10.1186/s40101-025-00388-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2025] [Accepted: 02/23/2025] [Indexed: 03/09/2025] Open
Abstract
BACKGROUND Bioelectrical impedance analysis (BIA) is widely used as a convenient method of measuring body composition. The validity of the phase angle (PhA), impedance rate (IR), and resistance rate (RR) as indices of muscle quality using BIA has been suggested. This study aimed to investigate the relationship between these muscle quality indices and age, and to clarify their characteristics. METHODS The appendicular muscle mass (AMM), AMM corrected for body mass index (AMM/BMI), PhA, IR, and RR were determined using BIA in 1376 Japanese individuals (532 males and 844 females) aged 15-95 years. The PhA was determined from a 50-kHz current, and the IR and RR were determined from the impedance and resistance ratios between the 250- and 5-kHz currents. RESULTS AMM/BMI showed greater age-related changes than the other indices of muscle mass. Significant differences in PhA, IR, and RR were found for the whole body at age ≥ 50 years and for the lower limbs at age ≥ 30 years, compared to those in their 20 s. For the arms, age-related changes were small, and significant differences in PhA of females were only observed at aged ≥ 85 years, whereas significant differences in IR and RR were observed at aged ≥ 75 years, compared to those in their 20s. CONCLUSION These results suggest that although PhA, IR, and RR in the whole body and lower limbs showed age-related changes, the change in PhA in the upper body was small, especially in females. However, IR and RR in the upper limbs of females reflected age-related changes more than PhA.
Collapse
Affiliation(s)
- Kazushige Oshita
- Department of Human Information Engineering, Okayama Prefectural University, Soja, Japan.
| | - Akihisa Hikita
- Department of Sport Science, Kyushu Kyoritsu University, Kitakyushu, Japan
| | - Ryota Myotsuzono
- Department of Sport Science, Kyushu Kyoritsu University, Kitakyushu, Japan
| | - Yujiro Ishihara
- Center for Fundamental Education, Okayama University of Science, Okayama, Japan
| |
Collapse
|
11
|
Ferrell C, Byham-Gray L, Samavat H, Hamdan M. Potential Determinants of Subjective Global Assessment Among Patients on Maintenance Hemodialysis. J Ren Nutr 2025; 35:319-327. [PMID: 38621433 DOI: 10.1053/j.jrn.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 02/18/2024] [Accepted: 04/07/2024] [Indexed: 04/17/2024] Open
Abstract
OBJECTIVE The Subjective Global Assessment (SGA) is a validated tool for identifying nutritional status in patients receiving maintenance hemodialysis (MHD), but it is not without limitations. Current research identifies additional clinical characteristics such as phase angle (PhA) associated with SGA. This study aimed to assess the overall correlation between PhA and SGA; associations between PhA and SGA by body mass index, and to identify clinical characteristics associated with SGA. DESIGN AND METHODS This is a secondary analysis of the Rutgers Nutrition & Kidney Database, which enrolled participants from four primary studies that included adults diagnosed with chronic kidney disease who were receiving MHD. Multivariable binary logistic regression analyses were conducted to estimate odds ratio (OR) and corresponding 95% confidence intervals (CIs). RESULTS The study sample included 60.0% males with 81.1% of the sample identifying as African American. Additionally, 38.9% were obese according to the body mass index classification, and 57.0% were moderately malnourished. Patients with obesity had 44% lower odds of being moderately malnourished (OR = 0.56, 95% CI = 0.37, 0.85). In the model adjusted for age and ethnicity and other clinical characteristics, increasing PhA values by one unit was associated with 28% lower odds (OR = 0.72, 95% CI = 0.53, 0.97) of being moderately malnourished while increasing waist circumference (WC) values by one unit was associated with 12% higher odds (OR = 1.12; 95% CI = 1.06, 1.19) of being moderately malnourished than well-nourished. In this fully adjusted model, increasing fat free mass (FFM, OR = 0.95, 95% CI = 0.91, 0.99) and fat mass (FM, OR = 0.92, 95% CI = 0.87, 0.97) by 1 kg was also associated with 5% and 8% lower odds of being moderately malnourished, respectively. CONCLUSION PhA and SGA were significantly associated only among patients classified as obese. PhA, WC, FM, and FFM were identified as potential clinical determinants of SGA. Patients receiving MHD and who have obesity may benefit from utilizing SGA along with WC, PhA, FM, and FFM to assess nutritional status.
Collapse
Affiliation(s)
- Carla Ferrell
- Department of Clinical and Preventive Nutrition Services, School of Health Professions; Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Laura Byham-Gray
- Department of Clinical and Preventive Nutrition Services, School of Health Professions; Rutgers, The State University of New Jersey, Newark, New Jersey.
| | - Hamed Samavat
- Department of Clinical and Preventive Nutrition Services, School of Health Professions; Rutgers, The State University of New Jersey, Newark, New Jersey
| | | |
Collapse
|
12
|
Di Vincenzo O, Pagano E, Ballarin G, Pasanisi F, Scalfi L. Phase angle is associated with nutritional risk in subacute stroke patients at the beginning of rehabilitation. Nutrition 2025; 131:112637. [PMID: 39693932 DOI: 10.1016/j.nut.2024.112637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 10/08/2024] [Accepted: 11/10/2024] [Indexed: 12/20/2024]
Abstract
OBJECTIVES Malnutrition in stroke is associated with poor clinical outcomes. Bioelectrical impedance analysis-derived phase angle (PhA) is widely used for assessing nutritional status as an index of muscle quality. This study aimed to evaluate the associations between whole body and limb PhAs and nutritional risk in stroke patients. PhA predictors were also identified. METHODS Consecutive subacute stroke patients aged ≥50 y at the beginning of rehabilitation participated in this retrospective analysis. Nutritional risk was assessed using the Geriatric Nutritional Risk Index, the Prognostic Nutritional Index, and the Controlling Nutritional Status score. PhAs at 50 kHz for both whole body and limbs were measured. The associations between PhA and nutritional risk were examined through univariate/multivariate analyses. RESULTS Overall, 272 subacute stroke patients were studied (age, 70.1 ± 12.4 y, body mass index, 26.8 ± 3.9 kg/m²). Both whole body and limb PhAs were associated with Geriatric Nutritional Risk Index, Prognostic Nutritional Index, and Controlling Nutritional Status score, and this was also true in patients aged ≥75 y (P < 0.001). Low PhA values were observed in patients at high nutritional risk. The general linear model identified age, female sex, hypertension, diabetes, dysphagia, and time from stroke onset as independent predictors of PhA (R² = 0.468, P < 0.001). Furthermore, PhA emerged as a significant predictor of high nutritional risk according to each screening tool. Finally, optimal cutoffs of whole body PhA for predicting high nutritional risk were around 4.08°. CONCLUSIONS In stroke patients, low PhA values were associated with high nutritional risk. PhA at the beginning of rehabilitation may serve as a reliable parameter to be considered in the evaluation of nutritional status.
Collapse
Affiliation(s)
| | | | - Giada Ballarin
- Department of Movement Sciences and Wellbeing, Parthenope University of Naples, Italy
| | - Fabrizio Pasanisi
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Italy
| | - Luca Scalfi
- Department of Public Health, Federico II University of Naples, Italy; Santa Maria del Pozzo Hospital, Somma Vesuviana, Naples, Italy
| |
Collapse
|
13
|
Wada O, Kamitani T, Mizuno K, Kurita N. Effect of Phase Angle on Change in Quadriceps Muscle Strength 1 Year After Total Knee Arthroplasty: The Screening for People Suffering Sarcopenia in Orthopedic Cohort of Kobe Study. J Arthroplasty 2025; 40:672-677.e1. [PMID: 39293699 DOI: 10.1016/j.arth.2024.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 09/10/2024] [Accepted: 09/10/2024] [Indexed: 09/20/2024] Open
Abstract
BACKGROUND Phase angle (PhA) has been reported to be associated with quadriceps strength in patients who have knee osteoarthritis and were scheduled for total knee arthroplasty (TKA). The PhA can also be expected to predict the time course of quadriceps muscle strength loss and recovery. We aimed to investigate the relationship between the preoperative PhA and the time course of quadriceps muscle strength change in patients undergoing TKA. METHODS A prospective cohort study was conducted on patients scheduled for primary unilateral TKA. A total of 855 patents were included in the analysis. The PhA and quadriceps muscle strength of the operated knee were measured preoperatively and at 3, 6, and 12 months postoperatively. To analyze the effect of the preoperative PhA on the change in postoperative quadriceps muscle strength, a linear mixed model with the quadriceps muscle strength as a dependent variable with the preoperative PhA, evaluation period (dummy variable), and their product terms as independent variables was conducted after adjusting for preoperative covariates. RESULTS A statistically significant negative effect was present for a higher PhA, resulting in a greater decrease in quadriceps muscle strength between preoperative and 3 months postoperative (P = 0.012). In contrast, the effect was not statistically significant between 3 and 6 months postoperatively (P = 0.17). However, a statistically significant positive effect for a higher PhA resulting in a greater increase in quadriceps muscle strength was present between 6 and 12 months postoperatively (P = 0.027). CONCLUSIONS Preoperative PhA is a useful predictor of the quadriceps muscle strength change after TKA. These findings suggest that evaluating the preoperative PhA could aid in the development of targeted rehabilitation programs aimed at optimizing quadriceps muscle function in patients undergoing TKA.
Collapse
Affiliation(s)
| | - Tsukasa Kamitani
- Section of Education for Clinical Research, Kyoto University Hospital, Kyoto, Japan
| | | | - Noriaki Kurita
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan; Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima, Japan; Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan
| |
Collapse
|
14
|
Gomes ACA, Fiorotti AM, Bortoli AMD, Brito BBD, Fiorido JAS, Salaroli LB, Lopes AB, Haraguchi FK. Decrease in phase angle after Roux-en-Y gastric bypass is related to increase of anti-inflammatory status. CLINICAL NUTRITION OPEN SCIENCE 2025; 59:159-170. [DOI: 10.1016/j.nutos.2025.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2025] Open
|
15
|
Šostakaitė G, Jauniškytė M, Budrys D, Budrevičius K, Šalčiūtė-Šimėnė E, Svetikienė M, Jovaiša T, Žvirblis T, Klimašauskas A, Šipylaitė J. Comparison of Two Techniques to Assess Muscle Mass Loss During ICU Stay: Muscle Ultrasound vs Bioelectrical Impedance Analysis. Nutrition 2025; 130:112607. [PMID: 39549651 DOI: 10.1016/j.nut.2024.112607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 10/01/2024] [Accepted: 10/14/2024] [Indexed: 11/18/2024]
Abstract
BACKGROUND AND AIMS Muscle wasting is a prevalent issue among long-term critically ill patients and is associated with adverse clinical outcomes. Evaluating muscle mass in the ICU presents challenges due to the lack of a consistent methodology and the significant impact of fluid balance range in ICU patients. This prospective study aimed to compare the utility of bioelectrical impedance analysis (BIA) and ultrasound (US) for monitoring muscle wasting in critically ill patients over an initial seven-day period of critical illness. METHODS Conducted in a tertiary teaching hospital's mixed ICU, the study included adult patients with ICU stays exceeding seven days. Measurements were taken on Day 1 (within 24 hours of ICU admission), Day 5, and Day 7. RESULTS Out of 101 enrolled patients, 74 were male, with a mean age of 55.3 (SD 14.8) years. The mean APACHE II score was 18.2 (SD 7.2), and the Day 1 SOFA score was 7.9 (SD 3.2). The ICU survival rate was 65%, and the mean ICU length of stay was 19.2 (SD 19.2) days. Statistically significant muscle mass loss was detected by US measurement, demonstrating the relative change in general muscle thickness: -2.5% (SD 11.8) by Day 5 and -6.5% (SD 12.4) by Day 7 (P < 0.001). BIA demonstrated no significant change in phase angle, as the relative change by Day 5 was -3.3% (SD 19.9) and by Day 7 it was -1.9% (SD 21.9), with no significant difference (P = 0.374). CONCLUSIONS Ultrasound was a more suitable method for assessing and monitoring muscle wasting during ICU stays, while bioelectrical impedance analysis failed to demonstrate a comparable degree of muscle loss at Days 5 and 7. This study highlights the importance of selecting an appropriate assessment method based on the specific clinical context, emphasizing the reliability of US in evaluating muscle wasting among critically ill patients.
Collapse
Affiliation(s)
- Gintarė Šostakaitė
- Clinic of Anaesthesiology and Intensive Care, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Martyna Jauniškytė
- Clinic of Anaesthesiology and Intensive Care, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | | | - Erika Šalčiūtė-Šimėnė
- Clinic of Anaesthesiology and Intensive Care, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Marija Svetikienė
- Clinic of Anaesthesiology and Intensive Care, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Tomas Jovaiša
- Clinic of Anaesthesiology and Intensive Care, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Tadas Žvirblis
- Institute of Biomedical sciences, Department of Human and Medical Genetics, Vilnius University, Vilnius, Lithuania
| | - Andrius Klimašauskas
- Clinic of Anaesthesiology and Intensive Care, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Jūratė Šipylaitė
- Clinic of Anaesthesiology and Intensive Care, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| |
Collapse
|
16
|
Plauth M, Bauer P, Viertel M, Reich M, Hiesmayr M. Disease modifies the dependency of percentiles of the phase angle distribution on age, sex, height and weight in hospitalized patients. Clin Nutr 2025; 45:43-52. [PMID: 39740298 DOI: 10.1016/j.clnu.2024.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2024] [Revised: 12/17/2024] [Accepted: 12/18/2024] [Indexed: 01/02/2025]
Abstract
BACKGROUND & AIMS Phase angle (PhA) is viewed as a holistic indicator of quantity and quality of cellularity and hydration status and has emerged as a significant predictor of patient outcome in clinical medicine. We sought to analyze the impact of hospitalization as a surrogate for disease on the distribution of PhA and its dependency on influence variables age, sex, height and weight without any assumption as to the form of PhA-distribution. METHODS First PhA measurements obtained from 2418 women (median age 75 IQR[63; 82]) and 2541 men (median age 70 IQR[60; 79]) hospitalized in a Community General Hospital were analyzed. Multivariable quantile regression was applied for estimating percentiles P1 - P95 using parsimonious models including a dichotomous factor for sex and cubic polynomials for age (model A) and height and weight (model B) using only linear interaction terms between the four variables sex, age, height, and weight. RESULTS The association of PhA was strongest with age (women r = -0.48; men r = -0.47). In each age class average PhA values of hospitalized patients were below those reported for healthy individuals. In contrast to percentiles above the median showing a monotonous decrease with age as reported from healthy individuals the lower percentiles of patients showed a marked dip-and-plateau deformation. This deformation was associated with a change in the distribution span of PhA between P1 and P95 which was narrower at young age, expanded markedly due to a persisting fraction of patients with low PhA over the age range from 50 to 80 years and became narrower again at higher age due to the decreasing fraction of patients with high PhA. These distribution patterns were the same, irrespective of using either model A or model B. Furthermore, bootstrapping confirmed the estimated form of the percentile curves. CONCLUSIONS Disease modifies the PhA distribution pattern resulting not only in lower PhA in patients than in healthy individuals but also in a dip-and-plateau deformation of lower PhA percentile curves for the association with age. The dip-and-plateau pattern and the narrowing of the span between P1 and P95 with older age suggest that there is a low threshold value for PhA, below which life is impossible. CLINICAL TRIAL REGISTRY DRKS00025307, https://www.drks.de/DRKS00025307.
Collapse
Affiliation(s)
- Mathias Plauth
- Dessau Community General Hospital, Dept Internal Medicine, Auenweg 38, 06847, Dessau-Rosslau, Germany.
| | - Peter Bauer
- Medical University Vienna, Center for Medical Data Science, Institute of Medical Statistics, Spitalgasse 30, 1090, Vienna, Austria
| | - Melanie Viertel
- Dessau Community General Hospital, Dept Internal Medicine, Auenweg 38, 06847, Dessau-Rosslau, Germany
| | - Michael Reich
- Dessau Community General Hospital, Dept Internal Medicine, Auenweg 38, 06847, Dessau-Rosslau, Germany
| | - Michael Hiesmayr
- Medical University Vienna, Center for Medical Data Science, Institute of Medical Statistics, Spitalgasse 30, 1090, Vienna, Austria
| |
Collapse
|
17
|
Tomborelli Bellafronte N, Atoui S, Carli F, Liberman AS, Schricker T, Gillis C. Preoperative Standardized Phase Angle Is Associated with Any and 30-Day Medical-related Postoperative Complications among Colorectal and Lung Surgical Patients: A Retrospective Analysis. Anesthesiology 2025; 142:405-408. [PMID: 39807920 DOI: 10.1097/aln.0000000000005268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2025]
|
18
|
Xia XX, Li CX, Xue XX, Chen YJ, He F, Guo HR. Association between phase angle and all-cause mortality in adults aged 18-49 years: NHANES 1999-2004. Sci Rep 2025; 15:2785. [PMID: 39843978 PMCID: PMC11754445 DOI: 10.1038/s41598-025-86825-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 01/14/2025] [Indexed: 01/24/2025] Open
Abstract
Phase angle (PhA) is an indicator of nutritional status. The association between PhA and all-cause mortality has been confirmed in older adults, but no relevant studies have been conducted in adults aged 18-49 years. This study aimed to investigate the relationship between PhA and all-cause mortality in adults aged 18-49 years. Our study included 6338 adults aged 18-49 from the National Health and Nutrition Examination Survey (1999-2004). Kaplan-Meier (KM) curve, multiple Cox regression and stratified analyses were performed. These adults were divided into two groups based on the median PhA value (the low PhA group: PhA < 6.96°; the high PhA group: PhA ≥ 6.96°). During a median follow-up of 214 months, 307 all-cause deaths were recorded. The all-cause mortality rate was 5.07% in the low PhA group and 3.98% in the high PhA group. After full adjustment, a higher PhA value was significantly associated with reduced risk of all-cause mortality (HR = 0.73,95CI%:0.59-0.91, P = 0.005). Similarly, compared with those in the low PhA group, individuals in the high PhA group had a lower risk of all-cause mortality (HR = 0.67, 95% CI 0.46-0.98, P = 0.041). There was an interaction between smoking status and PhA (P for interaction = 0.029), with a statistically significant negative association between PhA and all-cause mortality in the non-smokers (HR:0.62, 95%CI:0.53-0.88, P = 0.003). In conclusion, there was a significant negative association between PhA and all-cause mortality in adults aged 18-49 years. The negative association was stronger in non-smokers.
Collapse
Affiliation(s)
- Xian-Xin Xia
- Department of Respiratory and Critical Care Medicine, the Third Hospital of Wuhan, Wuhan, 430030, People's Republic of China
| | - Chuan-Xiang Li
- Department of Respiratory and Critical Care Medicine, the Third Hospital of Wuhan, Wuhan, 430030, People's Republic of China
| | - Xin-Xin Xue
- Department of Respiratory and Critical Care Medicine, the Third Hospital of Wuhan, Wuhan, 430030, People's Republic of China
| | - Ya-Jun Chen
- Department of Respiratory and Critical Care Medicine, the Third Hospital of Wuhan, Wuhan, 430030, People's Republic of China
| | - Fang He
- Department of Respiratory and Critical Care Medicine, the Third Hospital of Wuhan, Wuhan, 430030, People's Republic of China
| | - Hong-Rong Guo
- Department of Respiratory and Critical Care Medicine, the Third Hospital of Wuhan, Wuhan, 430030, People's Republic of China.
| |
Collapse
|
19
|
Vieira FT, Cai Y, Gonzalez MC, Goodpaster BH, Prado CM, Haqq AM. Poor muscle quality: A hidden and detrimental health condition in obesity. Rev Endocr Metab Disord 2025:10.1007/s11154-025-09941-0. [PMID: 39833502 DOI: 10.1007/s11154-025-09941-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2025] [Indexed: 01/22/2025]
Abstract
Poor muscle quality (MQ) is a hidden health condition in obesity, commonly disregarded and underdiagnosed, associated with poor health-related outcomes. This narrative review provides an in-depth exploration of MQ in obesity, including definitions, available assessment methods and challenges, pathophysiology, association with health outcomes, and potential interventions. MQ is a broad term that can include imaging, histological, functional, or metabolic assessments, evaluating beyond muscle quantity. MQ assessment is highly heterogeneous and requires further standardization. Common definitions of MQ include 1) muscle-specific strength (or functional MQ), the ratio between muscle strength and muscle quantity, and 2) muscle composition (or morphological MQ), mainly evaluating muscle fat infiltration. An individual with obesity might still have normal or higher muscle quantity despite having poor MQ, and techniques for direct measurements are needed. However, the use of body composition and physical function assessments is still limited in clinical practice. Thus, more accessible techniques for assessing strength, muscle mass, and composition should be further explored. Obesity leads to adipocyte dysfunction, generating a low-grade chronic inflammatory state, which leads to mitochondrial dysfunction. Adipocyte and mitochondrial dysfunction result in metabolic dysfunction manifesting clinically as insulin resistance, dyslipidemia, and fat infiltration into organs such as muscle, which in excess is termed myosteatosis. Myosteatosis decreases muscle cell function and insulin sensitivity, creating a vicious cycle of inflammation and metabolic derangements. Myosteatosis increases the risk of poor muscle function, systemic metabolic complications, and mortality, presenting prognostic potential. Interventions shown to improve MQ include nutrition, physical activity/exercise, pharmacology, and metabolic and bariatric surgery.
Collapse
Affiliation(s)
- Flavio T Vieira
- Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, AB, Canada
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Yuanjun Cai
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - M Cristina Gonzalez
- Postgraduate Program in Nutrition and Food, Federal University of Pelotas, Pelotas, Rio Grande Do Sul, Brazil
| | | | - Carla M Prado
- Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, AB, Canada.
| | - Andrea M Haqq
- Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, AB, Canada.
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
| |
Collapse
|
20
|
Vargas-Errázuriz P, Dreyse N, López R, Cano-Cappellacci M, Graf J, Guerrero J. Association between phase angle and daily creatinine excretion changes in critically ill patients: an approach to muscle mass. Front Physiol 2025; 15:1508709. [PMID: 39844897 PMCID: PMC11753204 DOI: 10.3389/fphys.2024.1508709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Accepted: 12/02/2024] [Indexed: 01/24/2025] Open
Abstract
Assessing muscle mass in critically ill patients remains challenging. This retrospective cohort study explores the potential of phase angle (PA°) derived from bioelectrical impedance analysis (BIA) as a surrogate marker for muscle mass monitoring by associating it with daily creatinine excretion (DCE), a structural and metabolic muscle mass marker. In 20 ICU patients, we observed a linear relationship between PA° and DCE at initial (S1) and follow-up (S2) points, with Rho values of 0.78 and 0.65, respectively, as well as between their percentage changes (Rho = 0.80). Multivariate analysis confirmed a strong association between changes in PA° and DCE (adjusted R2 of 0.73), while changes in the extracellular water to total body water (ECW/TBW) ratio showed no significant association. This study establishes a relationship between a BIA-derived independent-weight parameter and DCE, highlighting the potential of PA° for muscle mass monitoring during acute changes, such as those seen in ICU settings. Integrating PA° into clinical practice could provide a non-invasive and reliable tool to enhance muscle assessment and support targeted interventions in critically ill patients.
Collapse
Affiliation(s)
- Patricio Vargas-Errázuriz
- Grupo Intensivo, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
- Departamento de Paciente Crítico, Clínica Alemana de Santiago, Santiago, Chile
| | - Natalia Dreyse
- Grupo Intensivo, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
- Departamento de Paciente Crítico, Clínica Alemana de Santiago, Santiago, Chile
- Departamento de Farmacia, Clínica Alemana de Santiago, Santiago, Chile
| | - René López
- Grupo Intensivo, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
- Departamento de Paciente Crítico, Clínica Alemana de Santiago, Santiago, Chile
| | - Marcelo Cano-Cappellacci
- Physical Exercise Sciences Laboratory, Physical Therapy Department, University of Chile, Santiago, Chile
| | - Jerónimo Graf
- Departamento de Paciente Crítico, Clínica Alemana de Santiago, Santiago, Chile
| | - Julia Guerrero
- Departamento de Paciente Crítico, Clínica Alemana de Santiago, Santiago, Chile
- Disciplinary Program of Physiology and Biophysics, Institute of Biomedical Sciences, Medicine Faculty, University of Chile, Santiago, Chile
| |
Collapse
|
21
|
Son JW, Han BD, Bennett JP, Heymsfield S, Lim S. Development and clinical application of bioelectrical impedance analysis method for body composition assessment. Obes Rev 2025; 26:e13844. [PMID: 39350475 DOI: 10.1111/obr.13844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 07/20/2024] [Accepted: 09/11/2024] [Indexed: 12/19/2024]
Abstract
Obesity, which is characterized by excessive body fat, increases the risk of chronic diseases, such as type 2 diabetes, cardiovascular diseases, and certain cancers. Sarcopenia, a decline in muscle mass, is also associated with many chronic disorders and is therefore a major concern in aging populations. Body composition analysis is important in the evaluation of obesity and sarcopenia because it provides information about the distribution of body fat and muscle mass. It is also useful for monitoring nutritional status, disease severity, and the effectiveness of interventions, such as exercise, diet, and drugs, and thus helps assess overall health and longevity. Computed tomography, magnetic resonance imaging, and dual-energy X-ray absorptiometry are commonly used for this purpose. However, they have limitations, such as high cost, long measurement time, and radiation exposure. Instead, bioelectrical impedance analysis (BIA), which was introduced several decades ago and has undergone significant technological advancements, can be used. It is easily accessible, affordable, and importantly, poses no radiation risk, making it suitable for use in hospitals, fitness centers, and even at home. Herein, we review the recent technological developments and clinical applications of BIA to provide an updated understanding of BIA technology and its strengths and limitations.
Collapse
Affiliation(s)
- Jang Won Son
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Byoung-Duck Han
- Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea
| | | | - Steve Heymsfield
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Soo Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| |
Collapse
|
22
|
Lai YT, Peh HY, Binte Abdul Kadir H, Lee CF, Iyer NG, Wong TH, Tay GCA. Bioelectrical-Impedance-Analysis in the Perioperative Nutritional Assessment and Prediction of Complications in Head-and-Neck Malignancies. OTO Open 2025; 9:e70046. [PMID: 39759946 PMCID: PMC11696890 DOI: 10.1002/oto2.70046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 09/19/2024] [Accepted: 10/11/2024] [Indexed: 01/07/2025] Open
Abstract
Objective Identification of patients with head-and-neck malignancies who are especially vulnerable to malnutrition is critical for optimizing outcomes. The objectives are; to correlate Bioelectrical-impendence-analysis (BIA) parameters with Subjective-Global-Assessment (SGA) scores, and determine the association of BIA parameters with common perioperative complications in patients undergoing head-and-neck surgery. Study Design Patients underwent formal SGA scoring and BIA preoperatively in a multidisciplinary allied health clinic. Settings This is a cohort study of 61 patients with head-and-neck malignancies who were admitted for elective surgery from 2018 to 2019 in a tertiary hospital in Singapore. Methods BIA was performed using the Bodystat Quadscan 4000. Kruskal-Wallis rank sum tests and were performed for associations between SGA and BIA parameters. Wilcoxon rank sum tests and multivariable logistic regression models (Firth's bias reduction method) were performed to evaluate associations between BIA parameters and perioperative complications. Receiver-operating-characteristic (ROC) curves were plotted for determination of optimal cut-off values of phase angle and Wellness marker in detecting malnutrition and perioperative pneumonia using Youden's-Index (YI). Results 45 males and 16 females with median age of 62 were included in the study. Significant differences were observed in Wellness Marker (P = .006) and phase angle (P = .008) among patients in the 3 SGA categories. The Wellness Marker (P = .02) was associated with perioperative pneumonia in the univariate analysis. No significant differences were observed for other perioperative complications studied. Conclusion BIA shows promise as a preoperative tool, in conjunction with SGA, to detect malnutrition in patients undergoing surgery for head-and-neck malignancies and highlight patients at risk of developing perioperative pneumonia.
Collapse
Affiliation(s)
- Yi Ting Lai
- NUS MedicineYong Loo Lin School of MedicineSingapore
| | | | | | - Chun Fan Lee
- Centre for Quantitative MedicineDuke‐NUS Medical SchoolSingapore
| | - N. Gopalakrishna Iyer
- Department of Head and Neck SurgerySingapore General HospitalSingapore
- Department of Head and Neck SurgeryNational Cancer CentreSingapore
| | - Ting Hway Wong
- Health Services and Systems ResearchDuke‐NUS Medical SchoolSingapore
| | - Gerald Ci An Tay
- Department of Head and Neck SurgerySingapore General HospitalSingapore
| |
Collapse
|
23
|
Chen J, Lai T, Chung YY, Park JH, Liao Y. Associations of socio-demographic, anthropometric and behavioural factors with phase angle in older adults: a cross-sectional study in Taiwan. BMJ Open 2024; 14:e086240. [PMID: 39732489 PMCID: PMC11683944 DOI: 10.1136/bmjopen-2024-086240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 12/10/2024] [Indexed: 12/30/2024] Open
Abstract
OBJECTIVE Phase angle (PhA) is a prognostic factor for predicting and monitoring geriatric syndromes. However, multiple factors associated with increased PhA values as an outcome remain unclear in the older population. This study aimed to examine the association of socio-demographic, anthropometric and behavioural factors with PhA among older Taiwanese adults. DESIGN This cross-sectional study was conducted between May and August 2023. SETTING The study was carried out in northern Taiwan, specifically Taipei city and Yilan county. PARTICIPANTS Participants aged ≥65 years who were able to walk independently and had no artificial implants, such as cardiac pacemakers or joint replacements, were recruited using convenience sampling. A total of 198 participants were initially recruited for this study. PRIMARY OUTCOME MEASURES Data on socio-demographic and behavioural variables were collected using self-administered questionnaires. Anthropometric variables and PhA were measured using a multi-frequency bioelectrical impedance analyser (MC-780MA, TANITA). PhA was categorised into 'high' and 'low' using gender-specific cut-off points. A logistic regression analysis was performed. RESULTS A total of 152 participants (mean age: 72.0±5.5 years; 121 women (79.6%)) were included. Male (OR=0.72, 95% CI=0.02 to 0.33), unmarried (OR=0.22, 95% CI=0.06 to 0.82) and unemployed older adults (OR=0.16, 95% CI=0.03 to 0.87) were less probable to achieve high PhA values. After adjusting for potential confounders, older individuals with an increased body mass index (BMI) (OR=2.56, 95% CI=1.61 to 4.07) and greater muscle mass (OR=1.34, 95% CI=1.12 to 1.60) may have higher PhA values, whereas those with a greater fat mass may have lower PhA values (OR=0.61, 95% CI=0.48 to 0.78). No significant associations were observed between behavioural factors and PhA values. CONCLUSIONS The interventions designed to improve PhA should prioritise strategies tailored to male, unmarried or unemployed older adults, as well as those with low BMI, low muscle mass and high fat mass. Future studies with larger sample sizes are needed to confirm and strengthen our findings.
Collapse
Affiliation(s)
- Jiaren Chen
- Graduate Institute of Sport, Leisure and Hospitality Management, National Taiwan Normal University, Taipei, Taiwan
| | - Ting‐Fu Lai
- Graduate Institute of Sport, Leisure and Hospitality Management, National Taiwan Normal University, Taipei, Taiwan
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Yen-Yu Chung
- Graduate Institute of Sport, Leisure and Hospitality Management, National Taiwan Normal University, Taipei, Taiwan
| | - Jong-Hwan Park
- Department of Convergence Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
- Department of Clinical Bio-Convergence, Graduate School of Convergence in Biomedical Science, Pusan National University School of Medicine, Yangsan, Republic of Korea
- Convergence Medical Institute of Technology, Pusan National University Hospital, Busan, Republic of Korea
| | - Yung Liao
- Graduate Institute of Sport, Leisure and Hospitality Management, National Taiwan Normal University, Taipei, Taiwan
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| |
Collapse
|
24
|
Costa Pereira JPD, Rebouças ADS, Prado CM, Gonzalez MC, Cabral PC, Diniz ADS, Trussardi Fayh AP, Silva FM. Phase angle as a marker of muscle quality: A systematic review and meta-analysis. Clin Nutr 2024; 43:308-326. [PMID: 39549478 DOI: 10.1016/j.clnu.2024.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2024] [Revised: 10/29/2024] [Accepted: 11/06/2024] [Indexed: 11/18/2024]
Abstract
BACKGROUND & AIMS Phase angle (PhA) is a biomarker derived from raw bioelectrical impedance analysis (BIA) values: resistance (R) and reactance (Xc). PhA reflects cellular membrane integrity and, as a result, has been considered a marker of fluid distribution, making it a potential prognostic indicator. A growing body of research demonstrates independent associations between PhA and muscle strength, mass, and composition. In this context, PhA has the extra potential to serve as a marker of muscle quality. However, the evidence supporting its use for this purpose is not well established. This study aimed to investigate the relationship between PhA and markers of muscle quality. METHODS This systematic review and meta-analysis (Internal Prospective Register of Systematic Reviews - PROSPERO on a registration code: CRD42024507853) focused on observational studies assessing the relationship between PhA and markers of both concepts of muscle quality: the muscle quality index (MQI: strength by a unit of mass) and the muscle composition (i.e., skeletal muscle radiodensity [SMD], muscle echogenicity, muscle fat fraction, inter- and intramuscular adiposity). Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) and Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2), while the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Meta-analyses with a random-effects model were conducted. RESULTS Seventeen studies were included in this systematic review, encompassing 2710 participants. Meta-analyses demonstrated that PhA had a moderate positive correlation coefficient with SMD (4 studies, 924 participants; r = 0.54, 95 % confidence interval (CI) 0.38 to 0.69, heterogeneity (I2) = 92 %) and good accuracy (85 %) for classifying low SMD (2 studies, 390 participants; Area Under the Curve - AUCpooled 0.85, 95 % CI 0.78 to 0.92, I2 = 0 %). PhA was inversely-moderately correlated with muscle echogenicity (8 studies, 1401 participants; r = - 0.42, 95 % CI - 0.57 to - 0.24, I2 = 82 %) and positively-weakly correlated with MQI (2 studies, 191 participants; r = 0.36, 95 % CI 0.21 to 0.49, I2 = 17 %). All studies had a higher risk of bias. The certainty of evidence ranged from low to very low. CONCLUSION Despite technical challenges, this study demonstrates the potential of PhA as a surrogate marker for muscle quality, particularly expressing muscle composition (SMD). Future studies should utilize BIA with standardized protocols to potentially establish specific cutoff values for PhA, thereby enhancing its diagnostic accuracy and clinical applicability. These studies could additionally explore the mechanisms underlying the associations between PhA and muscle quality aspects. In cases where technical factors are not easily controlled, the use of standardized PhA (SPhA), which converts PhA into Z-scores, could be beneficial. Although this warrants investigation, this approach (SPhA) has the potential to account for variables such as age, sex, device differences, and health status.
Collapse
Affiliation(s)
| | - Amanda de Sousa Rebouças
- Postgraduate Program in Health Science, Health Science Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Carla M Prado
- Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Maria Cristina Gonzalez
- Postgraduate Program in Nutrition and Food, Federal University of Pelotas, Pelotas, RS, Brazil
| | | | | | - Ana Paula Trussardi Fayh
- Postgraduate Program in Health Science, Health Science Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil; Postgraduate Program in Nutrition, Nutrition Department, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Flávia Moraes Silva
- Nutrition Science Graduate Program of Federal University of Health Science of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| |
Collapse
|
25
|
Cortes R, Yañez AM, Capitán‐Moyano L, Millán‐Pons A, Bennasar‐Veny M. Evaluation of different screening tools for detection of malnutrition in hospitalised patients. J Clin Nurs 2024; 33:4759-4771. [PMID: 38629350 PMCID: PMC11579573 DOI: 10.1111/jocn.17170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/25/2024] [Accepted: 04/07/2024] [Indexed: 11/22/2024]
Abstract
AIMS AND OBJECTIVES To assess the prevalence of malnutrition in hospitalised adult patients, and to evaluate the accuracy of the most commonly used nutritional screening tools for identifying individuals at risk of malnutrition. METHODS A prospective cross-sectional study was conducted on a total of 248 hospitalised patients in internal medicine wards (mean age: 75.2 years; 39.5% females). Nutritional screening was performed within 48 h of admission using the following tools: Malnutrition Universal Screening Tool (MUST), Nutrition Risk Screening Tool (NRS-2002), Malnutrition Screening Tool (MST), Short Nutritional Assessment Questionnaire (SNAQ), and Mini Nutritional Assessment Short Form (MNA-SF). The criteria of the European Society for Clinical Nutrition and Metabolism (ESPEN) were used as the gold standard for defining malnutrition. Patients were also evaluated using the Subjective Global Assessment (SGA) and the Global Leadership Initiative on Malnutrition (GLIM) criteria. Accuracy was determined by examining sensitivity, specificity, and positive and negative predictive values, and diagnostic agreement was determined by calculation of Cohen's kappa (κ). The study is reported as per the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. RESULTS The ESPEN criteria classified 20.2% of the hospitalised patients as malnourished. Overall, the MUST had the highest sensitivity (80.0%), specificity (74.7%) and positive predictive value (44.4%). For the subgroup of patients aged >65 years, the MNA-SF had high sensitivity (94.4%) but low specificity (39.0%). Based on Cohen's κ, the SGA and GLIM criteria showed low agreement with the ESPEN criteria. CONCLUSION The MUST was the most accurate nutritional screening tool, through the MST is more easily applied in many clinical settings. A comprehensive assessment of malnutrition that considers muscle mass is crucial for the reliable diagnosis of malnutrition. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE The present findings underscore the importance of accurate assessment of the malnutrition status of hospitalised patients and the need for a reliable screening tool. No patient or public contribution.
Collapse
Affiliation(s)
- Regina Cortes
- Hospital Universitario Son Espases, Balearic Islands Health ServicePalmaSpain
| | - Aina M. Yañez
- Department of Nursing and PhysiotherapyUniversity of the Balearic Islands (UIB)PalmaSpain
- Research Group on Global HealthUniversity of the Balearic Islands (UIB)PalmaSpain
- Research Network on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos IIIMadridSpain
- Global Health and Lifestyle (EVES Group), Health Research Institute of the Balearic Islands (IdISBa)PalmaSpain
| | - Laura Capitán‐Moyano
- Department of Nursing and PhysiotherapyUniversity of the Balearic Islands (UIB)PalmaSpain
- Research Group on Global HealthUniversity of the Balearic Islands (UIB)PalmaSpain
| | - Aina Millán‐Pons
- Health Research Institute of the Balearic Islands (IdISBa)PalmaSpain
| | - Miquel Bennasar‐Veny
- Department of Nursing and PhysiotherapyUniversity of the Balearic Islands (UIB)PalmaSpain
- Research Group on Global HealthUniversity of the Balearic Islands (UIB)PalmaSpain
- Global Health and Lifestyle (EVES Group), Health Research Institute of the Balearic Islands (IdISBa)PalmaSpain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos IIIMadridSpain
| |
Collapse
|
26
|
Boros KK, Veres G, Pintér HK, Richter É, Cseh Á, Dezsőfi A, Arató A, Reusz GS, Dohos D, Müller KE, Cseprekál O. Novel approach to assess sarcopenia in children with inflammatory bowel disease. Front Pediatr 2024; 12:1204639. [PMID: 39629099 PMCID: PMC11611584 DOI: 10.3389/fped.2024.1204639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/15/2024] [Indexed: 12/06/2024] Open
Abstract
INTRODUCTION Sarcopenia is associated with poor clinical outcomes in chronic diseases. Our study aimed to characterize body composition (BC) parameters in patients with inflammatory bowel disease (IBD) and compare skeletal muscle mass (SMM) parameters with the healthy pediatric population. METHODS BC of healthy controls (HC) and of patients with IBD were measured via multifrequency bioelectrical impedance (InBody 720 device) in a cross-sectional manner. The effect of sex, age, height, weight, and body mass index (BMI) on BC parameters, with a special attention to SMM, was assessed. Reference tables from SMM were generated using a maximum-likelihood curve-fitting technique for calculating Z scores. RESULTS BC parameters were associated with age, body size, and sex. SMM was lower in patients with IBD (n = 57, aged 6.71 ± 8.7 years) compared to unadjusted HC (n = 307, aged 9.9-19.3 years; 143 males; SMM: 22.34 ± 8.38 vs. 24.4 ± 6.3 kg; p = 0.03). SMM showed a moderately strong correlation with age, weight, height, and BMI (R = 0.65, 0.9, 0.87, and 0.66; p < 0.05 for each) in HC. In multivariate stepwise, ridge regression analysis, age, sex, and BMI remained the significant predictors of SMM (age β = 0.47, -0.31, and 0.38, respectively; p < 0.05). SMM of sex-, age-, and BMI-adjusted HC did not differ from IBD. Therefore, BMI Z score-based references were plotted for normalizing SMM, and SMM Z score was calculated and found to be similar to that of HC. CONCLUSIONS BC is supposed to be an easy-to-measure and objective marker of sarcopenia in children with IBD. Adjustment of SMM for BMI Z score might be needed to avoid the overestimation of sarcopenia in this patient population.
Collapse
Affiliation(s)
- Kriszta Katinka Boros
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Gábor Veres
- Department of Internal Medicine, Pediatrics Clinic University of Debrecen, Clinical Center, ÁOK, DEKK, Debrecen, Hungary
- School of Ph.D. Studies, Semmelweis University, Budapest, Hungary
| | | | - Éva Richter
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Áron Cseh
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Antal Dezsőfi
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - András Arató
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - George S. Reusz
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Dóra Dohos
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Department of Gastroenterology and Nephrology, Heim Pál National Pediatric Institute, Budapest, Hungary
| | - Katalin E. Müller
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Department of Gastroenterology and Nephrology, Heim Pál National Pediatric Institute, Budapest, Hungary
- Department of Health Care Methodology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - Orsolya Cseprekál
- Department of Surgery Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| |
Collapse
|
27
|
Ayala-Guzmán CI, Ortiz-Hernandez L, Escudero Malpica C, Macias Rosas A, Castro Avila JI. Phase Angle and Body Composition as Predictors of Fitness and Athletic Performance in Adolescent Boxers. Pediatr Exerc Sci 2024; 36:201-210. [PMID: 39069282 DOI: 10.1123/pes.2023-0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 04/16/2024] [Accepted: 05/02/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Phase angle (PhA) is an indicator of cellular health, function, and integrity. PhA has been considered an indicator of nutritional and health status, but it is uncertain whether it could be used as a fitness or athletic performance indicator. OBJECTIVE To analyze the relationship between PhA and the fitness and athletic performance of adolescent boxers and to know whether this association is independent of body composition. METHODS Thirty-seven trained youth boxers (15-18 y old) participated in the study. Participants underwent anthropometry and bioelectrical impedance assessments. The following tests were conducted: Fitness-Gram battery; speed, agility, and quickness; ball throws; punch impact force; bench press maximal strength; and vertical and horizontal jumps. Linear regression models were estimated and adjusted by covariates. RESULTS The PhA was related to upper-limb strength. Nevertheless, in linear regression models, after adjusting models by body composition, only PhA remained as a predictor of relative maximal strength. The PhA was not a predictor of speed, agility, and quickness; cardiorespiratory fitness; or lower-limb power, in which adiposity was the main predictor of fitness. CONCLUSIONS In adolescent boxers, PhA can predict upper-limb maximal strength independently of bioelectrical impedance analysis premises. However, compared with mucle mass, PhA is not a better predictor of upper-limb maximal strength.
Collapse
Affiliation(s)
- César Iván Ayala-Guzmán
- Doctorado en Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana, Ciudad de México,Mexico
- Universidad del Valle de México campus Coyoacán-Tlalpan, Ciudad de México,Mexico
- Health Care Department, Universidad Autónoma Metropolitana, Mexico City,Mexico
| | - Luis Ortiz-Hernandez
- Universidad del Valle de México campus Coyoacán-Tlalpan, Ciudad de México,Mexico
- Health Care Department, Universidad Autónoma Metropolitana, Mexico City,Mexico
| | - Cristian Escudero Malpica
- Health Care Department, Universidad Autónoma Metropolitana, Mexico City,Mexico
- Professional College of Graduates in Sports Training, Mexico City,Mexico
| | - Alejandro Macias Rosas
- Health Care Department, Universidad Autónoma Metropolitana, Mexico City,Mexico
- Professional College of Graduates in Sports Training, Mexico City,Mexico
| | | |
Collapse
|
28
|
Zhang J, Wang N, Li J, Wang Y, Xiao Y, Sha T. The Diagnostic Accuracy and Cutoff Value of Phase Angle for Screening Sarcopenia: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2024; 25:105283. [PMID: 39326856 DOI: 10.1016/j.jamda.2024.105283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 08/21/2024] [Accepted: 08/21/2024] [Indexed: 09/28/2024]
Abstract
OBJECTIVES Phase angle (PhA) declines with age and is a reliable marker for muscle function, making it a potential screening indicator for sarcopenia. However, studies examined the reliability and validity of PhA for detecting sarcopenia, yielding inconsistent results. This meta-analysis aimed to evaluate the accuracy and cutoff value of PhA for screening sarcopenia and examine the potential confounding factors. DESIGN This is a meta-analysis. SETTING AND PARTICIPANTS PubMed, Embase, and Cochrane Library were searched up to September 18, 2023. Eighteen studies (6184 participants) were included reporting the diagnostic accuracy of PhA for screening sarcopenia. METHODS Pooled accuracy [ie, the computed area under the curve value (AUC)] and cutoff value interval for screening sarcopenia were estimated using a random-effects model. Meta-regression analyses were conducted to identify sources of heterogeneity. RESULTS The AUC value was 0.81. Pooled sensitivity and specificity were 80% and 70%. The calculated 95% CI of the cutoff value of PhA for screening sarcopenia falls between 4.54° and 5.25°. The results of meta-regression analyses showed that ethnicity, body mass index (BMI), health status, and diagnostic criteria were the main factors affecting the diagnostic accuracy for screening sarcopenia (with all P values < 0.01). CONCLUSION AND IMPLICATIONS PhA may serve as a robust screening tool for sarcopenia, and the recommended cutoff interval falls between 4.54° and 5.25°. Ethnicity, BMI, health status, and diagnostic criteria can affect PhA's efficacy in sarcopenia screening.
Collapse
Affiliation(s)
- Jian Zhang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Ning Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Jiatian Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Yilun Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China; Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Changsha, China
| | - Yongbing Xiao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.
| | - Tingting Sha
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China; Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Changsha, China.
| |
Collapse
|
29
|
Moriyama T, Tokunaga M, Hori R, Hachisuka A, Itoh H, Ochi M, Matsushima Y, Saeki S. Association between phase angle and sarcopenia in patients with connective tissue diseases. Clin Nutr ESPEN 2024; 64:503-508. [PMID: 39486475 DOI: 10.1016/j.clnesp.2024.10.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 10/21/2024] [Indexed: 11/04/2024]
Abstract
BACKGROUND AND AIMS Early detection and management of sarcopenia in patients with connective tissue diseases (CTDs) are essential. However, the relationship between the phase angle and sarcopenia in patients with CTDs is unknown. This study investigated the association between the phase angle and sarcopenia in patients with (CTDs) and determined the optimal phase angle cutoff values for the early detection of sarcopenia. METHODS A retrospective cross-sectional study was conducted in 279 hospitalized patients with CTDs undergoing rehabilitation (median age 73.3 years; 80 men and 199 women). Bioimpedance analysis was used to measure the phase angle, and sarcopenia was assessed according to the Asian Working Group for Sarcopenia criteria. RESULTS Sarcopenia was identified in 134 patients (36 men and 98 women). Patients with sarcopenia had a significantly smaller phase angle than those without sarcopenia. Multivariate analysis revealed that phase angle was significantly associated with sarcopenia after adjusting for confounding factors in each sex. The optimal phase angle cutoff value for identifying sarcopenia was 4.6° for men and 4.3° for women, with area under the curve values of 0.795 and 0.754, respectively. CONCLUSION Phase angle is a valuable marker for identifying sarcopenia in patients with CTDs. The established phase angle cutoff values of 4.6° in men and 4.3° in women can facilitate the early detection and management of sarcopenia.
Collapse
Affiliation(s)
- Toshiyuki Moriyama
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, School of Medicine, Japan; National Hospital Organization Fukuokahigashi Medical Center, Japan.
| | - Mizuki Tokunaga
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
| | - Ryoko Hori
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
| | - Akiko Hachisuka
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
| | - Hideaki Itoh
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
| | - Mitsuhiro Ochi
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
| | - Yasuyuki Matsushima
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
| | - Satoru Saeki
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
| |
Collapse
|
30
|
Constantinou C, Jefford J, Zygo M, White J, Dale M, Morris R, Jenkins J. Assessing the nutritional status and impact of a series of nutritional interventions on elderly inpatients using bioelectrical impedance analysis: A service evaluation. J Hum Nutr Diet 2024; 37:1197-1208. [PMID: 39038170 DOI: 10.1111/jhn.13352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 07/08/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND The aim of the study was to use bioelectrical impedance analysis (BIA) to assess nutritional status of elderly patients admitted to hospital and quantitatively measure the impact of the Cardiff and Vale University Health Board (CAVUHB) model ward. Secondary objectives were to assess the feasibility of using BIA in this patient population and compare nutrition risk screening tools against fat-free mass index (FFMI). METHODS A prospective, comparative, single-centre, service evaluation of a 'model ward for nutrition and hydration' undertaken in medical and rehabilitation beds in a large UK teaching hospital. RESULTS A total of 450 BIA measurements were taken using a Bodystat Multiscan 5000 on 162 patients; several patients had repeated measurements during their hospital stay. Patients tolerated the procedure well, but lack of accurate weight, implanted medical devices and tissue viability precluded some participants. CONCLUSIONS BIA is quick, non-invasive, simple to complete and can elicit huge data about an individual's body composition. In a larger cohort of medical admissions, BIA could assist in identifying the sensitivity and specificity of the nutrition screening tools. The collective benefit of a series of nutritional interventions preserved nutritional status better in this elderly inpatient population than usual models of care. Although results were not statistically significant, there is an opportunity with the new model of care to better support frail patients and prevent deconditioning.
Collapse
Affiliation(s)
| | - Joanne Jefford
- Cardiff and Vale Local University Health Board, Cardiff, UK
| | - Marzena Zygo
- Cardiff and Vale Local University Health Board, Cardiff, UK
| | - Judith White
- Cardiff and Vale Local University Health Board, Cardiff, UK
| | - Megan Dale
- Cardiff and Vale Local University Health Board, Cardiff, UK
| | - Rhys Morris
- Cardiff and Vale Local University Health Board, Cardiff, UK
| | - Judyth Jenkins
- Cardiff and Vale Local University Health Board, Cardiff, UK
| |
Collapse
|
31
|
Mazza E, Maurotti S, Ferro Y, Doria P, Moraca M, Montalcini T, Pujia A. Portable bioimpedance analyzer for remote body composition monitoring: A clinical investigation under controlled conditions. Nutrition 2024; 126:112537. [PMID: 39121809 DOI: 10.1016/j.nut.2024.112537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 06/11/2024] [Accepted: 07/17/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVES In an era when telemedicine is becoming increasingly essential, the development and validation of miniaturized Bioelectrical Impedance Analysis (BIA) devices for accurate and reliable body composition assessment is crucial. This study investigates the BIA Metadieta, a novel miniaturized BIA device, by comparing its performance with that of standard hospital BIA equipment across a diverse demographic. The aim is to enhance remote health monitoring by integrating compact and efficient technology into routine healthcare practices. METHODS A cross-sectional observational study was conducted with 154 participants from the Clinical Nutrition Unit. The study compared resistance (R), reactance (Xc), and phase angle (PhA) measurements obtained from the BIA Metadieta device and a traditional hospital-based BIA device. RESULTS Analysis revealed strong positive correlations between the BIA Metadieta and the hospital-based device for R (r = 0.988, P < 0.001), Xc (r = 0.946, P < 0.001), and PhA (r = 0.929, P < 0.001), indicating the miniaturized device's high accuracy and reliability. These correlations were consistent across different genders and BMI categories, demonstrating the device's versatility. CONCLUSIONS The BIA Metadieta device, with its miniaturized form factor, represents a significant step forward in the field of remote health monitoring, providing a reliable, accurate, and accessible means for assessing body composition.
Collapse
Affiliation(s)
- Elisa Mazza
- Department of Clinical and Experimental Medicine, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Samantha Maurotti
- Department of Clinical and Experimental Medicine, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Yvelise Ferro
- Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy.
| | - Paola Doria
- Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Marta Moraca
- Clinical Nutrition Unit, AOU "Renato Dulbecco", Catanzaro, Italy
| | - Tiziana Montalcini
- Department of Clinical and Experimental Medicine, University "Magna Græcia" of Catanzaro, Catanzaro, Italy; Research Center for the Prevention and Treatment of Metabolic Diseases (CR METDIS), University Magna Græcia, Catanzaro, Italy
| | - Arturo Pujia
- Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy; Research Center for the Prevention and Treatment of Metabolic Diseases (CR METDIS), University Magna Græcia, Catanzaro, Italy
| |
Collapse
|
32
|
Arero AG, Dassie GA. Preoperative bioelectrical impedance, measured phase angle, and hand-grip strength as predictors of postoperative outcomes in patients undergoing cardiac surgery: a systematic review. BMC Cardiovasc Disord 2024; 24:515. [PMID: 39333863 PMCID: PMC11430153 DOI: 10.1186/s12872-024-04182-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 09/10/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Postoperative problems are a major danger for patients after heart surgery. Predicting postoperative outcomes for cardiac surgery is limited by current preoperative evaluations. Handgrip strength (HGS) testing and bioelectrical impedance analysis (BIA) may provide extra ways to identify individuals at risk of surgical problems, enhancing risk assessment and results. OBJECTIVE The purpose of this systematic review is to assess the utility of measured phase angle (PA), HGS, and bioelectrical impedance as perioperative risk markers in adult patients undergoing elective heart surgery. METHOD The PRISMA principles were followed in this review. We searched all available electronic databases, including the Science Direct search engine and PubMed, MEDLINE, EMBASE, Cochrane Library, Web of Science, PsycINFO, CINAHL, Google Scholar, Scopus, and the Science Direct search engine, from their creation to the present, as well as the medRxiv pre-print site. We considered studies with adult subjects undergoing elective heart surgery who were monitored for problems after surgery and had perioperative BIA and HGS testing. RESULTS As a result, out of the 1544 pieces of research that were discovered, eight studies were deemed suitable for inclusion in the review and supplied data from 2781 people. The findings demonstrated a substantial correlation between poor preoperative PA and a higher risk of serious postoperative morbidity, as well as prolonged hospital stays. Furthermore, poor HGS and low PA were linked to greater death rates. Additionally, there was a strong correlation found between low PA and HGS and longer stays in the ICU, as well as an increased chance of dying from all causes in a year. In conclusion these results imply that preoperative HGS and PA may be significant indicators of postoperative results and may assist in identifying patients who are more vulnerable to problems and death.
Collapse
Affiliation(s)
| | - Gadana Arero Dassie
- Department of Public Health, Adama Hospital Medical College, Baltimore, MD, USA.
| |
Collapse
|
33
|
Hatanaka S, Shida T, Osuka Y, Kojima N, Motokawa K, Okamura T, Hirano H, Awata S, Sasai H. Association between phase angle and inflammatory blood biomarkers in community-dwelling older adults: Itabashi Longitudinal Study on Aging. Clin Nutr ESPEN 2024; 64:114-121. [PMID: 39341597 DOI: 10.1016/j.clnesp.2024.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 08/19/2024] [Accepted: 09/19/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND & AIM Bioelectrical impedance analysis-derived phase angle (PhA) reflects the disruption of the cell membrane and intra- and extracellular fluid imbalances caused by chronic inflammation. This study examined the association between PhA and inflammatory markers in community-dwelling older adults. METHODS A sex-stratified logistic regression analysis was conducted, with elevated C-reactive protein (CRP; ≥3.0 mg/L) and interleukin-6 (IL-6; >4.0 pg/mL) levels as the outcomes and whole-body and local PhAs as the exposures. The same analysis was conducted with further stratification for age, overweight status, history of inflammation-related non-communicable diseases, and dietary inflammatory index. The ability to identify inflammation in whole-body and local PhAs was assessed using a receiver operating characteristic (ROC) curve. RESULTS This study included 1664 participants (age: 76 [73-80] years; 855 women). In men, significant odds ratios (ORs) at the 95 % confidence interval (95 % CI) were observed for abnormal CRP and IL-6 levels for both whole-body and leg PhAs in the third quartile compared with the lowest quartile (OR [95 % CI] for abnormal CRP levels: 0.36 [0.18, 0.68] for whole-body PhA, 0.51 [0.27, 0.95] for leg PhA; OR [95 % CI] for abnormal IL-6 levels: 0.36 [0.15, 0.81] for whole-body PhA, 0.33 [0.12, 0.78] for leg PhA). The areas under the ROC curves (95 % CI) for identifying abnormal IL-6 were mild in men (0.62 [0.54, 0.70] for whole-body PhA and 0.62 [0.55, 0.70] for leg PhA). In men without a history of inflammation-related non-communicable diseases, it was 0.72 (0.59, 0.85) for whole-body PhA and 0.68 (0.54, 0.81) for leg PhA. In women, the PhA was not significantly associated with inflammatory markers. CONCLUSION PhA is associated with inflammation in community-dwelling older men, but may need to be combined with other information to identify inflammation.
Collapse
Affiliation(s)
- Sho Hatanaka
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi, Tokyo, 173-0015, Japan; Integrated Research Initiative for Living Well with Dementia, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi, Tokyo, 173-0015, Japan.
| | - Takashi Shida
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi, Tokyo, 173-0015, Japan
| | - Yosuke Osuka
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi, Tokyo, 173-0015, Japan; Department of Frailty Research, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi, 474-8511, Japan
| | - Narumi Kojima
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi, Tokyo, 173-0015, Japan
| | - Keiko Motokawa
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi, Tokyo, 173-0015, Japan
| | - Tsuyoshi Okamura
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi, Tokyo, 173-0015, Japan
| | - Hirohiko Hirano
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi, Tokyo, 173-0015, Japan
| | - Shuichi Awata
- Integrated Research Initiative for Living Well with Dementia, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi, Tokyo, 173-0015, Japan
| | - Hiroyuki Sasai
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi, Tokyo, 173-0015, Japan.
| |
Collapse
|
34
|
Rezazadegan M, Shirani M, Samadanian F, Akbari M, Shirani F. Association between dietary inflammatory index and phase angle in university employees: a cross-sectional study. Sci Rep 2024; 14:21664. [PMID: 39289398 PMCID: PMC11408530 DOI: 10.1038/s41598-024-71855-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 09/01/2024] [Indexed: 09/19/2024] Open
Abstract
Phase angle (PhA), measured by bioelectrical impedance analysis, indicates cellular health, integrity, and function. As inflammation can damage cells, phase angle may be useful in detecting inflammatory status early. The relationship between dietary inflammatory index (DII) and PhA has not been studied yet. Therefore, we aimed to examine this association in Iranian adults. This cross-sectional study included 206 university employees. Dietary intakes were assessed by using a validated 86-item food frequency questionnaire (FFQ). Anthropometric indices and blood pressure were measured. A short form of the validated International Physical Activity Questionnaire (IPAQ) was used for evaluating physical activity. The PhA was measured by the Body Composition Analyzer Mc780 MA device. The mean age of participants was 43.50 ± 8.82 years and the range of DII score was - 4.66 to 0 among them. The highest tertile of DII compared to the lowest tertile, showed greater weight, WC, HC, basal metabolic rate (BMR), and diastolic blood pressure. We found no significant association between DII and PhA (crude model: OR: 0.68; 95% CI 0.34, 1.33, fully-adjusted model: OR: 0.65; 95% CI 0.26, 1.64). Also, after BMI stratification this association remained (fully-adjusted: normal weight: OR: 0.61; 95% CI 0.11, 3.27; Overweight and obese: OR: 0.57; 95% CI 0.16, 1.98). Having a higher DII score was not associated with a lower PhA. Further well-controlled prospective studies are warranted.
Collapse
Affiliation(s)
- Mahsa Rezazadegan
- Department of Clinical Nutrition, Nutrition and Food Security Research Center, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahsa Shirani
- Department of Community Nutrition, Nutrition and Food Security Research Center, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Samadanian
- Nutrition and Food Security Research Center, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojtaba Akbari
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Shirani
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| |
Collapse
|
35
|
van der Ven E, Patra S, Riemann-Lorenz K, Kauschke K, Freese-Schwarz K, Welsch G, Krause N, Heesen C, Rosenkranz SC. Individualized activity recommendation based on a physical fitness assessment increases short- and long-term regular physical activity in people with multiple sclerosis in a retrospective cohort study. Front Neurol 2024; 15:1428712. [PMID: 39268074 PMCID: PMC11391639 DOI: 10.3389/fneur.2024.1428712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 08/14/2024] [Indexed: 09/15/2024] Open
Abstract
Background Despite the evidence of beneficial effects of physical activity (PA), people with multiple sclerosis (pwMS) are less physically active than the general population. To increase PA in pwMS, we developed a structured individually tailored PA promotion program which is conducted within clinical practice in a university-based outpatient clinic since 2016. This study serves as retrospective quality control of this program. Objective In a retrospective cohort study, we assessed the physical fitness of pwMS and the impact of the program on short- and long-term PA changes and behavioral determinants. Methods The program consisted of four appointments each 2-4 weeks apart. Spiroergometric test results of female pwMS were compared to female non-MS controls who underwent a voluntary physical fitness analysis. The short version of the Freiburger questionnaire, self-developed questions and the modified Physical activity screening questionnaire (PASQ) were sent to all participants assessing the PA levels before the program, 3 months after the program (short-term), and at the time of the survey (long-term). Additionally, established questionnaires assessed behavioral determinants before the program and long-term. Results A total of 166 participants [mean age 38.32 (± 10.61 SD), mean EDSS 2.30 (±1.29 SD)] and mostly females (63.3%, n = 105) were included in the study and started the program. A total of 136 participants completed the program. Out of these 63.9% (n = 87) answered the questionnaires in 12.38 (±11.34 SD) months after finishing the program. At baseline female pwMS (n = 100) showed a lower physical fitness in comparison to non-MS controls (n = 26) (maximal workload (Watts): 138.86 ± 37.85 vs. 191.73 ± 45.25, p < 0.001; peak oxygen consumption (ml min-1 kg-1): 26.40 ± 7.23 vs. 31.56 ± 10.10, p = 0.020). pwMS were more regularly active in short- (62.1%) and long-term (55.2%) compared to baseline (24.2%, p < 0.001). Among the activated participants, we observed improved internal motivation (p = 0.002) and decreased perception of barriers (p = 0.006) compared to baseline. Conclusion PwMS showed a lower physical fitness in comparison to non-MS controls. An individually tailored PA promotion program might improve behavioral determinants and thereby increase short- and long-term PA levels of pwMS.
Collapse
Affiliation(s)
- Eva van der Ven
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Patra
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karin Riemann-Lorenz
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Kauschke
- University Center of Excellence for Sports and Movement Medicine (UKE Athleticum), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Freese-Schwarz
- University Center of Excellence for Sports and Movement Medicine (UKE Athleticum), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Welsch
- University Center of Excellence for Sports and Movement Medicine (UKE Athleticum), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicole Krause
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sina Cathérine Rosenkranz
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
36
|
Yang J, Zhang J, Liu J, Liu G, Qian S. Bioelectrical impedance phase angle and the mortality in critically ill children. Front Nutr 2024; 11:1359814. [PMID: 39224183 PMCID: PMC11366603 DOI: 10.3389/fnut.2024.1359814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
Background Phase angle (PhA) is a variable obtained from bioelectrical impedance analysis (BIA). It is highly sensitive and specific and is commonly used in clinical nutrition assessment. Recently, PhA has shown promise in predicting clinical outcomes, especially as a new indicator of mortality, but its use in pediatric research is limited. This study aims to investigate the association between PhA measured at admission using BIA and PICU length of stay (LOS) and 60-day mortality in critically ill children and adolescents. Methods A consecutive series of pediatric patients in the PICU underwent BIA measurements within 72 h of admission. All patients met the inclusion and exclusion criteria. Patient demographics, anthropometric measurements, pediatric index of mortality 2 score (PIM-2), and laboratory exams were recorded. Kaplan-Meier (K-M) survival curves were constructed based on the critical PhA value to assess differences in survival status within the 60-day window. Multivariate cox regression model was employed to illustrate the relationship between PhA and 60-day mortality rates. The Youden's index method was used to identify the critical cut-off value for PhA in relation to mortality rates. ROC curves provided the area under the curve (AUC) and a 95% confidence interval (CI). Results A total of 205 pediatric patients (118 boys) were included, with a mean age of 9.2 years (±6.0). Survival curves indicated a cutoff value of 3.1°, with higher survival in patients with PhA ≥3.1° compared to those with PhA <3.1° (F = 10.51, p < 0.0001). The area under the ROC curve was 0.70, with a sensitivity of 0.65 and specificity of 0.72. Total hospital LOS was longer in the PhA <3.1° group compared to the PhA ≥3.1° group (p = 0.000). The PhA <3.1° group had a longer PICU LOS (adjusted for age and sex, HR 1.871, p = 0.000, log-rank test, p = 0.000). PhA and PIM-2 were two independently significant correlated variables (p < 0.05) for the 60-day mortality rate in this study. Conclusion Low PhA in patients is associated with longer PICU LOS and an increased risk of PICU patient mortality. PhA not only serves as an indicator for monitoring pediatric nutrition but also as a prognostic indicator for PICU patients.
Collapse
Affiliation(s)
- Jiongxian Yang
- Department of Health Care Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Jie Zhang
- Department of Pediatric Intensive Care Unit, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Jun Liu
- Department of Pediatric Intensive Care Unit, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Gang Liu
- Department of Pediatric Intensive Care Unit, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Suyun Qian
- Department of Pediatric Intensive Care Unit, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| |
Collapse
|
37
|
Kujawowicz K, Mirończuk-Chodakowska I, Cyuńczyk M, Witkowska AM. Identifying Malnutrition Risk in the Elderly: A Single- and Multi-Parameter Approach. Nutrients 2024; 16:2537. [PMID: 39125416 PMCID: PMC11314023 DOI: 10.3390/nu16152537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 07/23/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024] Open
Abstract
Malnutrition is a significant concern affecting the elderly, necessitating a complex assessment. This study aims to deepen the understanding of factors associated with the assessment of malnutrition in the elderly by comparing single- and multi-parameter approaches. In this cross-sectional study, 154 individuals underwent a comprehensive geriatric assessment (CGA). Malnutrition risk was determined using the mini nutritional assessment (MNA). Additional factors assessed included sarcopenia, polypharmacy, depression, appetite, handgrip strength, and gait speed. Phase angle (PA) and body composition were measured using bioelectrical impedance analysis (BIA). The MNA identified a malnutrition risk in 36.8% of individuals. The geriatric depression scale (GDS) and PA demonstrated moderate effectiveness in assessing malnutrition risk, with AUC values of 0.69 (95% CI: 0.60-0.78) and 0.62 (95% CI: 0.54-0.72), respectively. A logistic regression model incorporating handgrip strength, skeletal muscle mass, sarcopenia, osteoporosis, depression, specific antidepressant use, mobility, appetite, and smoking achieved superior performance in predicting malnutrition risk, with an AUC of 0.84 (95% CI: 0.77-0.91). In conclusion, this study demonstrates that integrating multiple parameters into a composite model provides a more accurate and comprehensive assessment of malnutrition risk in elderly adults.
Collapse
Affiliation(s)
- Karolina Kujawowicz
- Department of Food Biotechnology, Medical University of Białystok, 15-089 Białystok, Poland; (I.M.-C.); (M.C.); (A.M.W.)
| | | | | | | |
Collapse
|
38
|
Cereda E, Casirati A, Klersy C, Nardi M, Vandoni G, Agnello E, Crotti S, Masi S, Ferrari A, Pedrazzoli P, Caccialanza R. Bioimpedance-derived body composition parameters predict mortality and dose-limiting toxicity: the multicenter ONCO-BIVA study. ESMO Open 2024; 9:103666. [PMID: 39137479 PMCID: PMC11369426 DOI: 10.1016/j.esmoop.2024.103666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/10/2024] [Accepted: 07/15/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND In patients with cancer, lean body mass loss is frequent and associated with worse outcomes, including reduced treatment tolerance and survival. Bioelectrical impedance analysis (BIA) is a popular method for body composition assessment. We evaluated the value of BIA-derived body composition parameters in predicting mortality and, for the first time, dose-limiting toxicity (DLT). PATIENTS AND METHODS We conducted a prospective multicenter (n = 12) observational study in adult patients with solid neoplastic disease and receiving primary systemic treatment. We collected information on BIA-derived parameters: phase angle (PhA) <5th percentile of age and gender-specific normative values; standardized PhA (SPA) <-1.65; Nutrigram® <660 mg/24 h/m and <510 mg/24 h/m for males and females, respectively. The primary outcome and the key secondary were 1-year mortality and DLT (any-type severe toxicity requiring a delay in systemic treatment administration or a reduction of its dosage), respectively. RESULTS In total, 640 patients were included. At 12 months, death occurred in 286 patients (47.6%). All BIA-derived body composition parameters were independently associated with death: SPA, hazard ratio (HR) = 1.59 [95% confidence interval (CI) 1.30-1.95] (P < 0.001); PhA, HR = 1.38 (95% CI 1.13-1.69) (P = 0.002); Nutrigram®, HR = 1.71 (95% CI 1.42-2.04) (P < 0.001). DLT occurred in 208 patients (32.5%) and body composition parameters were associated with this outcome, particularly SPA: odds ratio = 6.37 (95% CI 2.33-17.44) (P < 0.001). CONCLUSIONS The study confirmed that BIA-derived body composition parameters are independently associated not only with survival but also with DLT. Although our findings were limited to patients receiving first-line systemic treatment, the evidence reported may have important practice implications for the improvement of the clinical work-up of cancer patients.
Collapse
Affiliation(s)
- E Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - A Casirati
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - C Klersy
- Biostatistics & Clinical Trial Center, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - M Nardi
- Nutritional Support Unit, Veneto Institute of Oncology IOV-IRCCS, Padua
| | - G Vandoni
- Clinical Nutrition, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan
| | - E Agnello
- Dietetic and Clinical Nutrition Unit, Città della Salute e della Scienza Hospital, Turin
| | - S Crotti
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - S Masi
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - A Ferrari
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - P Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia; Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - R Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia.
| |
Collapse
|
39
|
Shida T, Hatanaka S, Ohta T, Osuka Y, Kojima N, Motokawa K, Iwasaki M, Miyamae F, Okamura T, Hirano H, Awata S, Sasai H. Proposal and validation of an equation to identify sarcopenia using bioelectrical impedance analysis-derived parameters. Nutrition 2024; 124:112453. [PMID: 38669830 DOI: 10.1016/j.nut.2024.112453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 03/29/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVE This study aimed to develop a simpler approach for diagnosing sarcopenia by using only bioelectrical impedance vector analysis parameters. METHODS The study design was a cross-sectional study. The research was conducted based on the Itabashi Longitudinal Study on Aging, a community-based cohort study, with data collected from the 2022 and 2023 surveys in Itabashi Ward, Tokyo, Japan. The development cohort consisted of 1146 participants from the 2022 survey, and the validation cohort included 656 participants from the 2023 survey. Both cohorts were comprised of community-dwelling older adults with similar inclusion criteria. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria. The logistic model utilized height divided by impedance at 50 kHz and phase angle to establish a new regression equation to identify sarcopenia. Regression equations were generated for the development cohort and validated for the validation cohort. Discriminatory ability was assessed using the area under the receiver operating characteristic curve (AUC) for men and women. RESULTS The prevalence of sarcopenia was 20.7% and 14.8% in the development and validation cohort, respectively. The AUC (95% confidence interval) of the logistic model in discriminating sarcopenia was 0.92 (0.88, 0.95) for men and 0.82 (0.78, 0.86) for women in the development cohort and 0.85 (0.78, 0.91) for men and 0.90 (0.86, 0.95) for women in the validation cohort. CONCLUSION The study demonstrated that a simple formula using bioelectrical parameters at 50 kHz proved useful in identifying sarcopenia in the older adult population.
Collapse
Affiliation(s)
- Takashi Shida
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
| | - Sho Hatanaka
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Takahisa Ohta
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Yosuke Osuka
- Department of Frailty Research, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Narumi Kojima
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Keiko Motokawa
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Masanori Iwasaki
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan; Department of Preventive Dentistry, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Hokkaido, Japan
| | - Fumiko Miyamae
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Tsuyoshi Okamura
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Hirohiko Hirano
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Shuichi Awata
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Hiroyuki Sasai
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| |
Collapse
|
40
|
Utsumi Y, Takase K, Murakami N, Nakagawa T, Obayashi T, Ogura R, Hosokawa S. Investigation of Skeletal Muscle Indices Affecting Anaerobic Thresholds after Acute Myocardial Infarction. Phys Ther Res 2024; 27:100-107. [PMID: 39257518 PMCID: PMC11382791 DOI: 10.1298/ptr.e10286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/30/2024] [Indexed: 09/12/2024]
Abstract
OBJECTIVE To investigate skeletal muscle indices influencing the anaerobic threshold (AT) measured by cardiopulmonary exercise testing (CPX). METHODS This study included 125 consecutive men (median age: 66.0 years) diagnosed with acute myocardial infarction who underwent CPX before discharge. Participants were categorized into two groups based on their AT: the AT-lowering and AT-maintaining groups, comprising those with AT <11 and ≥11 ml/min/kg, respectively. Skeletal muscle indices that influenced AT, strengths of such influences, and respective cutoff values were investigated using multiple logistic regression analysis, decision-tree analysis, and the random-forest method. Skeletal muscle indices included grip strength, knee extension strength, lower-limb skeletal muscle index, phase angle (PhA), lower-limb PhA, arm circumference (AC), and calf circumference. RESULTS Lower-limb PhA, AC, age, and body mass index (BMI) influenced AT (model X2 test: p <0.05; Hosmer-Lemeshow test: p = 0.98). Among the skeletal muscle indices, Gini impurity reduction was the highest in the lower-limb PhA. The cutoff values for AT were ≥4.0° for BMI <24 kg/m2 and ≥6.4° for BMI ≥24 kg/m2. CONCLUSION Lower-limb PhA was the most influential skeletal muscle index affecting AT. PhA measured using body composition analyzers is useful to identify exercise-limiting factors and determine the effectiveness of exercise because it can be easily performed shortly.
Collapse
Affiliation(s)
- Yuya Utsumi
- Department of Rehabilitation, Tokushima Red Cross Hospital, Japan
| | - Koji Takase
- Department of Rehabilitation, Tokushima Red Cross Hospital, Japan
| | - Naoya Murakami
- Department of Rehabilitation, Tokushima Red Cross Hospital, Japan
| | - Tokiko Nakagawa
- Department of Rehabilitation, Tokushima Red Cross Hospital, Japan
| | - Takuya Obayashi
- Department of Rehabilitation, Tokushima Red Cross Hospital, Japan
| | - Riyo Ogura
- Department of Cardiology, Tokushima Red Cross Hospital, Japan
| | | |
Collapse
|
41
|
Yang J, Yu J, Kim J, Park E. Association between Physical Activity and Phase Angle Obtained via Bioelectrical Impedance Analysis in South Korean Adults Stratified by Sex. Nutrients 2024; 16:2136. [PMID: 38999883 PMCID: PMC11242964 DOI: 10.3390/nu16132136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/28/2024] [Accepted: 07/02/2024] [Indexed: 07/14/2024] Open
Abstract
This cross-sectional study aimed to examine the association of various aspects of physical activity, including intensity, duration, type, and purpose, with the phase angle (PhA), an objective indicator of health, in Korean adults after stratification by sex. Data from the 2022 Korean National Health and Nutrition Examination Survey, a nationwide, representative, population-based survey, were used. In total, 3996 participants were included in the study. Participants self-reported their weekly intensity, frequency, duration of engagement in physical activity. PhA was categorized into two groups on the basis of sex-specific averages. Multiple logistic regression analysis was used to investigate the relationship between physical activity and PhA, and proportional odds logistic regression analysis was performed to determine the association between physical activity and different subclasses of PhA. A positive association was found between sufficiently active aerobic physical activity and PhA compared with inactive physical activity (sufficiently active, male: odds ratio = 1.952, 95% confidence interval = 1.373-2.776; female: odds ratio = 1.333, 95% confidence interval = 1.019-1.745). This association was further strengthened when aerobic physical activity was accompanied by muscle-strengthening activity (sufficiently active with muscle-strengthening activity, male: aOR = 2.318, 95% CI = 1.512-3.554; female: aOR = 1.762, 95% CI = 1.215-2.556) and vigorous-intensity activities (sufficiently active with sufficient vigorous-intensity activity, male: aOR = 2.785, 95% CI = 1.647-4.709; female: aOR = 2.505, 95% CI = 1.441-4.356) and when there was more leisure-time physical activity than occupational physical activity (sufficiently active with more leisure-time physical activity, male: aOR = 2.158, 95% CI = 1.483-3.140; female: aOR = 1.457, 95% CI = 1.078-1.969). Furthermore, the inclusion of muscle-strengthening activity made a significant difference in the values of PhA for males with insufficiently active physical activity (aOR = 2.679, 95% CI = 1.560-4.602). For females with highly active physical activity (aOR = 1.521, 95% CI = 1.068-2.166), the inclusion of muscle-strengthening and vigorous-intensity activities were significantly associated with higher values for PhA. This study can be utilized to provide specific suggestions for better health programs and can change perception that only occupational physical activity is enough. This study also indicated that PhA can be used for personalized health assessments.
Collapse
Affiliation(s)
- Jiwon Yang
- Medical Courses, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Jiho Yu
- Medical Courses, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Jinhyun Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul 03722, Republic of Korea
- Department of Psychiatry, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Euncheol Park
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul 03722, Republic of Korea
| |
Collapse
|
42
|
Ricarte JRO, Nogueira MDDA, Firmino MAD, de Oliveira LFN, Valentim AB, Martins GDS, Dantas ACP, Matias NSL, Rocha EVDS, Almondes KGDS, Maia CSC. Phase angle and anthropometric indicators of cardiometabolic risk in children and adolescents. Eur J Clin Nutr 2024; 78:639-646. [PMID: 38632332 DOI: 10.1038/s41430-024-01439-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/19/2024]
Abstract
RATIONALE/OBJECTIVE The phase angle (PhA) is a measurement obtained from the resistance and reactance found in the bioelectrical impedance examination and is useful in assessing nutritional status and in assessing cardiometabolic diseases. Therefore, the objective was to correlate the phase angle to the anthropometric variables of cardiometabolic risk (CMR) in children and adolescents. SUBJECTS/METHODS Weight, height, body mass index (BMI), waist circumference (WC) and neck circumference (NC), waist-to-height ratio (WHtR), and PhA of 1231 children and adolescents aged between 5 and 18 years were assessed. PhA was assessed in tertiles and CMR was identified using the anthropometric variables BMI, WC, NC, and WHtR. Linear regression models were used to verify the association between PhA tertiles and CMR anthropometric variables, stratified by sex. RESULTS No relationship was found between PhA and CMR variables in children. In adolescents, lower values of NC (β = -0.019, p = 0.005) and BMI (β = -0.025, p = 0.023) were found in boys, WC (β = -0.017, p = 0.020), WHtR (β = -0.017, p = 0.020), NC (β = -0.011, p = 0.027) and BMI (β = -0.026, p = 0.009) in girls when they were in tertile 1 when compared to tertile 3 of the PhA, even after adjusting for age. CONCLUSION The PhA was directly associated with CMR in the assessed adolescents.
Collapse
Affiliation(s)
- Juliana Raissa Oliveira Ricarte
- Nutritionist. Master's degree. Ph.D student from the Graduate Program in Public Health, State University of Ceará, Fortaleza - CE, Brazil
| | - Maria Dinara de Araújo Nogueira
- Nutritionist. Master's degree. Ph.D student from the Graduate Program in Public Health, State University of Ceará, Fortaleza - CE, Brazil
| | - Matheus Aragão Dias Firmino
- Nutritionist. Master's student in the Graduate Program in Nutrition and Health, State University of Ceará, Fortaleza - CE, Brazil
| | - Luis Felipe Nunes de Oliveira
- Nutritionist. Master's student in the Graduate Program in Nutrition and Health, State University of Ceará, Fortaleza - CE, Brazil
| | - Ashley Brito Valentim
- Nutritionist. Master's student in the Graduate Program in Nutrition and Health, State University of Ceará, Fortaleza - CE, Brazil
| | - Géssica de Souza Martins
- Nutritionist. Master's degree. Ph.D student from the Graduate Program in Public Health, State University of Ceará, Fortaleza - CE, Brazil
| | - Ana Cecília Pereira Dantas
- Undergraduate Student in the Bachelor's program in Nutrition, State University of Ceará, Fortaleza - CE, Brazil
| | - Nayeli Silva Lima Matias
- Undergraduate Student in the Bachelor's program in Nutrition, State University of Ceará, Fortaleza - CE, Brazil
| | | | - Kaluce Gonçalves de Sousa Almondes
- Nutritionist. Ph.D. Researcher at the study and research Group on Micronutrients and Chronic Diseases, State University of Ceará, Fortaleza - CE, Brazil
| | - Carla Soraya Costa Maia
- Nutritionist. Ph.D. Faculty member in the Graduate Programs in Nutrition and Health, and Public Health, State University of Ceará, Fortaleza - CE, Brazil.
| |
Collapse
|
43
|
Zhang J, Xu Z, Fu Y, Chen L. Association between phase angle and diabetic peripheral neuropathy in Type 2 diabetes patients. Endocrine 2024; 85:196-205. [PMID: 38367144 DOI: 10.1007/s12020-024-03689-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/06/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Diabetic peripheral neuropathy (DPN), the very prevalent microvascular complication of type 2 diabetes mellitus (T2DM), severely threatens the quality of life of diabetic patients. Thus, prevention of DPN is extremely important for public health, and the identification of potential biomarkers may help with early prevention. Our work determined the association between phase angles (PhAs) and the risk of DPN in T2DM patients. MATERIALS AND METHODS This cross-sectional study recruited 697 T2DM patients from the Third Affiliated Hospital of Soochow University. All patients were divided into the non-diabetic peripheral neuropathy group and diabetic peripheral neuropathy group, and the DPN group was further divided into low, medium, and high diabetic foot ulcer risk groups according to vibration perception threshold results. Using univariate and multivariate logistic regression analyses continuously, the relationship between PhAs (arms, legs, trunk, and whole body) and the risk of DPN were evaluated. Further analysis was conducted on different subgroups of the study population. RESULTS After adjusting for the potential covariates, multivariate logistic regression analyses indicated that PhAs of the arms, legs, and whole body correlated inversely with the risk of DPN. However, the PhA of the trunk had no significant correlation with DPN. According to the stratified subgroup analysis, the negative association between PhA of the whole body and the risk of DPN remained significant in the sex and BMI group except for participants with BMI ≥ 28 kg/m². CONCLUSIONS For the first time, PhAs were acknowledged to be independently associated with DPN. Further exploration is needed to explain the findings.
Collapse
Affiliation(s)
- Junli Zhang
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Zhenghui Xu
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Yu Fu
- Department of Clinical Nutrition, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Lu Chen
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China.
- Department of Clinical Nutrition, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China.
| |
Collapse
|
44
|
Jiménez-Sánchez A, Pereira-Cunill JL, Limón-Mirón ML, López-Ladrón A, Salvador-Bofill FJ, García-Luna PP. A Cross-Sectional Validation Study of Camry EH101 versus JAMAR Plus Handheld Dynamometers in Colorectal Cancer Patients and Their Correlations with Bioelectrical Impedance and Nutritional Status. Nutrients 2024; 16:1824. [PMID: 38931179 PMCID: PMC11206484 DOI: 10.3390/nu16121824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Reduced muscle strength (dynapenia) and mass (atrophy) are prognostic factors in oncology. Measuring maximal handgrip strength with dynamometers is feasible but limited by the cost of the reference device (JAMAR). METHODS A cross-sectional study was conducted on colorectal cancer outpatients treated with chemotherapy or under active surveillance in our center from September 2022 to July 2023. Accuracy, reliability, and concordance were compared for two handheld dynamometers: the JAMAR Plus (the gold-standard device) and the Camry EH101 (a low-cost index device). A simultaneous nutritional diagnosis with GLIM criteria and bioelectrical impedance analysis (BIA) was carried out. RESULTS A total of 134 participants were included. The median of maximal strength for the JAMAR Plus had a non-significant difference of 1.4 kg from the Camry EH101. The accuracy and reliability of the devices were high. Bland-Altman analysis showed a 0.8 kg bias and -4.1 to 5.6 kg limits of agreement (LoA); a 0.1 kg bias and -5.3 to 5.4 kg LoA in men; a 1.5 kg bias and -2.2 to 5.3 kg LoA in women. In total, 29.85% of the participants were malnourished. Prevalence of dynapenia increased from 3.67% with the JAMAR Plus to 5.14% with the Camry EH101. Both devices had a moderate and significant correlation with BIA-estimated muscle mass. CONCLUSIONS The Camry EH101 was a cost-effective alternative to JAMAR Plus in our sample.
Collapse
Affiliation(s)
- Andrés Jiménez-Sánchez
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Avda. Manuel Siurot s/n, 41013 Seville, Spain;
| | - José Luis Pereira-Cunill
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Avda. Manuel Siurot s/n, 41013 Seville, Spain;
| | - María Luisa Limón-Mirón
- Unidad de Gestión Clínica de Oncología Médica, Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Seville, Spain; (M.L.L.-M.); (A.L.-L.); (F.J.S.-B.)
| | - Amelia López-Ladrón
- Unidad de Gestión Clínica de Oncología Médica, Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Seville, Spain; (M.L.L.-M.); (A.L.-L.); (F.J.S.-B.)
| | - Francisco Javier Salvador-Bofill
- Unidad de Gestión Clínica de Oncología Médica, Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Seville, Spain; (M.L.L.-M.); (A.L.-L.); (F.J.S.-B.)
| | - Pedro Pablo García-Luna
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Avda. Manuel Siurot s/n, 41013 Seville, Spain;
| |
Collapse
|
45
|
Rodríguez Jiménez B, Rodríguez de Vera Gómez P, Belmonte Lomas S, Mesa Díaz ÁM, Caballero Mateos I, Galán I, Morales Portillo C, Martínez-Brocca MA. Transforming body composition with semaglutide in adults with obesity and type 2 diabetes mellitus. Front Endocrinol (Lausanne) 2024; 15:1386542. [PMID: 38894744 PMCID: PMC11182984 DOI: 10.3389/fendo.2024.1386542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024] Open
Abstract
Background Glucagon-like peptide-1 receptor-agonists (GLP-1ra), such as semaglutide, have emerged as promising treatments, demonstrating sustained weight reduction and metabolic benefits. This study aims to assess the impact of oral and subcutaneous semaglutide on body composition and metabolic parameters in patients with T2DM and obesity. Methods A 24-week quasi-experimental retrospective study including adults with T2DM and obesity (BMI ≥ 30 kg/m²) who were treated with either daily-oral or weekly-subcutaneous semaglutide. Body composition was measured using bioelectrical impedance analysis, evaluating fat mass, fat-free mass, total body water, skeletal muscle mass, and whole-body phase angle. Analytical parameters included lipid profile and glycaemic control. Statistical analyses were performed using SPSS v.26. Results Participants (n=88) experienced significant weight loss after treatment with semaglutide (9.5% in subcutaneous, 9.4% in oral, P<0.001). Weight reduction primarily resulted from fat mass reduction without substantial lean mass compromise. Visceral fat area decreased, whiles phase-angle remained stable. Improvements in lipid profiles and glycaemic control were observed, with a decrease in both HbA1c and insulin requirements. Multivariate analysis demonstrated comparable impacts of oral and subcutaneous semaglutide on body composition. Conclusion Semaglutide, administered orally or subcutaneously, demonstrated positive effects on body composition, metabolic and glycaemic control in patients with T2DM and obesity. This real-world study highlights the potential of bioelectrical impedance analysis in assessing antidiabetic drugs' impact on body composition, providing valuable insights for future research and clinical applications.
Collapse
|
46
|
Tapasco-Tapasco LO, Gonzalez-Correa CA, Letourneur A. Phase angle and impedance ratio as meta-inflammation biomarkers after a colon cleansing protocol in a group of overweight young women. Physiol Meas 2024; 45:055021. [PMID: 38697207 DOI: 10.1088/1361-6579/ad46df] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 05/01/2024] [Indexed: 05/04/2024]
Abstract
Objective. Blood C-reactive protein (CRP) and the electrical bioimpedance spectroscopy (EBIS) variables phase angle (PhA) and impedance ratio (IR) have been proposed as biomarkers of metainflammation in overweight/obesity. CRP involves taking blood samples, while PhA and IR imply a less-than-2-minute-non-invasive procedure. In this study, values for these variables and percent body fat mass (PBFM) were obtained and compared before and immediately after a colon cleansing protocol (CCP), aimed at modulating intestinal microbiota and reducing metainflammation, as dysbiosis and the latter are intrinsically related, as well as along a period of 8 weeks after it.Approach. 20 female volunteers (20.9-24.9 years old) participated: 12 in an overweight group (OG), and 8 in a lean group (LG). TheOGwas divided in two subgroups (n= 6, each): control (CSG) and experimental (ESG). TheESGunderwent a 6-day CCP at week 2, while 5 volunteers in theCSGunderwent it at week 9.Main results.Pre/post-CCP mean values for the variables in theOGwere: PBFM (34.3/31.3%), CRP (3.7/0.6 mg dl-1), PhA (6.9/7.5°) and IR*10 (0.78/0.77). CalculatedR2correlation factors among these variables are all above 0.89. The favourable changes first seen in theESGwere still present 8 weeks after the CCP.Significance.(a) the CCP drastically lowers meta-inflammation, (b) EBIS can be used to measure metainflammation, before and after treatment, (c) for microbiota modulation, CCP could be a good alternative to more drastic procedures like faecal microbiota transplantation; (d) reestablishing eubiosis by CCP could be an effective coadjutant in the treatment of overweight young adult women.
Collapse
Affiliation(s)
- L O Tapasco-Tapasco
- Research Group on Electrical Bioimpedance (GruBIE), University of Caldas, Manizales, Caldas, Colombia
| | - C A Gonzalez-Correa
- Research Group on Electrical Bioimpedance (GruBIE), University of Caldas, Manizales, Caldas, Colombia
| | | |
Collapse
|
47
|
Prete M, Ballarin G, Porciello G, Arianna A, Luongo A, Belli V, Scalfi L, Celentano E. Bioelectrical impedance analysis-derived phase angle (PhA) in lung cancer patients: a systematic review. BMC Cancer 2024; 24:608. [PMID: 38769506 PMCID: PMC11106952 DOI: 10.1186/s12885-024-12378-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/13/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Lung cancer is the second most diagnosed cancer in the world. Up to 84% of diagnosed patients have malnutrition, which can negatively affect quality of life and survival and may worsen with neoadjuvant treatment. Bioelectrical Impedance Analysis-Derived Phase Angle (PhA) in these patients could be a valid tool to assess the nutritional status in order to improve their condition. METHODS This review provides an update on PhA assessment in lung cancer patients over the past twenty years. We searched PubMed, Embase, Scopus, Web of Science, and Cochrane, for articles regarding the PhA obtained from Bioelectrical Impedance Analysis in lung cancer patients. The authors independently performed a literature search: sample size, patient population, study type, study dates, survival and interventions were evaluated. The final review included 11 studies from different countries. RESULTS Eight studies only considered patients with lung cancer, while three studies considered patients with different kind of cancer, including lung. Correlation data between PhA and age are conflicting. In patients undergoing clinical treatment and patients undergoing surgical treatment lower PhA was observed. A lower PhA is associated with a shorter survival. In three studies emerged a relationship between Karnofski Performance Status and Handgrip Strenght with PhA. From one study, univariate logistic regression analysis showed that higher PhA values represent a protective factor for sarcopenia. CONCLUSION Our research underlined interesting, but not conclusive, results on this topic; however more researches are needed to understand the clinical meaning of PhA.
Collapse
Affiliation(s)
- Melania Prete
- Division of Radiotherapy, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, 80131, Italy
| | - Giada Ballarin
- Department of Medical, Movement Sciences and Wellbeing, University of Naples "Parthenope", Naples, 80133, Italy
| | - Giuseppe Porciello
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, 80131, Italy.
| | - Aniello Arianna
- Department of Public Health, Federico II University Hospital, Via Pansini 5, Naples, 80131, Italy
| | - Assunta Luongo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, 80131, Italy
| | - Valentina Belli
- Scientific Direction, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, 80131, Italy
| | - Luca Scalfi
- Department of Public Health, Federico II University Hospital, Via Pansini 5, Naples, 80131, Italy
| | - Egidio Celentano
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, 80131, Italy
| |
Collapse
|
48
|
Zhang L, Wang L, Long J, Yin Y, Patil S. Nutritional and Body Composition Changes in Paediatric β-Thalassemia Patients Undergoing Hematopoietic Stem Cell Transplantation: A Retrospective Study Using Bioelectrical Impedance Analysis. J Multidiscip Healthc 2024; 17:2203-2214. [PMID: 38751668 PMCID: PMC11094366 DOI: 10.2147/jmdh.s463796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/29/2024] [Indexed: 05/18/2024] Open
Abstract
Objective This retrospective study evaluated nutritional status and body composition changes in paediatric β-thalassemia (β-TM) patients before and after hematopoietic stem cell transplantation (HSCT), using bioelectrical impedance analysis (BIA), and explored their relationship with HSCT outcomes. Methods A cohort of 40 paediatric β-TM patients undergoing allogeneic HSCT was assessed for their nutritional status, anthropometric parameters, including body mass index (BMI), weight, and height, and body composition parameters pre-and post-HSCT, focusing on BIA measurements, including intracellular water (ICW), extracellular water (ECW), fat mass (FAT), fat-free mass (FFM), Skeletal Muscle Mass (SMM), soft Lean Mass (SLM), percent body fat (PBF), Body Cell Mass (BCM), Phase angle (PA) and muscle balance pre- and post-HSCT. Post-HSCT clinical outcomes, including acute graft-vs-host disease (aGVHD), engraftment time, oral mucositis (OM), sinusoidal obstruction syndrome (SOS), and diarrhoea in relation to nutrition status after HSCT were analysed. Results After HSCT, 28.21% experienced diminished nutritional status, with 71.43% of those who were wasting before HSCT showing diminished nutritional status, significantly higher than the normal group (18.75%, P = 0.012). Anthropometric changes included significant weight reduction (87.5%, 22.15 ± 7.46 vs 20.74 ± 6.57, P < 0.001) and BMI decrease (90%, 15.19 ± 1.70 vs 14.05 ± 1.48, P < 0.001). Body composition parameters, which are FFM, SMM, SLM, ICW, ECW, BCM, and PA (18.26 ± 5.71 vs 17.27 ± 5.19, 8.68 ± 3.30 vs 7.93 ± 3.02, 17.11 ± 5.28 vs 16.06 ± 4.84, 8.19 ± 2.54 vs 7.62 ± 2.31, 5.15 ± 1.58 vs 4.94 ± 1.47, 11.74 ± 3.63 vs 10.92 ± 3.32, 4.42 ± 0.50 vs 3.90 ± 0.57, respectively, P < 0.001) analysis revealed significant decreases. No significant differences in clinical outcomes were observed based on nutritional status. Conclusion Paediatric β-TM patients undergoing HSCT exhibit significant changes in nutrition status and body composition, emphasizing the need for focused attention on malnourished children who are more prone to diminished nutritional status. Comprehensive BIA aids in understanding the impact, urging consideration for extended follow-up and larger cohorts in future research.
Collapse
Affiliation(s)
- Luyang Zhang
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, 518000, People’s Republic of China
| | - Li Wang
- Department of Clinical Nutrition, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, 518000, People’s Republic of China
| | - Jiewen Long
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, 518000, People’s Republic of China
| | - Yan Yin
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, 518000, People’s Republic of China
| | - Sandip Patil
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, 518000, People’s Republic of China
| |
Collapse
|
49
|
Luna TB, Bello JLG, Carbonell AG, Montoya ADLCR, Lafargue AL, Ciria HMC, Zulueta YA. The role of various physiological and bioelectrical parameters for estimating the weight status in infants and juveniles cohort from the Southern Cuba region: a machine learning study. BMC Pediatr 2024; 24:313. [PMID: 38711132 PMCID: PMC11075357 DOI: 10.1186/s12887-024-04789-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 04/24/2024] [Indexed: 05/08/2024] Open
Abstract
OBJECTIVE The search for other indicators to assess the weight status of individuals is important as it may provide more accurate information and assist in personalized medicine.This work is aimed to develop a machine learning predictions of weigh status derived from bioimpedance measurements and other physical parameters of healthy infant juvenile cohort from the Southern Cuba Region, Santiago de Cuba. METHODS The volunteers were selected between 2002 and 2008, ranging in age between 2 and 18 years old. In total, 393 female and male infant and juvenile individuals are studied. The bioimpedance parameters are obtained by measuring standard tetrapolar whole-body configuration. A classification model are performed, followed by a prediction of other bioparameters influencing the weight status. RESULTS The results obtained from the classification model indicate that fat-free mass, reactance, and corrected resistance primarily influence the weight status of the studied population. Specifically, the regression model demonstrates that other bioparameters derived from impedance measurements can be highly accurate in estimating weight status. CONCLUSION The classification and regression predictive models developed in this work are of the great importance for accessing to the weigh status with high accuracy of younger individuals at the Oncological Hospital in Santiago de Cuba, Cuba.
Collapse
Affiliation(s)
- Taira Batista Luna
- Autonomous University of Santo Domingo (UASD), UASD Nagua Center, Santo Domingo, Dominican Republic.
| | - Jose Luis García Bello
- Autonomous University of Santo Domingo (UASD), San Francisco de Macorís Campus, Santo Domingo, Dominican Republic
| | - Agustín Garzón Carbonell
- National Center for Applied Electromagnetism (CNEA), Universidad de Oriente CP 90500, Santiago de Cuba, Cuba
| | | | - Alcibíades Lara Lafargue
- National Center for Applied Electromagnetism (CNEA), Universidad de Oriente CP 90500, Santiago de Cuba, Cuba
| | - Héctor Manuel Camué Ciria
- National Center for Applied Electromagnetism (CNEA), Universidad de Oriente CP 90500, Santiago de Cuba, Cuba
| | - Yohandys A Zulueta
- Departamento de Física, Facultad de Ciencias Naturales y Exactas, Universidad de Oriente, Santiago de Cuba, CP 90500, CP, Cuba.
| |
Collapse
|
50
|
Shiraishi R, Sato K, Chijiiwa N, Tajima F, Ogawa T. Calculation of trunk muscle mass and trunk muscle quality indices for walking independence in asian patients with hip fractures. Clin Nutr ESPEN 2024; 60:11-16. [PMID: 38479898 DOI: 10.1016/j.clnesp.2023.12.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/14/2023] [Accepted: 12/28/2023] [Indexed: 04/12/2024]
Abstract
BACKGROUND & AIMS This study aimed to investigate the association between trunk muscle mass and muscle quality, as evaluated by bioelectrical impedance analysis (BIA), and the ability to walk independently in patients with hip fractures. Cutoff values for quantitative and qualitative indicators of the trunk muscles were also calculated. METHODS This study included 181 patients with hip fractures who were admitted to a convalescent rehabilitation ward. Trunk muscle mass and phase angle of the participants were evaluated on admission. The phase angle in this study was defined as the trunk muscle quality index (TMQI). Patients were classified into the independent (functional independence measure [FIM]-walk score ≥6; n = 101) and non-independent (FIM-walk score ≤5; n = 80) walking groups according to the FIM mobility scores at discharge. RESULTS The independent group had a higher FIM gain than the non-independent group (37.0 ± 13.6 vs. 27.1 ± 13.5, p < 0.001). Logistic regression analysis showed that the trunk muscle mass index (TMI) and TMQI were associated with the ability to walk independently. Furthermore, cutoff values of TMI and TMQI for male and female to estimate the ability to walk independently were 6.5 kg/m2 and 5.7 kg/m2, and 4.5° and 3.4°, respectively. CONCLUSION TMI and TMQI are related to the ability to walk independently in patients with hip fractures. These results suggest the importance of improving trunk muscle mass and muscle quality during rehabilitation of patients with hip fractures.
Collapse
Affiliation(s)
- Ryo Shiraishi
- Clinical Education and Research Center, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa City, Okinawa 904-2151, Japan; Department of Clinical Research and Quality Management, Graduate School of Medicine, University of the Ryukyus, Nishihara-cho, Okinawa, 903-0215, Japan
| | - Keisuke Sato
- Clinical Education and Research Center, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa City, Okinawa 904-2151, Japan; Ginowan Kinen Hospital, 3-3-13, Ginowan, Ginowan City, Okinawa, 901-2211, Japan; Department of Rehabilitation Medicine, Aichi Medical University, Nagakute City, Aichi, 480-1103, Japan.
| | - Nobumasa Chijiiwa
- Clinical Education and Research Center, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa City, Okinawa 904-2151, Japan
| | - Fumihiro Tajima
- Clinical Education and Research Center, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa City, Okinawa 904-2151, Japan
| | - Takahiro Ogawa
- Clinical Education and Research Center, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa City, Okinawa 904-2151, Japan; Department of Rehabilitation Medicine, Aichi Medical University, Nagakute City, Aichi, 480-1103, Japan
| |
Collapse
|