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Moriyama T, Tokunaga M, Hori R, Itoh H, Hachisuka A, Ochi M, Matsushima Y, Saeki S. Low phase angle is associated with swallowing outcomes in patients with acute stroke. Clin Neurol Neurosurg 2024; 243:108388. [PMID: 38936173 DOI: 10.1016/j.clineuro.2024.108388] [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: 05/22/2024] [Accepted: 06/09/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND AND PURPOSE Stroke-induced dysphagia is a critical complication that can lead to severe secondary worldwide health issues. This retrospective cohort study investigated the association between phase angle (PhA) and swallowing function in the acute phase of stroke. We aim to establish whether nutritional and muscular interventions associated with PhA could enhance swallowing recovery and reduce related risks post-stroke. METHODS Stroke patients requiring rehabilitation were assessed for the association between low PhA-with cutoff values for low PhA defined as less than 5.28 for men and 4.32 for women-and swallowing function using a functional oral intake scale (FOIS) on Day 7 after admission and after the completion of acute stroke treatment. RESULTS In this study of 140 acute stroke patients (median age 74[69-81], and 85 men and 55 women), 76 patients with low PhA significantly exhibited older age, lower body mass index, more decline in skeletal muscle mass index, and lower premorbid modified Rankin Scale scores compared to 64 patients with high PhA. Multivariate linear regression revealed that low PhA was independently associated with FOIS scores on Day 7 after admission (β=-0.143 and p=0.036) and after the completion of acute stroke treatment (β=-0.513 and p=0.024), even when adjusting for confounding factors. CONCLUSIONS Low PhA is associated with swallowing function in patients with acute stroke. Nutritional and physical interventions improving PhA may lead to a reduction of the risk associated with stroke sequelae.
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Affiliation(s)
- Toshiyuki Moriyama
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan; National Hospital Organization Fukuoka-higashi Medical Center, Fukuoka, Japan.
| | - Mizuki Tokunaga
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Ryoko Hori
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Hideaki Itoh
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Akiko Hachisuka
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Mitsuhiro Ochi
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Yasuyuki Matsushima
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Satoru Saeki
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
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Matsumoto Y, Tada M, Yamada Y, Mandai K, Hidaka N. Relationship between the phase angle from bioelectrical impedance analysis and daily physical activity in patients with rheumatoid arthritis. Mod Rheumatol 2024; 34:340-345. [PMID: 37026712 DOI: 10.1093/mr/road036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/10/2023] [Accepted: 03/28/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVES This study aimed to examine the relationship between daily physical activity and the phase angle (PhA) obtained by bioelectrical impedance analysis in rheumatoid arthritis (RA) patients. METHODS Data from a prospective cohort study of RA patients who were surveyed every year were analysed. The PhA was assessed by the bioelectrical impedance analysis method, and physical activity was assessed as the amount of time of exercise in metabolic equivalents (METs) per day using a triaxial accelerometer for 7 consecutive days. The association between physical activity and the PhA was evaluated using the isotemporal substitution model in multiple regression analysis. RESULTS Seventy-six RA patients were included in the analysis (81% female and age 66.2 ± 13.1 years). On cross-sectional analysis, the isotemporal substitution model in multiple regression analysis showed that the PhA was 0.05 points higher every 10 minutes when activities with intensity of 1 ≤ METs < 2 were replaced by activities with intensity of ≥3 METs (P = .01). Over 1 year, the rate of change in the PhA was 0.69% higher every 10 minutes when activities with intensity of 1 ≤ METs < 2 were replaced by activities with intensity of ≥3 METs (P = .037). CONCLUSION The PhA in RA patients may be related to physical activity level.
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Affiliation(s)
- Yoshinari Matsumoto
- Department of Nutrition, Graduate School of Human Life and Ecology, Osaka Metropolitan University, Habikino, Osaka, Japan
| | - Masahiro Tada
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Yutaro Yamada
- Department of Orthopaedic Surgery, Osaka Metropolitan University Medical School, Osaka, Japan
| | - Koji Mandai
- Department of Orthopaedic Surgery, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Noriaki Hidaka
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
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Güner M, Ceylan S, Okyar Baş A, Kahyaoğlu Z, Çöteli S, Koca M, Öztürk Y, Deniz O, Doğu BB, Halil MG, Cankurtaran M, Balcı C. Phase angle is associated with frailty in community-dwelling older adults. Nutrition 2023; 116:112157. [PMID: 37562186 DOI: 10.1016/j.nut.2023.112157] [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: 01/23/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVES Frailty is a geriatric syndrome associated with adverse outcomes. Malnutrition and sarcopenia are conditions intertwined with frailty. Phase angle (PhA), used to evaluate nutritional status and sarcopenia, shows the cell membrane integrity and is closely related to clinical outcomes and mortality in many chronic conditions. The aim of this study was to evaluate the relationship between PhA and frailty in community-dwelling older adults. METHODS The study included 299 older adults admitted to a geriatric outpatient clinic. A comprehensive geriatric assessment was performed on all participants. Frailty was evaluated via the Clinical Frailty Scale, ≥4 levels were accepted as living with frailty. All participants underwent bioelectrical impedance analysis, and PhA was recorded for each participant. RESULTS The prevalence of frailty among the participants was 53%. The median PhA was lower in patients living with frailty than in those who were robust (5.10 [4.55-7.80] and 5.90 [3.90-6.90] degrees, respectively, and P = 0.014). Multivariable regression analysis showed that PhA was also associated with frailty in both sexes (odds ratio [OR], 0.920; P = 0.034 for men; OR, 0.81; P = 0.005 for women, respectively) independent of age, handgrip strength, nutritional status, body mass index, living alone, and burden of morbidities. CONCLUSION PhA calculated with bioelectrical impedance analysis was significantly associated with frailty. Further research with large samples is needed to determine whether PhA demonstrates potential utility as a biomarker for frailty.
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Affiliation(s)
- Merve Güner
- Hacettepe University Faculty of Medicine, Division of Geriatric Medicine, Ankara Turkey.
| | - Serdar Ceylan
- Hacettepe University Faculty of Medicine, Division of Geriatric Medicine, Ankara Turkey
| | - Arzu Okyar Baş
- Hacettepe University Faculty of Medicine, Division of Geriatric Medicine, Ankara Turkey
| | - Zeynep Kahyaoğlu
- Hacettepe University Faculty of Medicine, Division of Geriatric Medicine, Ankara Turkey
| | - Süheyla Çöteli
- Hacettepe University Faculty of Medicine, Division of Geriatric Medicine, Ankara Turkey
| | - Meltem Koca
- Hacettepe University Faculty of Medicine, Division of Geriatric Medicine, Ankara Turkey
| | - Yelda Öztürk
- Hacettepe University Faculty of Medicine, Division of Geriatric Medicine, Ankara Turkey
| | - Olgun Deniz
- Hacettepe University Faculty of Medicine, Division of Geriatric Medicine, Ankara Turkey
| | - Burcu Balam Doğu
- Hacettepe University Faculty of Medicine, Division of Geriatric Medicine, Ankara Turkey
| | - Meltem Gülhan Halil
- Hacettepe University Faculty of Medicine, Division of Geriatric Medicine, Ankara Turkey
| | - Mustafa Cankurtaran
- Hacettepe University Faculty of Medicine, Division of Geriatric Medicine, Ankara Turkey
| | - Cafer Balcı
- Hacettepe University Faculty of Medicine, Division of Geriatric Medicine, Ankara Turkey
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Kang SH, Do JY. Phase Angle as a Risk Factor for Mortality in Patients Undergoing Peritoneal Dialysis. Nutrients 2023; 15:4991. [PMID: 38068848 PMCID: PMC10707951 DOI: 10.3390/nu15234991] [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: 11/08/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
Phase angle (PhA) is measured using bioimpedance analysis and calculated using body reactance and resistance in the waveform at 50 kHz. Further studies are necessary to clarify the predictive efficacy of PhA in the mortality of peritoneal dialysis (PD) patients. The objective of this study was to assess the utility of PhA for predicting patient mortality and technique failure and compare the predictability of PhA with other risk factors. Our study had a retrospective cohort design. Our center routinely evaluates bioimpedance measurements for all prevalent PD patients (n = 199). The PhA was measured using multifrequency bioimpedance analysis. Our study evaluated patient and technique survival. There were 66, 68, and 65 patients in the low, middle, and high tertiles of PhA, respectively. The PhA values of the low, middle, and high tertiles were 3.6° (3.4-3.9), 4.4° (4.2-4.7), and 5.5° (5.2-6.0), respectively. The 5-year patient survival rates for the high, middle, and low tertiles were 100%, 81.7%, 69.9%, respectively (p < 0.001). The 5 year technique survival rates for the high, middle, and low tertiles were 91.9%, 74.8%, 63.7%, respectively (p = 0.004). Patient and technique survival increased as the PhA tertiles increased. Both univariate and multivariate Cox regression analyses demonstrated a consistent pattern. The prediction of patient or technique survival was better in PhA than in the other classical indicators. The present study demonstrated that PhA may be an effective indicator for predicting patient or technique survival in PD patients. Furthermore, it suggests that routine measurement of PhA and pre-emptive intervention to recover PhA according to causes of low PhA may help improve patient or technique survival in PD patients.
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Affiliation(s)
| | - Jun-Young Do
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea;
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Li J, Wang Z, Zhang Q, Zhang H, Shen Y, Zhang Q, Jian G, Cheng D, Wang N. Association between disability in activities of daily living and phase angle in hemodialysis patients. BMC Nephrol 2023; 24:350. [PMID: 38031052 PMCID: PMC10688067 DOI: 10.1186/s12882-023-03400-1] [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: 01/10/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Disability in activities of daily living (ADL) significantly increases the risk of mortality among patients undergoing hemodialysis. Malnutrition and decreased exercise capacity are closely correlated with ADL disability. Phase angle (PhA) has been proposed as a measure of nutritional status and exercise capacity. This study aims to investigate the prevalence of ADL disability in hemodialysis patients and its association with PhA. METHODS A prospective, observational study was conducted, involving hemodialysis patients treated between November 2019 and January 2020 in an affiliated hospital of Chinese university. ADL was measured using both basic ADL (BADL) scales and instrumental ADL (IADL) scales. PhA measurements were obtained using a BIA device while the patients were in the supine position after dialysis. RESULTS A total of 237 hemodialysis patients with a mean age of 60.01 ± 13.55 years were included in this study. The prevalence of disability in ADL was 43.5%. Multivariable analysis results showed a robust association between low PhA and disability in both BADL and IADL (for each unit decrease in PhA: odds ratio 4.83 [95% CI: 2.56-9.0], and 3.57 [95% CI: 2.14-5.95], respectively). The optimal cut-off values of PhA for disability in BADL and IADL were 4.8 and 5.4, with the area under the ROC curve (AUC) were 0.783 (0.727, 0.835) and 0.799 (0.743, 0.848), respectively. CONCLUSIONS Low PhA is strongly associated with disability in ADL in hemodialysis patients. These findings suggest that PhA may serve as a potentially objective measure of ADL disability in hemodialysis patients.
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Affiliation(s)
- Junhui Li
- Department of Nephrology, Putuo People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhi Wang
- Department of Nephrology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, P.R. China
| | - Qiannan Zhang
- Department of Nephrology, Putuo People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Huiping Zhang
- Department of Nephrology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, P.R. China
| | - Yuxin Shen
- Department of Nephrology, Putuo People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qi Zhang
- Tian Lin Community Health Center, Xuhui District, Shanghai, China
| | - Guihua Jian
- Department of Nephrology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, P.R. China.
| | - Dongsheng Cheng
- Department of Nephrology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, P.R. China.
| | - Niansong Wang
- Department of Nephrology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, P.R. China
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López-Plaza B, Gil Á, Menéndez-Rey A, Bensadon-Naeder L, Hummel T, Feliú-Batlle J, Palma-Milla S. Effect of Regular Consumption of a Miraculin-Based Food Supplement on Taste Perception and Nutritional Status in Malnourished Cancer Patients: A Triple-Blind, Randomized, Placebo-Controlled Clinical Trial-CLINMIR Pilot Protocol. Nutrients 2023; 15:4639. [PMID: 37960292 PMCID: PMC10648678 DOI: 10.3390/nu15214639] [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: 10/02/2023] [Revised: 10/20/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Taste disorders are common among cancer patients undergoing chemotherapy, with a prevalence ranging from 20% to 86%, persisting throughout treatment. This condition leads to reduced food consumption, increasing the risk of malnutrition. Malnutrition is associated not only with worse treatment efficacy and poor disease prognosis but also with reduced functional status and quality of life. The fruit of Synsepalum dulcificum (Daniell), commonly known as miracle berry or miracle fruit, contains miraculin, a taste-modifying protein with profound effects on taste perception. The CLINMIR Protocol is a triple-blind, randomized, placebo-controlled clinical trial designed to evaluate the regular consumption of a food supplement containing a miraculin-based novel food, dried miracle berry (DMB), on the taste perception (measured through electrogustometry) and nutritional status (evaluated through the GLIM Criteria) of malnourished cancer patients under active antineoplastic treatment. To this end, a pilot study was designed with 30 randomized patients divided into three study arms (150 mg DMB + 150 mg freeze-dried strawberries, 300 mg DMB, or placebo) for three months. Throughout the five main visits, an exhaustive assessment of different parameters susceptible to improvement through regular consumption of the miraculin-based food supplement will be conducted, including electrical and chemical taste perception, smell perception, nutritional and morphofunctional assessment, diet, quality of life, the fatty acid profile of erythrocytes, levels of inflammatory and cancer-associated cytokines, oxidative stress, antioxidant defense system, plasma metabolomics, and saliva and stool microbiota. The primary anticipated result is that malnourished cancer patients with taste distortion who consume the miraculin-based food supplement will report an improvement in food taste perception. This improvement translates into increased food intake, thereby ameliorating their nutritional status and mitigating associated risks. Additionally, the study aims to pinpoint the optimal dosage that provides maximal benefits. The protocol adheres to the SPIRIT 2013 Statement, which provides evidence-based recommendations and is widely endorsed as an international standard for trial protocols. The clinical trial protocol has been registered at the platform for Clinical Trials (NCT05486260).
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Affiliation(s)
- Bricia López-Plaza
- Nutrition Research Group, La Paz University Hospital Institute for Health Research (IdiPAZ), 28046 Madrid, Spain;
- Medicine Department, Faculty of Medicine, Complutense University of Madrid, Plaza de Ramón y Cajal s/n, 28040 Madrid, Spain
| | - Ángel Gil
- Department of Biochemistry and Molecular Biology II, University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria IBS.GRANADA, Complejo Hospitalario Universitario de Granada, 18014 Granada, Spain
- Institute of Nutrition and Food Technology “José Mataix”, Centre of Biomedical Research, University of Granada, Avda. del Conocimiento s/n, Armilla, 18016 Granada, Spain
- CIBEROBN (CIBER Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | | | | | - Thomas Hummel
- Smell & Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany;
| | - Jaime Feliú-Batlle
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain;
- CIBERONC (CIBER Cancer), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Medicine Department, Faculty of Medicine, Autonomous University of Madrid, Arzobispo Morcillo 4, 28029 Madrid, Spain;
| | - Samara Palma-Milla
- Medicine Department, Faculty of Medicine, Autonomous University of Madrid, Arzobispo Morcillo 4, 28029 Madrid, Spain;
- Nutrition Department, Hospital University La Paz, 28046 Madrid, Spain
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Conde Frio C, Härter J, Santos LP, Orlandi SP, Gonzalez MC. Phase angle, physical quality of life and functionality in cancer patients undergoing chemotherapy. Clin Nutr ESPEN 2023; 57:331-336. [PMID: 37739676 DOI: 10.1016/j.clnesp.2023.07.017] [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: 12/06/2022] [Revised: 05/14/2023] [Accepted: 07/11/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION Nutritional deficiency, especially malnutrition, is frequent in cancer patients and is associated with changes in body composition, such as low muscle mass. Phase angle (PhA) has been used as a prognostic indicator and may be related to nutritional status, functionality, and quality of life in these patients. The objectives of this study were to assess the effect of chemotherapy treatment on PhA values, comparing the PhA variation before and after treatment, and to evaluate the PhA correlation, as a muscle mass surrogate, with the physical domain of quality of life, functionality, and nutritional risk in a sample of patients with cancer. METHODS A longitudinal study was conducted in patients with cancer undergoing chemotherapy for the first time. All patients aged 18 years or older, newly diagnosed, and undergoing chemotherapy for the first time were included. To analyze the difference in the PhA means according to the different classification variables, the t-test - or ANOVA - was used. The variation of the final and initial PhA was evaluated through the linear regression test. RESULTS A total of 175 patients were analyzed, of which 66.3% were female. The mean PhA of the initial assessment was significantly higher when compared to the final assessment of the patients PhA (p = 0.018). In both the initial and final assessments, PhA was correlated with the physical domain (r = 0.29; p < 0.001 and r = 0.19; p = 0.021) and with the functionality score (r = - 0.32; p < 0.001 and r = - 0.30; p < 0.001) and total PG-SGA (r = - 0.31; p < 0.001 and r = - 0.23; p = 0.006). CONCLUSION PhA can be considered a predictor of physical quality of life and functionality in cancer patients receiving chemotherapy treatment.
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Affiliation(s)
- Camila Conde Frio
- Post-Graduate Program in Nutrition and Food, Universidade Federal de Pelotas, Pelotas, RS, Brazil.
| | - Jéssica Härter
- Medical Sciences of Universidade Federal do Rio Grande Do Sul, Brazil.
| | | | | | - Maria Cristina Gonzalez
- Post-Graduate Program in Nutrition and Food, Universidade Federal de Pelotas, Pelotas, RS, Brazil.
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Abstract
The most challenging feature of heart failure (HF) still remains the evaluation of congestion. Residual congestion at discharge and the difficulties in perfectly dosing therapies in order to balance the hydration status of the patient are the most worrisome issues when dealing with HF.The use of bioimpedance vector analysis (BIVA) might promote a different approach in the general management of patients with HF. BIVA is a reliable, fast, bedside tool able to assess the congestion status. It proved to be helpful to physicians for diagnosing congestive status, managing therapies, and providing prognostic information in the setting of HF.Bioelectrical Phase Angle (PhA) - as derived from equations related to the parameters of BIVA - recently surged as a possible biomarker for patients with HF. Studies provided data about the application of PhA in the clinical management and in the overall risk stratification of HF patients.Basically, the use of PhA might be considered as a holistic evaluation of patients with HF which includes the need for a multiparametric approach able to effectively depict the clinical status of patients. There is no definite biomarker able to comprehensively describe and identify all the features of HF patient, but scores based on molecules/techniques able to explore the different pathogenetic mechanisms of HF are desirable.The aim of this review was to provide a comprehensive evaluation of literature related to PhA role in HF and the impact of this biomarker on clinical management and risk stratification of HF patients.
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Affiliation(s)
- Pietro Scicchitano
- Cardiology Section, F. Perinei Hospital, SS 96 Altamura-Gravina Km 73, 800 - 70022, Altamura, Bari, Italy.
| | - Francesco Massari
- Cardiology Section, F. Perinei Hospital, SS 96 Altamura-Gravina Km 73, 800 - 70022, Altamura, Bari, Italy
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Ceolin J, de Borba EL, Mundstock E, de Oliveira JR, Mattiello R, Bodanese LC. Phase angle of bioimpedance as a marker of inflammation in cardiovascular diseases: A systematic review. Nutrition 2023; 112:112064. [PMID: 37263162 DOI: 10.1016/j.nut.2023.112064] [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: 06/29/2022] [Revised: 04/14/2023] [Accepted: 04/23/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The aim of this systematic review was to investigate whether phase angle (PhA) of bioelectrical impedance is associated with inflammatory markers in cardiovascular diseases (CVDs). METHODS A search was performed in the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Latin American Caribbean Health Sciences Literature (LILACS), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and Scopus; and in the gray literature up to January 2022. Studies with individuals with CVDs were included, to evaluate the association between PhA and the inflammatory markers interleukin (IL)-6, IL-10, IL-18, IL-1β, IL-33, tumor necrosis factor (TNF)-α, C-reactive protein (CRP), toll-like receptor (TLR) 2, TLR 4, nuclear factor κB, pathogen-associated molecular pattern molecules, lipopolysaccharides, interferon-γ-inducing factor, and JAK STAT. RESULTS We identified 755 articles and, after an eligibility analysis, 5 studies were included. The inflammatory markers investigated in the studies were CRP, TNF-α, and IL-33. In patients with CVDs, PhA was negatively associated with CRP and TNF-α in 80% and 100% of the studies, respectively. CONCLUSIONS The present results suggested that PhA is inversely associated with inflammatory markers in individuals with CVDs, and its clinical use is encouraged for better therapeutic planning.
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Affiliation(s)
- Jamile Ceolin
- Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Evandro Lucas de Borba
- Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Eduardo Mundstock
- Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Rita Mattiello
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Luiz Carlos Bodanese
- Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, Rio Grande do Sul, Brazil
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Bellido D, García-García C, Talluri A, Lukaski HC, García-Almeida JM. Future lines of research on phase angle: Strengths and limitations. Rev Endocr Metab Disord 2023; 24:563-583. [PMID: 37043140 PMCID: PMC10090740 DOI: 10.1007/s11154-023-09803-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 04/13/2023]
Abstract
Bioelectrical impedance analysis (BIA) is the most widely used technique in body composition analysis. When we focus the use of phase sensitive BIA on its raw parameters Resistance (R), Reactance (Xc) and Phase Angle (PhA), we eliminate the bias of using predictive equations based on reference models. In particular PhA, have demonstrated their prognostic utility in multiple aspects of health and disease. In recent years, as a strong association between prognostic and diagnostic factors has been observed, scientific interest in the utility of PhA has increased. In the different fields of knowledge in biomedical research, there are different ways of assessing the impact of a scientific-technical aspect such as PhA. Single frequency with phase detection bioimpedance analysis (SF-BIA) using a 50 kHz single frequency device and tetrapolar wrist-ankle electrode placement is the most widely used bioimpedance approach for characterization of whole-body composition. However, the incorporation of vector representation of raw bioelectrical parameters and direct mathematical calculations without the need for regression equations for the analysis of body compartments has been one of the most important aspects for the development of research in this area. These results provide new evidence for the validity of phase-sensitive bioelectrical measurements as biomarkers of fluid and nutritional status. To enable the development of clinical research that provides consistent results, it is essential to establish appropriate standardization of PhA measurement techniques. Standardization of test protocols will facilitate the diagnosis and assessment of the risk associated with reduced PhA and the evaluation of changes in response to therapeutic interventions. In this paper, we describe and overview the value of PhA in biomedical research, technical and instrumental aspects of PhA research, analysis of Areas of clinical research (cancer patients, digestive and liver diseases, critical and surgical patients, Respiratory, infectious, and COVID-19, obesity and metabolic diseases, Heart and kidney failure, Malnutrition and sarcopenia), characterisation of the different research outcomes, Morphofunctional assessment in disease-related malnutrition and other metabolic disorders: validation of PhA with reference clinical practice techniques, strengths and limitations. Based on the detailed study of the measurement technique, some of the key issues to be considered in future PhA research. On the other hand, it is important to assess the clinical conditions and the phenotype of the patients, as well as to establish a disease-specific clinical profile. The appropriate selection of the most critical outcomes is another fundamental aspect of research.
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Affiliation(s)
- Diego Bellido
- Department of Endocrinology and Nutrition, Complejo Hospitalario de Ferrol, 15405, Ferrol, A Coruña, Spain
| | - Cristina García-García
- PhD Program in Biomedicine, Translational Research and New Health Technologies, Faculty of Medicine, Málaga University, 29010, Málaga, Spain
| | | | - Henry C Lukaski
- Department of Kinesiology and Public Health Education, University of North Dakota, Grand Forks, ND, 58202, USA
| | - José Manuel García-Almeida
- Department of Endocrinology and Nutrition, Virgen de La Victoria Hospital, Malaga University, 29010, Malaga, Spain.
- Centro de Investigación Biomédica en Red de La Fisiopatología de La Obesidad Y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 29010, Malaga, Spain.
- Málaga University, 29010, Málaga, Spain.
- Department of Endocrinology and Nutrition, Quironsalud Málaga Hospital, 29004, Málaga, Spain.
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Papaemmanouil A, Bakaloudi DR, Gkantali K, Kalopitas G, Metallidis S, Germanidis G, Chourdakis M. Phase Angle and Handgrip Strength as Predictors of Clinical Outcomes in Hospitalized COVID-19 Patients. Nutrients 2023; 15:nu15061409. [PMID: 36986138 PMCID: PMC10057973 DOI: 10.3390/nu15061409] [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: 01/31/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Phase angle (PhA) and muscle strength are predictors of clinical outcomes in critically ill patients. Malnutrition may affect body composition measurements. The aim of this prospective study was to investigate the association between PhA and handgrip strength (HGS), and clinical outcomes in hospitalized COVID-19 patients. The study included a total of 102 patients. Both PhA and HGS were measured twice, within 48 h of hospital admission and on the 7th day of hospitalization. The primary outcome was the clinical status on the 28th day of hospitalization. Secondary outcomes included the hospital length of stay (LOS), the concentrations of ferritin, C-reactive protein and albumin, oxygen requirements and the severity of pneumonia. A one-way analysis of variance (ANOVA) test and Spearman rS correlation coefficient were used for statistical analysis. No differences were found for PhA [on day 1 (p = 0.769) and day 7 (p = 0.807)] and the primary outcome. A difference was found between HGS on day 1 and the primary outcome (p = 0.008), while no difference was found for HGS on day 7 (p = 0.476). Body mass index was found to be associated with the oxygen requirement on day 7 (p = 0.005). LOS was correlated neither with PhA (rs = −0.081, p = 0.422) nor with HGS (rs = 0.137, p = 0.177) on the first day. HGS could be a useful indicator of clinical outcomes in COVID-19 patients, while PhA does not seem to have a clinical impact. However, further research is needed to validate the results of our study.
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Affiliation(s)
- Androniki Papaemmanouil
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Dimitra Rafailia Bakaloudi
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
- Division of Oncology, Department of Medicine, University of Washington, Seattle, WA 98109, USA
| | - Konstantina Gkantali
- Division of Infectious Diseases, 1st Department of Internal Medicine, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Georgios Kalopitas
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
- Division of Gastroenterology and Hepatology, 1st Department of Internal Medicine, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Simeon Metallidis
- Division of Infectious Diseases, 1st Department of Internal Medicine, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Georgios Germanidis
- Division of Gastroenterology and Hepatology, 1st Department of Internal Medicine, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Michael Chourdakis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
- Correspondence:
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Rosato E, Gigante A, Pellicano C, Colalillo A, Alunni-Fegatelli D, Muscaritoli M. Phase angle, nutritional status, and mortality in systemic sclerosis: An exploratory pilot study. Nutrition 2023; 107:111946. [PMID: 36577164 DOI: 10.1016/j.nut.2022.111946] [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: 10/08/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Systemic sclerosis (SSc) is a rare autoimmune disease characterized by microvascular damage and fibrosis of the skin and internal organs. Among SSc complications, changes in nutritional status have a negative effect on quality of life and predispose patients to malnutrition. The aim of this exploratory pilot study was to examine whether bioelectrical impedance analysis-derived phase angle (PhA) is a parameter of nutritional status and a marker of mortality in patients with SSc. METHODS Consecutive adult patients with SSc were included in the study. Biochemical analyses, anthropometric data, and bioelectrical impedance analysis assessments were recorded at the time of enrollment. The Malnutrition Universal Screening Tool (MUST) and Global Leadership Initiative on Malnutrition (GLIM) were applied to assess nutritional status. RESULTS A total of 104 patients with SSc (88 women; median age: 55 y [interquartile range (IQR), 45.5- 66 y]) were enrolled. In patients with SSc and high malnutrition risk according to MUST, mean values of PhA were significantly lower than those of patients with SSc and low malnutrition risk (4° [IQR, 3.7°-4.4°] vs 4.6° [IQR, 4.2°-5.1°]; P = 0.004). Patients with SSc and malnutrition according to the GLIM criteria showed significantly lower PhA than patients with SSc but without malnutrition (3.8° [IQR, 3.5°-4.3°] vs 4.6° [IQR, 4.2°-5.1°]; P < 0.0001). Kaplan-Meier curves demonstrated that overall survival was significantly shorter (34.57 mo [±13.35] vs 48 mo [±0]; P = 0.001) in patients with SSc and PhA <3.75°. In the multivariate analysis, only PhA was a predictive factor for death (hazard ratio: 0.283; 95% confidence interval, 0.083-0.965; P = 0.044). CONCLUSIONS The data obtained suggest that lower PhA values in patients with SSc are associated with an increased malnutrition risk with MUST, malnutrition with GLIM, and increased mortality. Additional studies are necessary to confirm these preliminary results.
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Affiliation(s)
- Edoardo Rosato
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Antonietta Gigante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
| | - Chiara Pellicano
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Amalia Colalillo
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Danilo Alunni-Fegatelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
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Muñoz-Redondo E, Morgado-Pérez A, Pérez-Sáez MJ, Faura A, Sánchez-Rodríguez D, Tejero-Sánchez M, Meza-Valderrama D, Muns MD, Pascual J, Marco E. Low Phase Angle Values Are Associated with Malnutrition according to the Global Leadership Initiative on Malnutrition Criteria in Kidney Transplant Candidates: Preliminary Assessment of Diagnostic Accuracy in the FRAILMar Study. Nutrients 2023; 15:nu15051084. [PMID: 36904084 PMCID: PMC10005429 DOI: 10.3390/nu15051084] [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: 01/22/2023] [Revised: 02/09/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
Malnutrition has a negative impact on patients with chronic diseases and its early identification is a priority. The primary objective of this diagnostic accuracy study was to assess the performance of the phase angle (PhA), a bioimpedance analysis (BIA)-derived parameter, for malnutrition screening using the Global Leadership Initiative for Malnutrition (GLIM) criteria as the reference standard in patients with advanced chronic kidney disease (CKD) waiting for kidney transplantation (KT); criteria associated with low PhA in this population were also analyzed. Sensitivity, specificity, accuracy, positive and negative likelihood ratios, predictive values, and area under the receiver operating characteristic curve were calculated for PhA (index test) and compared with GLIM criteria (reference standard). Of 63 patients (62.9 years old; 76.2% men), 22 (34.9%) had malnutrition. The PhA threshold with the highest accuracy was ≤4.85° (sensitivity 72.7%, specificity 65.9%, and positive and negative likelihood ratios 2.13 and 0.41, respectively). A PhA ≤ 4.85° was associated with a 3.5-fold higher malnutrition risk (OR = 3.53 (CI95% 1.0-12.1)). Considering the GLIM criteria as the reference standard, a PhA ≤ 4.85° showed only fair validity for detecting malnutrition, and thus cannot be recommended as a stand-alone screening tool in this population.
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Affiliation(s)
- Elena Muñoz-Redondo
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar–Hospital de l’Esperança), 08003 Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar Medical Research Group, 08003 Barcelona, Spain
- PhD Program in Medicine, Department of Medicine, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Andrea Morgado-Pérez
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar–Hospital de l’Esperança), 08003 Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar Medical Research Group, 08003 Barcelona, Spain
| | - María-José Pérez-Sáez
- Nephrology Department, Hospital del Mar, 08003 Barcelona, Spain
- Kidney Disease Research Group, Hospital del Mar Medical Research Group, 08003 Barcelona, Spain
- Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Dr Aiguader Building (Mar Campus), 08003 Barcelona, Spain
| | - Anna Faura
- Nephrology Department, Hospital del Mar, 08003 Barcelona, Spain
| | - Dolores Sánchez-Rodríguez
- Geriatrics Department, Brugmann University Hospital, Université Libre de Bruxelles, 1020 Brussels, Belgium
- Geriatrics Department, Parc de Salut Mar (Centre Fòrum), 08019 Barcelona, Spain
- WHO Collaborating Centre for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, Université of Liège, Campus Sart Tilman, Quartier Hôpital, 4000 Liège, Belgium
| | - Marta Tejero-Sánchez
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar–Hospital de l’Esperança), 08003 Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar Medical Research Group, 08003 Barcelona, Spain
| | - Delky Meza-Valderrama
- Rehabilitation Research Group, Hospital del Mar Medical Research Group, 08003 Barcelona, Spain
- Physical Medicine and Rehabilitation Department, National Institute of Physical Medicine and Rehabilitation (INMFRE), Diagonal a la Universidad Tecnológica de Panamá, Panama City 0819, Panama
| | - María Dolors Muns
- Department of Endocrinology and Nutrition, Hospital del Mar, 08003 Barcelona, Spain
| | - Julio Pascual
- Nephrology Department, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Ester Marco
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar–Hospital de l’Esperança), 08003 Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar Medical Research Group, 08003 Barcelona, Spain
- Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Dr Aiguader Building (Mar Campus), 08003 Barcelona, Spain
- Correspondence:
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14
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Amano K, Bruera E, Hui D. Diagnostic and prognostic utility of phase angle in patients with cancer. Rev Endocr Metab Disord 2022; 24:479-489. [PMID: 36484944 DOI: 10.1007/s11154-022-09776-z] [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: 12/05/2022] [Indexed: 12/13/2022]
Abstract
Patients with cancer experience dynamic and longitudinal changes in nutritional status and body composition along the disease trajectory. They often want to know about their outlook with regard to treatment outcomes and overall survival. One of the commonly used measures for body composition is bioelectrical impedance analysis (BIA). BIA is an easy-to-use, quick, inexpensive, noninvasive, and reproducible technique that is often incorporated in daily clinical practice. Phase angle (PA), which is derived from BIA, is an indicator of cell membrane health and integrity. Higher PA values reflect better cell function, higher muscle mass, and lower fat mass. PA is also thought to be a proxy of water distribution (ratio between extracellular water [ECW] and intracellular water [ICW]) and body cell mass. In this narrative review, we discuss studies examining the diagnostic and prognostic value of PA regarding nutritional status, body composition and physical function, complications of cancer treatments, overall survival, symptoms, and quality of life (QOL) in patients with cancer. The literature suggests that PA is moderately to strongly correlated with body composition and physical function but only weakly correlated with nutritional status, complications, survival, symptoms, and QOL. Furthermore, the PA cutoff values vary significantly according to study and patient population with the diversity of bioelectrical impedance technology and electrode composition and placement. Thus, PA has yet to be routinely incorporated into clinical practice for patients with cancer. Future research is needed to determine how to translate scientific understanding of PA to clinical practice.
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Affiliation(s)
- Koji Amano
- Department of Palliative Medicine, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, 104-0045, Tokyo, Japan.
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, 480-1195, Nagakute city, Aichi, Japan.
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation & Integrative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, 1414, 77030, Unit, Houston, TX, USA
| | - David Hui
- Department of Palliative, Rehabilitation & Integrative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, 1414, 77030, Unit, Houston, TX, USA
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15
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da Silva BR, Orsso CE, Gonzalez MC, Sicchieri JMF, Mialich MS, Jordao AA, Prado CM. Phase angle and cellular health: inflammation and oxidative damage. Rev Endocr Metab Disord 2022; 24:543-562. [PMID: 36474107 PMCID: PMC9735064 DOI: 10.1007/s11154-022-09775-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
Phase angle is a composite measure that combines two raw bioelectrical impedance analysis measures: resistance and reactance. Phase angle has been considered an indicator of cellular health, integrity, and hydration. As inflammation and oxidative stress can damage cellular structures, phase angle has potential utility in early detecting inflammatory and oxidative status. Herein, we aimed to critically review the current understanding on the determinants of phase angle and its relationship with markers of inflammation and oxidative stress. We also discussed the potential role of phase angle in detecting chronic inflammation and related adverse outcomes. Several factors have been identified as predictors of phase angle, including age, sex, extracellular to intracellular water ratio, and fat-free mass. In addition to these factors, body mass index (BMI) also seems to influence phase angle. Available data also show that lower phase angle values are correlated (negligible to high correlation coefficients) with higher c-reactive protein, tumour necrosis factor-α, interleukin-6, and interleukin-10 in studies involving the general and aging populations, as well as patients with chronic conditions. Although fewer studies have evaluated the relationship between phase angle and markers of oxidative stress, available data also suggest that phase angle has potential to be used as an indicator (for screening) of oxidative damage. Future studies including diverse populations and bioelectrical impedance devices are required to confirm the validity and accuracy of phase angle as a marker of inflammation and oxidative stress for clinical use.
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Affiliation(s)
- Bruna Ramos da Silva
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada
| | - Camila E Orsso
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada
| | - Maria Cristina Gonzalez
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Juliana Maria Faccioli Sicchieri
- Department of Health Sciences, Division of Nutrition and Metabolism, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Mirele Savegnago Mialich
- Department of Health Sciences, Division of Nutrition and Metabolism, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Alceu A Jordao
- Department of Health Sciences, Division of Nutrition and Metabolism, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Carla M Prado
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada.
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16
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Norman K, Herpich C, Müller-Werdan U. Role of phase angle in older adults with focus on the geriatric syndromes sarcopenia and frailty. Rev Endocr Metab Disord 2022; 24:429-437. [PMID: 36456777 PMCID: PMC9715408 DOI: 10.1007/s11154-022-09772-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 12/05/2022]
Abstract
Age-related changes in body composition reflect an increased risk for disease as well as disability. Bioimpedance analysis is a safe and inexpensive bed side method to measure body composition, but the calculation of body compartments with BIA is hampered in older adults. Phase angle, a raw parameter derived from bioimpedance analysis, is free from calculation-inherent errors. It declines with age and disease and is highly predictive of a variety of clinical outcomes as well as mortality. This review summarizes the current evidence linking the phase angle to geriatric syndromes such as malnutrition, sarcopenia and frailty and also investigates whether the phase angle reacts to interventions. Since the majority of studies show an association between the phase angle and these geriatric syndromes, a low phase angle is not suitable to exclusively indicate a specific condition. It does not inform on the underlying cause and as such, a low phase angle mainly indicates increased risk. Phase angle decline over time is reflected by deterioration of e.g. frailty status. It reacts to physical training and detraining, but studies investigating whether these induced changes are also associated with improved outcome are missing.
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Affiliation(s)
- Kristina Norman
- Institute of Nutritional Science, University of Potsdam, 14558, Nuthetal, Germany.
- Department of Geriatrics and Medical Gerontology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany.
- Department of Nutrition and Gerontology, German Institute for Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.
| | - Catrin Herpich
- Institute of Nutritional Science, University of Potsdam, 14558, Nuthetal, Germany
- Department of Geriatrics and Medical Gerontology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Ursula Müller-Werdan
- Department of Geriatrics and Medical Gerontology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
- Evangelisches Geriatriezentrum Berlin gGmbH, Berlin, Germany
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17
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Nutritional and health status of adult Syrian refugees in the early years of asylum in Germany: a cross-sectional pilot study. BMC Public Health 2022; 22:2217. [PMID: 36447164 PMCID: PMC9706931 DOI: 10.1186/s12889-022-14684-7] [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: 05/03/2022] [Accepted: 11/21/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Migration is usually accompanied by changes in the social, cultural, and religious environment, socioeconomic status, and housing conditions, all of which affect nutritional health. In a cross-sectional study, we assessed the dietary intake as well as nutritional and health situation in a population of Syrian refugees who have resided in Germany for at least six months up to four years since 2015. The primary aim of this pilot study was to evaluate the nutritional and health status in comparison to reference values. METHODS Between December 2018 and March 2020, 114 adult Syrian refugees were included in the study. The subjects filled out questionnaires on sociodemographic variables, exercise, and nutrition behavior (three-day nutrition record). After a fasting blood draw, the subjects were examined for anthropometric parameters (height, weight, body mass index, waist circumference, waist-hip ratio, and body composition via a bioelectrical impedance analyzer). Various blood markers including iron status, hematological parameters, Vitamin D status, lipid metabolism, glucose metabolism, and total homocysteine (tHcy) were measured. RESULTS About half of the participants (71 male, 43 female) had lived in Germany for less than three years. Over 60% of men and 30% of women were overweight (BMI 25-30 kg/m2) or obese (BMI > 30 kg/m2), while 79% of men and 74% of women observed an elevated body fat mass. The evaluation of the three-day nutrition records revealed an unfavorable supply situation for numerous critical nutrients. More than half of the women (53.5%) had depleted iron stores (serum ferritin < 15 µg/l). The 25-OH-Vitamin D blood levels showed a high prevalence of Vitamin D insufficiency (25-49.9 nmol/l: 38% of men and 21% of women) and deficiency (< 25 nmol/l: 44% of men and 70% of women). 83% of men and 67% of women showed tHcy levels in plasma > 10 nmol/l. Fasting insulin levels and the HOMA-IR index indicate a risk for insulin resistance. Hyperlipidemia was prevalent, especially in males with 24% showing hypertriglyceridemia (> 150 mg/dl) and LDL-hypercholesterolemia (> 130 mg/dl). CONCLUSIONS The nutritional and health status of the cohort of Syrian refugees in Germany examined in this study is unsatisfactory, and many of the investigated refugees are at risk for developing cardiovascular disease and type 2 diabetes mellitus. Further studies are required to investigate the nutritional and health situation of refugees. This is obligatory to find ways to avoid malnutrition with all its associated health, sociodemographic, and economic consequences.
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Matsumoto Y, Tada M, Yamada Y, Mandai K, Hidaka N, Koike T. The Bioimpedance Phase Angle may be Associated With Frailty in Rheumatoid Arthritis Patients: Results From a Prospective, Cohort Study. Mod Rheumatol 2022:6646949. [PMID: 35856591 DOI: 10.1093/mr/roac078] [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: 05/23/2022] [Revised: 07/06/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES This study investigated whether the phase angle (PhA) on bioelectrical impedance analysis (BIA) is related to frailty in rheumatoid arthritis (RA) patients. METHODS Data from a prospective cohort study of RA patients were analyzed. The PhA was assessed by the BIA method, and frailty was assessed by the Kihon Check List (KCL) annually. The cutoff value of the PhA for frailty was calculated by receiver-operating characteristic analysis. The relationships between the PhA and frailty were evaluated by logistic regression analysis. The relationships between the change in PhA and frailty status and the KCL score were evaluated by analysis of covariance and multiple regression analysis. RESULTS A total of 170 patients (81.2% female, 66.2±13.1 years) were included in the analysis. A PhA of less than the cutoff for frailty was significantly associated with frailty (odds ratio: 4.75, 95% confidence interval: 1.86-12.17). Change in the PhA was significantly associated with change in the KCL score (β = -0.15). In robust patients, there was a significant difference in the rate of change of the PhA between the group that became pre-frail in the next year and the group that remained robust. CONCLUSIONS The PhA may be associated with frailty in RA patients.
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Affiliation(s)
- Yoshinari Matsumoto
- Department of Nutrition, Graduate School of Human Life and Ecology, Osaka Metropolitan University, Osaka, Japan
| | - Masahiro Tada
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Yutaro Yamada
- Department of Orthopaedic Surgery, Osaka Metropolitan University Medical School, Osaka, Japan
| | - Koji Mandai
- Department of Orthopaedic Surgery, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Noriaki Hidaka
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Tatsuya Koike
- Search Institute for Bone and Arthritis Disease (SINBAD), Shirahama Foundation for Health and Welfare, Wakayama, Japan.,Center for Senile Degenerative Disorders (CSDD), Osaka Metropolitan University Medical School, Osaka, Japan
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Matsumoto Y, Tada M, Yamada Y, Mandai K, Hidaka N, Koike T. The bioimpedance phase angle is more useful than sarcopenia as a predictor of falls in patients with rheumatoid arthritis: Results from a two-year prospective cohort study. Nutrition 2022; 102:111729. [DOI: 10.1016/j.nut.2022.111729] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 12/13/2021] [Accepted: 05/04/2022] [Indexed: 12/31/2022]
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Phase Angle Is a Stronger Predictor of Hospital Outcome than Subjective Global Assessment-Results from the Prospective Dessau Hospital Malnutrition Study. Nutrients 2022; 14:nu14091780. [PMID: 35565747 PMCID: PMC9100773 DOI: 10.3390/nu14091780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 02/06/2023] Open
Abstract
This prospective cohort study of 16,943 consecutive patients compared phase angle (PhA, foot-to-hand at 50 kHz) and subjective global assessment (SGA) to predict outcomes length of hospital stay (LOS) and in-hospital mortality in patients at risk of malnutrition (NRS-2002 ≥ 3). In 1505 patients, the independent effects on LOS were determined by competing risk analysis and on mortality by logistic regression. In model I, including influence factors age, sex, BMI, and diagnoses, malnourished (SGA B and C) patients had a lower chance for a regular discharge (HR 0.74; 95%CI 0.69−0.79) and an increased risk of mortality (OR 2.87; 95%CI 1.38−5.94). The association of SGA and outcomes regular discharge and mortality was completely abrogated when PhA was added (model II). Low PhA reduced the chance of a regular discharge by 53% in patients with a PhA ≤ 3° (HR 0.47; 95%CI 0.39−0.56) as compared to PhA > 5°. Mortality was reduced by 56% for each 1° of PhA (OR 0.44; 95%CI 0.32−0.61). Even when CRP was added in model III, PhA ≤ 3° was associated with a 41% lower chance for a regular discharge (HR 0.59; 95%CI 0.48−0.72). In patients at risk of malnutrition, the objective measure PhA was a stronger predictor of LOS and mortality than SGA.
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21
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Manoel R, Venâncio FA, Miguel GPS, Haraguchi FK, Pedrosa RG. A Higher Phase Angle Is Associated with Greater Metabolic Equivalents in Women 1 Year After Bariatric Surgery. Obes Surg 2022; 32:2003-2009. [PMID: 35419697 DOI: 10.1007/s11695-022-06050-8] [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: 11/26/2021] [Revised: 03/28/2022] [Accepted: 04/07/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Phase angle (PhA), proposed as an indicator of the number, integrity, and function of cells and evaluated in some clinical situations, decreases after bariatric surgery (BS). In contrast, higher values are found in physically active or exercising individuals. We therefore evaluated the influence of physical activity on PhA after BS. METHODS The PhA and body composition (obtained by bioelectrical impedance analysis), physical activity level (obtained by International Physical Activity Questionnaire), and metabolic equivalents (METs) were evaluated in adult women submitted to BS. The PhA and body composition were evaluated at three time points: before and 6 and 12 months after surgery. Physical activity level and METs were measured at the two postoperative time points. RESULTS A reduction in PhA was observed 6 (p < 0.01) and 12 months (p < 0.01) after BS, with no significant difference between time points. A moderate or high physical activity level was found in 81% of the volunteers after 6 months and in 65% after 12 months. METs were reduced after 12 months compared to 6 months. A positive correlation (p < 0.05) was observed between PhA and body cell mass after surgery. There was a significant positive correlation (p < 0.01) between PhA and METs after 12 months. CONCLUSIONS Physical activity may attenuate the PhA reduction that occurs after BS, with this parameter reflecting the engagement of these patients in this type of activity.
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Affiliation(s)
- Renata Manoel
- Postgraduate Program in Nutrition and Health (PPGNS), Federal University of Espírito Santo, Vitória, Brazil
| | - Fernanda A Venâncio
- Postgraduate Program in Nutrition and Health (PPGNS), Federal University of Espírito Santo, Vitória, Brazil
| | - Gustavo P S Miguel
- Department of Surgical Clinic, Health Sciences Center, Federal University of Espírito Santo, Vitória, Brazil
| | - Fabiano K Haraguchi
- Postgraduate Program in Nutrition and Health (PPGNS), Federal University of Espírito Santo, Vitória, Brazil.,Department of Integrated Education in Health, Health Sciences Center, Federal University of Espírito Santo, Vitória, Brazil
| | - Rogerio G Pedrosa
- Postgraduate Program in Nutrition and Health (PPGNS), Federal University of Espírito Santo, Vitória, Brazil. .,Department of Integrated Education in Health, Health Sciences Center, Federal University of Espírito Santo, Vitória, Brazil.
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Muscular Ultrasonography in Morphofunctional Assessment of Patients with Oncological Pathology at Risk of Malnutrition. Nutrients 2022; 14:nu14081573. [PMID: 35458134 PMCID: PMC9025957 DOI: 10.3390/nu14081573] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Muscular ultrasonography is a technique that allows assessing the amount and quality of muscle in a specific body region. The aim of the study was to compare the value of muscle ultrasonography in diagnosis of malnutrition with techniques such as anthropometry, handgrip strength and impedanciometry in patients with oncological pathology. Methods: Cross-sectional study in 43 patients with oncological pathology and high nutritional risk. Classical anthropometry (body mass index (BMI), arm circumference (AC), calf circumference (CC) and estimated appendicular muscle mass index (ASMI)) was performed. Body composition was measured with impedanciometry (BIA), phase angle (PA) and fat-free mass index (FFMI) and muscle ultrasonography of quadriceps rectus femoris (muscle area (MARA) and circumference (MCR) in section transverse). Malnutrition was diagnosed using the GLIM criteria and sarcopenia was assessed using EWGSOP2 criteria. Results: The mean age was 68.26 years (±11.88 years). In total, 23/20 of the patients were men/women. The BMI was 23.51 (4.75) kg/m2. The ASMI was 6.40 (1.86) kg/m2. The MARA was 3.31 cm2 in ultrasonography. In impedanciometry, phase angle was 4.91 (0.75)°; the FFMI was 17.01 kg/m2 (±2.65 kg/m2). A positive correlation was observed between the MARA with anthropometric measurements (AC: r = 0.39, p = 0.009; CC: r = 0.44, p < 0.01; ASMI: r = 0.47, p < 0.001); and with BIA (FFMI: r = 0.48, p < 0.01 and PA: r = 0.45, p < 0.001). Differences were observed when comparing the MARA based on the diagnosis of sarcopenia (Sarcopenia: 2.47 cm2 (±0.54 cm2); no sarcopenia: 3.65 cm2 (±1.34 cm2); p = 0.02). Conclusions: Muscle ultrasonography correlates with body composition measurement techniques such as BIA and anthropometry in patients with cancer.
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Sukackiene D, Rimsevicius L, Miglinas M. Standardized Phase Angle for Predicting Nutritional Status of Hemodialysis Patients in the Early Period After Deceased Donor Kidney Transplantation. Front Nutr 2022; 9:803002. [PMID: 35252294 PMCID: PMC8889040 DOI: 10.3389/fnut.2022.803002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background This study was designed to verify whether early posttransplant standardized phase angle (SPhA) determines nutrition status of hemodialysis patients in regard to different nutritional markers and predicts handgrip strength (HGS) 6 months after kidney transplantation. Methods A total of 82 kidney transplant recipients on maintenance hemodialysis treatment entered the study. Nutritional status was evaluated before kidney transplantation, at the hospital discharge date, and 6 months after. We used bioelectrical impedance analysis (BIA), three different malnutrition screening tools, HGS, and anthropometric measurements. Demographic profiles and biochemical nutritional markers were collected. SPhA values, adjusted for age and BMI, were used in our study. Results In the early posttransplant period, kidney transplant recipients lost muscle mass, gained fat mass, and developed mostly negative SPhA, accompanied by significantly lower albumin levels. The subjects with lower than median (<-1.46) SPhAdis [the SPhA (at discharge) adjusted for hospitalization time and the baseline SPhA] displayed lower values of albumin concentration (43.4 vs. 45.1 g/l, p = 0.010), hemoglobin (124 vs. 133 g/l, p = 0.016), GNRI (113 vs. 118, p = 0.041), and HGS (30 vs. 33 kg, p = 0.043). These patients had higher ferritin concentrations (420 vs. 258 mkmol/l, p = 0.026), longer inpatient stays (32 vs. 21 days, p < 0.001), and higher MIS scores (3 vs. 1, p = 0.001). Conclusion At the moment of hospital discharge, lower than the median SPhA is related to protein-energy wasting, represented as lower concentrations of nutrition biomarkers and an active inflammatory response. Higher SPhA before kidney transplantation predicts HGS 6 months after kidney transplantation, especially in women.
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Evidence-based recommendations of the Andalusian Group for Nutrition Reflection and Investigation (GARIN) for the management of adult patients with short bowel syndrome. NUTR HOSP 2021; 38:1287-1303. [PMID: 34448398 DOI: 10.20960/nh.03705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction In order to develop evidence-based recommendations and expert consensus for the nutritional management of patients with short bowel syndrome (SBS), we conducted a systematic literature search using the PRISMA methodology plus a critical appraisal following the GRADE scale procedures. Pharmacological treatment with antisecretory drugs, antidiarrheal drugs, and somatostatin contributes to reducing intestinal losses. Nutritional support is based on parenteral nutrition; however, oral intake and/or enteral nutrition should be introduced as soon as possible. In the chronic phase, the diet should have as few restrictions as possible, and be adapted to the SBS type. Home parenteral nutrition (HPN) should be individualized. Single-lumen catheters are recommended and taurolidine should be used for locking the catheter. The HPN's lipid content must be greater than 1 g/kg per week but not exceed 1 g/kg per day, and omega-6 fatty acids (ω6 FAs) should be reduced. Trace element vials with low doses of manganese should be used. Patients with chronic SBS who require long-term HPN/fluid therapy despite optimized treatment should be considered for teduglutide treatment. All patients require a multidisciplinary approach and specialized follow-up. These recommendations and suggestions regarding nutritional management in SBS patients have direct clinical applicability.
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25
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Haigis D, Matting L, Wagner S, Sudeck G, Frahsa A, Thiel A, Eschweiler G, Nieß AM. Identification of Sarcopenic Obesity in German Nursing Home Residents-The Role of Body Composition and Malnutrition in the BaSAlt Cohort-Study. Nutrients 2021; 13:nu13113791. [PMID: 34836048 PMCID: PMC8625583 DOI: 10.3390/nu13113791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Sarcopenic obesity (SO) is a phenotype, which is defined by reduced muscle strength, muscle mass, and obesity. Limited mobility leads to increased sedentary behavior and decreased physical activity. Both sarcopenia and obesity are aggravated by these factors. In combination, SO is an additional challenge for the setting nursing home (NH). Previous studies have shown a low prevalence of residents with SO in comparable settings, such as community-dwelling. We hypothesize that the BaSAlt cohort also has a small proportion of residents with SO. Methods: For the analysis, 66 residents (women: 74.2%) aged ≥ 65 years from NH, were screened for SO based on EWGSOP2 specifications and cut-off values to classify obesity. Results: Severe sarcopenia was quantified in eleven residents (16.7%). The majority of sarcopenic residents were women (n = 10) compared to men (n = 1). However, no SO could be identified by assessment of body mass index, fat mass in percentage, and fat mass index. Conclusion: As expected, the setting-specific cohort showed a low number of SO. Furthermore, no case of SO was identified in our study. Sarcopenia was associated with an increased fat-free mass in NH residents. Nevertheless, sarcopenia and obesity play important roles in the preservation of residents’ health.
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Affiliation(s)
- Daniel Haigis
- Department of Sports Medicine, University Hospital of Tuebingen, 72076 Tübingen, Germany; (S.W.); (A.M.N.)
- Interfaculty Research Institute for Sport and Physical Activity, University of Tuebingen, 72074 Tübingen, Germany; (L.M.); (G.S.); (A.F.); (A.T.)
- Correspondence:
| | - Leon Matting
- Interfaculty Research Institute for Sport and Physical Activity, University of Tuebingen, 72074 Tübingen, Germany; (L.M.); (G.S.); (A.F.); (A.T.)
- Institute of Sport Science, Faculty of Economics and Social Sciences, Eberhard Karls University of Tuebingen, 72074 Tübingen, Germany
| | - Silas Wagner
- Department of Sports Medicine, University Hospital of Tuebingen, 72076 Tübingen, Germany; (S.W.); (A.M.N.)
- Interfaculty Research Institute for Sport and Physical Activity, University of Tuebingen, 72074 Tübingen, Germany; (L.M.); (G.S.); (A.F.); (A.T.)
| | - Gorden Sudeck
- Interfaculty Research Institute for Sport and Physical Activity, University of Tuebingen, 72074 Tübingen, Germany; (L.M.); (G.S.); (A.F.); (A.T.)
- Institute of Sport Science, Faculty of Economics and Social Sciences, Eberhard Karls University of Tuebingen, 72074 Tübingen, Germany
| | - Annika Frahsa
- Interfaculty Research Institute for Sport and Physical Activity, University of Tuebingen, 72074 Tübingen, Germany; (L.M.); (G.S.); (A.F.); (A.T.)
- Institute of Sport Science, Faculty of Economics and Social Sciences, Eberhard Karls University of Tuebingen, 72074 Tübingen, Germany
- Institute of Social and Preventive Medicine, Faculty of Medicine, University of Bern, 3012 Bern, Switzerland
| | - Ansgar Thiel
- Interfaculty Research Institute for Sport and Physical Activity, University of Tuebingen, 72074 Tübingen, Germany; (L.M.); (G.S.); (A.F.); (A.T.)
- Institute of Sport Science, Faculty of Economics and Social Sciences, Eberhard Karls University of Tuebingen, 72074 Tübingen, Germany
| | - Gerhard Eschweiler
- Centre for Geriatric Medicine, Faculty of Medicine, University Hospital of Tuebingen, 72076 Tübingen, Germany;
| | - Andreas Michael Nieß
- Department of Sports Medicine, University Hospital of Tuebingen, 72076 Tübingen, Germany; (S.W.); (A.M.N.)
- Interfaculty Research Institute for Sport and Physical Activity, University of Tuebingen, 72074 Tübingen, Germany; (L.M.); (G.S.); (A.F.); (A.T.)
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26
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Fernandes SA, Rossoni C, Koch VW, Imbrizi M, Evangelista-Poderoso R, Pinto LP, Magro DO. Phase angle through electrical bioimpedance as a predictor of cellularity in inflammatory bowel disease. Artif Intell Gastroenterol 2021; 2:111-123. [DOI: 10.35712/aig.v2.i4.111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/19/2021] [Accepted: 07/26/2021] [Indexed: 02/06/2023] Open
Abstract
It is estimated in Western industrialized countries that inflammatory bowel disease (IBD) has a prevalence of 1 for every 200 inhabitants. In the past, the fat mass disproportionate increase in relation to the fat-free mass was considered uncommon in patients with IBD, due to the observation of the disease being more common with weight loss and malnutrition. However, more in-depth investigations demonstrate that the fat/lean mass disproportion stands out both in prevalence in patients with new diagnoses of ulcerative colitis or Crohn's disease as well as a factor of poor prognosis to the natural evolution of the disease or to the therapeutic response. Another important aspect associated with obesity in IBD is the increased risk of drug clearance [including anti-tumor necrosis factor (TNF) and anti-integrin agents], resulting in short half-life and low trough drug concentrations, since the levels of TNF secreted by adipocytes sequester anti-TNF agents, which could result in suboptimal response to biologics. In view of these characteristic aspects of the inflammatory process of IBD, the identification of cellular functioning is necessary, which can be associated with the staging of the underlying disease, biochemical parameters, and body composition, helping as an indicator for a more accurate clinical and nutritional conduct.
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Affiliation(s)
- Sabrina A Fernandes
- Postgraduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
| | - Carina Rossoni
- Institute of Environmental Health (ISAMB), Faculty of Medicine, University of Lisbon, Lisbon 1649-028, Portugal
| | - Vivian W Koch
- Gastroenterology Department, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020-090, Brazil
- Gastroenterology Department, Grupo Hospitalar Conceição, Porto Alegre 91350-250, Brazil
| | - Marcello Imbrizi
- Coloproctology Department, State University of Campinas (UNICAMP-SP), São Paulo 13056-405, Brazil
| | | | - Letícia Pereira Pinto
- Postgraduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
| | - Daniéla Oliveira Magro
- Department of Surgery, State University of Campinas (UNICAMP-SP) and Faculty of Medical Sciences (FCM), São Paulo 13056-405, Brazil
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27
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Osuna-Padilla IA, Salazar Arenas MDLA, Rodríguez-Moguel NC, Aguilar-Vargas A, Montano Rivas JA, Ávila-Ríos S. Phase angle as predictor of malnutrition in people living with HIV/AIDS. Nutr Clin Pract 2021; 37:146-152. [PMID: 34270135 DOI: 10.1002/ncp.10744] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/06/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Phase angle (PhA), measured by bioelectrical impedance analysis (BIA) has been studied as an indicator of survival in people living with HIV (PLWH). However, it remains unclear whether PhA is associated with malnutrition or low CD4+ T-cell counts. OBJECTIVE In this study, we assessed the discriminative capacity of PhA for malnutrition detection using Global Leadership Initiative on Malnutrition (GLIM) criteria in PLWH, aiming to propose cutoff points for this population. METHODS This retrospective observational study included 427 adult PLWH (13% female). Participants were classified according to malnutrition status by using GLIM criteria. Body composition was assessed by using BIA. CD4+ T-cell counts were determined by flow cytometry. RESULTS According to GLIM criteria, 30% of the participants were malnourished. Multivariate regression analysis showed that PhA (adjusted odds ratio [OR], 0.10; 95% CI, 0.05-0.18; P < 0.001), fat-mass percentage (adjusted OR, 0.86; 95% CI, 0.82-0.90; P < 0.001), and male sex (adjusted OR, 0.26; 95% CI, 0.09-0.76; P = 0.013) were independently associated with malnutrition. A PhA cutoff of 5.45° in men and 4.95° in women may predict malnutrition with sensitivity and specificity >70%. CONCLUSION PhA could be a valid, useful, and simple predictor of malnutrition in PLWH.
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Affiliation(s)
- Iván Armando Osuna-Padilla
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | | | | | - Adriana Aguilar-Vargas
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | | | - Santiago Ávila-Ríos
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
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28
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Grootswagers P, Smeets E, Oteng AB, Groot LD. A novel oral nutritional supplement improves gait speed and mitochondrial functioning compared to standard care in older adults with (or at risk of) undernutrition: results from a randomized controlled trial. Aging (Albany NY) 2021; 13:9398-9418. [PMID: 33799307 PMCID: PMC8064187 DOI: 10.18632/aging.202912] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/23/2021] [Indexed: 01/02/2023]
Abstract
Undernutrition in older adults is mainly addressed by oral nutritional supplements, which do not affect physical functioning. In this study, we tested a novel oral nutritional supplement that included whey and casein protein, ursolic acid, free branch-chained amino acids and vitamin D against a standard supplement. We included older adults (>65y) with (or at risk of) undernutrition (n=82) and randomized them to 12 weeks of novel or standard supplement. Both groups showed significant increases in body mass. No within or between-group differences in lean body mass were observed. Fat mass increased significantly more in the standard than the novel supplement group (time*treatment effect P=0.045). The novel supplement group showed a larger improvement in walking performance on distances of 4m (treatment x time interaction P=0.048) and 400m (treatment x time interaction P=0.038) than the standard treatment group. Gene sets related to mitochondrial functioning and oxidative phosphorylation were upregulated in the novel supplement group and downregulated in the standard supplement group. We conclude that a 12-week intervention with the novel supplement improved walking performance both during short and long distance as compared to a standard supplement, which can largely be explained by increased mitochondrial functioning in the group receiving the novel supplement.
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Affiliation(s)
- Pol Grootswagers
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Ellen Smeets
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Antwi-Boasiako Oteng
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Lisette de Groot
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
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Performance of functionality measures and phase angle in women exposed to chemotherapy for early breast cancer. Clin Nutr ESPEN 2021; 42:105-116. [DOI: 10.1016/j.clnesp.2021.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/07/2021] [Accepted: 02/14/2021] [Indexed: 12/21/2022]
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30
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Rinaldi S, Gilliland J, O'Connor C, Seabrook JA, Mura M, Madill J. Exercise capacity and its relationship with body composition and nutrition status in patients with interstitial lung disease. Nutr Clin Pract 2021; 36:891-898. [PMID: 33786852 DOI: 10.1002/ncp.10651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Patients with interstitial lung disease (ILD) are known to have diminished exercise ability. This study aimed to explore the relationship between nutrition status and body composition parameters with exercise capacity in ILD patients. A second aim focused on assessing the appropriateness of surrogate markers of nutrition status in ILD patients. METHODS Disease severity was determined by the percentage of predicted forced vital capacity. Exercise capacity was determined using 6-minute walk distance. Nutrition status was assessed using the subjective global assessment (SGA), standardized phase angle (SPhA), and impedance ratio z-score (z-IR). Bioelectrical impedance analysis estimated body composition parameters. RESULTS 45 of 79 participants (57%) were malnourished according to the SGA. FFM index z-score (z-FFMI) (r = 0.42, P = .02) and SGA (r = 0.49, P < .01) were significant predictors of exercise capacity independent of disease severity. Age (odds ratio [OR] = 1.1; 95% CI, 1.01-1.25; P = .04), low body mass index (OR = 0.73; 95% CI, 0.57-0.92; P = .01), z-FFMI (OR = 0.34; 95% CI, 0.17-0.68; P < .01), and body fat mass index z-score (OR = 0.39; 95% CI, 0.17-0.91; P = .03) were significantly associated with severe malnutrition. There was no significant difference in SPhA across SGA groups; however, a higher z-IR (poorer cell health) significantly increased the odds of severe malnutrition (OR = 2.75; 95% CI, 1.27-6.03; P = .02). CONCLUSION In ILD patients, malnutrition and loss of FFM negatively impact the ability to perform activities of daily living.
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Affiliation(s)
- Sylvia Rinaldi
- School of Health Studies, Western University, London, Ontario, Canada.,School of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada.,Human Environments Analysis Laboratory, Western University, London, Ontario, Canada
| | - Jason Gilliland
- School of Health Studies, Western University, London, Ontario, Canada.,Human Environments Analysis Laboratory, Western University, London, Ontario, Canada.,Department of Geography, Western University, London, Ontario, Canada.,Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Children's Health Research Institute, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Colleen O'Connor
- School of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada.,Human Environments Analysis Laboratory, Western University, London, Ontario, Canada
| | - Jamie A Seabrook
- School of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada.,Human Environments Analysis Laboratory, Western University, London, Ontario, Canada.,Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Children's Health Research Institute, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Marco Mura
- Division of Respirology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Janet Madill
- School of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada
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31
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Matthews L, Bates A, Wootton SA, Levett D. The use of bioelectrical impedance analysis to predict post-operative complications in adult patients having surgery for cancer: A systematic review. Clin Nutr 2021; 40:2914-2922. [PMID: 33962360 DOI: 10.1016/j.clnu.2021.03.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/09/2021] [Accepted: 03/04/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Patients undergoing surgery for cancer are at particular risk of post-operative complications. The pre-operative period is an opportunity to identify and mitigate risk factors and improve outcome. Bioelectrical impedance analysis (BIA) may offer an additional means of identifying patients at risk of post-operative morbidity. AIMS The aim of this systematic review was to assess the use of measures and estimates of body composition determined by BIA as markers of peri-operative risk in adult patients undergoing elective surgery for cancer. METHODS This review was performed in accordance with the PRISMA guidelines. The electronic databases of MEDLINE, EMBASE, CINAHL, CENTRAL and the Web of Science were searched from inception. Studies of adult participants having elective surgery for cancer were included if participants underwent BIA in the peri-operative period and were assessed for post-operative complications. RESULTS 2578 studies were identified, of which 12 were eligible for inclusion. In total the studies report data from 1508 subjects. Five studies examined phase angle or standardized phase angle, six examined derived measures and one examined both. Eight of the 12 demonstrated an association between phase angle and/or body composition and an increased risk of post-operative complications. CONCLUSIONS Bioelectrical impedance analysis in the peri-operative period may be useful in predicting the risk of complications following elective cancer surgery. Phase angle more consistently demonstrates an association than derived estimates. Further high quality studies are needed and should report the raw impedance values, standardized phase angle and the equations used to derive body composition.
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Affiliation(s)
- L Matthews
- Department of Perioperative Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK; University of Southampton, Southampton, UK.
| | - A Bates
- National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S A Wootton
- University of Southampton, Southampton, UK; National Institute for Health Research Cancer and Nutrition Collaboration, UK
| | - D Levett
- Department of Perioperative Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK; University of Southampton, Southampton, UK
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Arab A, Karimi E, Vingrys K, Shirani F. Is phase angle a valuable prognostic tool in cancer patients' survival? A systematic review and meta-analysis of available literature. Clin Nutr 2021; 40:3182-3190. [PMID: 33581951 DOI: 10.1016/j.clnu.2021.01.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 01/05/2021] [Accepted: 01/18/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND & AIMS The phase angle (PA), expressed via bioelectrical impedance, is an indicator of cell membrane health and integrity, hydration, and nutritional status, and may have further application as a prognostic marker in cancer survival. However, the associations between PA and cancer survival are inconsistent and unclear. The present systematic review and meta-analysis investigated the relationship between PA and survival among adult patients diagnosed with cancer. METHODS A systematic search of observational studies up to November 2020 was conducted through PubMed, Scopus, and ISI Web of Science. The critical appraisal of the eligible studies was performed using the Newcastle-Ottawa Quality Assessment Scale. Statistical analyses were performed using STATA 11.2 software. A P-value <0.05 was considered statistically significant. RESULTS A total of 14 studies covering 2625 participants were included in this study. There was a positive and significant correlation between PA and cancer survival (Fisher's Z: 0.30; 95% CI, 0.21-0.40; P < 0.001; I2 = 0.0%). Also, there was a significant prognostic role for PA on patients' survival (HR 0.77; 95% CI, 0.74-0.81; P < 0.001; I2 = 0.0%). In other words, patients with low values of PA were 23% less likely to survive than patients with high values of PA. CONCLUSIONS Given that predicting survival in advanced cancer patients remains a challenge, the findings of this systematic review and meta-analysis suggest that phase angle may be an important prognostic factor of survival in this population.
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Affiliation(s)
- Arman Arab
- Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Elham Karimi
- Department of Clinical Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Research Development Center, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Kristina Vingrys
- Institute for Health and Sport, Victoria University, PO Box 14428, Melbourne, Victoria 8001, Australia.
| | - Fatemeh Shirani
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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Bourdon C, Bartels RH, Chimwezi E, Kool J, Chidzalo K, Perot L, Brals D, Bandsma RHJ, Boele van Hensbroek M, Voskuijl WP. The clinical use of longitudinal bio-electrical impedance vector analysis in assessing stabilization of children with severe acute malnutrition. Clin Nutr 2020; 40:2078-2090. [PMID: 33097306 DOI: 10.1016/j.clnu.2020.09.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 08/31/2020] [Accepted: 09/22/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Severe Acute Malnutrition (SAM) in children is determined using anthropometry. However, bio-electrical impedance (BI) analysis could improve the estimation of altered body composition linked to edema and/or loss of lean body mass in children with SAM. We aimed to assess: 1) the changes in BI parameters during clinical stabilization and 2) whether BI parameters add prognostic value for clinical outcome beyond the use of anthropometry. METHODS This prospective observational study enrolled children, aged 6-60 months, that were admitted at Queen Elizabeth Central Hospital in Blantyre, Malawi, for complicated SAM (i.e., having either severe wasting or edematous SAM with a complicating illness). Height, weight, mid-upper arm circumference (MUAC), and BI were measured on admission and after clinical stabilization. BI measures were derived from height-adjusted indices of resistance (R/H), reactance (Xc/H), and phase angle (PA) and considered to reflect body fluids and soft tissue in BI vector analysis (BIVA). RESULTS We studied 183 children with SAM (55% edematous; age 23.0 ± 12.0 months; 54% male) and 42 community participants (age 20.1 ± 12.3 months; male 62%). Compared to community participants, the BIVA of children with edematous SAM were short with low PA and positioned low on the hydration axis which reflects severe fluid retention. In contrast, children with severe wasting had elongated vectors with a PA that was higher than children with edematous SAM but lower than community participants. Their BIVA position fell within the top right quadrant linked to leanness and dehydration. BIVA from severely wasted and edematous SAM patients differed between groups and from community children both at admission and after stabilization (p < 0.001). Vector position shifted during treatment only in children with edematous SAM (p < 0.001) and showed a upward translation suggestive of fluid loss. While PA was lower in children with SAM, PA did not contribute more than anthropometry alone towards explaining mortality, length of stay, or time-to-discharge or time-to-mortality. The variability and heterogeneity in BI measures was high and their overall added predictive value for prognosis of individual children was low. CONCLUSIONS BIVA did not add prognostic value over using anthropometry alone to predict clinical outcome. Several implementation challenges need to be optimized. Thus, in low-resource settings, the routine use of BI in the management of pediatric malnutrition is questionable without improved implementation.
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Affiliation(s)
- Céline Bourdon
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Canada; The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
| | - Rosalie H Bartels
- Global Child Health Group, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, the Netherlands; Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Emmanuel Chimwezi
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya; Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Jacintha Kool
- Department of Pediatrics, Center for Liver, Digestive and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Katherine Chidzalo
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya; Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Lyric Perot
- Woodrow Wilson School of Public and International Affairs, Princeton University, NJ, USA
| | - Daniella Brals
- Amsterdam Institute for Global Health and Development, Department of Global Health, Amsterdam University Medical Centres, Amsterdam, the Netherlands.
| | - Robert H J Bandsma
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Canada; The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya; Department of Pediatrics, Center for Liver, Digestive and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Biomedical Sciences, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Michael Boele van Hensbroek
- Global Child Health Group, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Wieger P Voskuijl
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya; Global Child Health Group, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, the Netherlands; Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi; Amsterdam Institute for Global Health and Development, Department of Global Health, Amsterdam University Medical Centres, Amsterdam, the Netherlands
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Congestion and nutrition as determinants of bioelectrical phase angle in heart failure. Heart Lung 2020; 49:724-728. [PMID: 32871396 DOI: 10.1016/j.hrtlng.2020.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/18/2020] [Accepted: 07/13/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The whole-body bioelectrical phase-angle (PhA) is emerging as a new tool in stratifying prognosis in patients with both acute (AHF) and chronic heart failure (CHF). OBJECTIVE To evaluate the determinants of PhA in HF patients. METHODS We analyzed data from 900 patients with AHF or CHF (mean age: 76±10 years, 54% AHF). Clinical, serum biochemical, echocardiographic and bioelectrical measurements were collected from all of patients. PhA was quantified in degrees. Congestion was assessed by a multiparametric approach, including the presence of peripheral edema, brain natriuretic peptides (BNP) plasma levels, blood urea nitrogen to creatinine ratio (BUN/Cr), and relative plasma volume status (PVS) calculated by Kaplan-Hakim's formula. Geriatric Nutritional Risk Index (GNRI) was adopted as indicator for nutritional status. RESULTS At univariate analysis, PhA was significantly lower in females, in patients with peripheral edema, and AHF. PhA significantly correlates age, BNP, PVS, BUN/Cr, and GNRI. At multivariate analysis, congestion biomarkers emerged as the major determinant of PhA as they explained the 34% of data variability, while age, GNRI, and gender only explained 6%, 0.5%, and 0.5%, respectively (adjusted R2 = 0.41). In particular, PVS (regression of coefficient B=-0.17) explained the 20% of PhA variability, while peripheral congestion (B=-0.27) and BNP (B=-0.15) contributed to 10% and 2%, respectively. CONCLUSIONS The main determinant of bioelectrical PhA in patients with HF is congestion and PVS in particular, while nutritional status has marginal impact.
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Hirose S, Nakajima T, Nozawa N, Katayanagi S, Ishizaka H, Mizushima Y, Matsumoto K, Nishikawa K, Toyama Y, Takahashi R, Arakawa T, Yasuda T, Haruyama A, Yazawa H, Yamaguchi S, Toyoda S, Shibasaki I, Mizushima T, Fukuda H, Inoue T. Phase Angle as an Indicator of Sarcopenia, Malnutrition, and Cachexia in Inpatients with Cardiovascular Diseases. J Clin Med 2020; 9:jcm9082554. [PMID: 32781732 PMCID: PMC7463846 DOI: 10.3390/jcm9082554] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/25/2020] [Accepted: 08/04/2020] [Indexed: 12/13/2022] Open
Abstract
Malnutrition is associated with sarcopenia, cachexia, and prognosis. We investigated the usefulness of phase angle (PhA) as a marker of sarcopenia, cachexia, and malnutrition in 412 hospitalized patients with cardiovascular disease. We analyzed body composition with bioelectrical impedance analysis, and nutritional status such as controlling nutritional status (CONUT) score. Both skeletal muscle mass index (SMI) and PhA correlated with age, grip strength and knee extension strength (p < 0.0001) in both sexes. The SMI value correlated with CONUT score, Hb, and Alb in males. Phase angle also correlated with CONUT score, Hb, and Alb in males, and more strongly associated with these nutritional aspects. In females, PhA was correlated with Hb and Alb (p < 0.001). In both sexes, sarcopenia incidence was 31.6% and 32.4%; PhA cut-off in patients with sarcopenia was 4.55° and 4.25°; and cachexia incidence was 11.5% and 14.1%, respectively. The PhA cut-off in males with cachexia was 4.15°. Multivariate regression analysis showed that grip strength and brain natriuretic peptide (BNP) were independent determinants of SMI, whereas grip strength, BNP, and Hb were independent determinants of PhA. Thus, PhA appears to be a useful marker for sarcopenia, malnutrition, and cachexia in hospitalized patients with cardiovascular disease.
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Affiliation(s)
- Suguru Hirose
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (S.H.); (A.H.); (H.Y.); (S.Y.); (S.T.); (T.I.)
| | - Toshiaki Nakajima
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (S.H.); (A.H.); (H.Y.); (S.Y.); (S.T.); (T.I.)
- Correspondence:
| | - Naohiro Nozawa
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.N.); (S.K.); (H.I.); (Y.M.); (K.M.); (K.N.); (Y.T.); (R.T.); (T.A.); (T.M.)
| | - Satoshi Katayanagi
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.N.); (S.K.); (H.I.); (Y.M.); (K.M.); (K.N.); (Y.T.); (R.T.); (T.A.); (T.M.)
| | - Hayato Ishizaka
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.N.); (S.K.); (H.I.); (Y.M.); (K.M.); (K.N.); (Y.T.); (R.T.); (T.A.); (T.M.)
| | - Yuta Mizushima
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.N.); (S.K.); (H.I.); (Y.M.); (K.M.); (K.N.); (Y.T.); (R.T.); (T.A.); (T.M.)
| | - Kazuhisa Matsumoto
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.N.); (S.K.); (H.I.); (Y.M.); (K.M.); (K.N.); (Y.T.); (R.T.); (T.A.); (T.M.)
| | - Kaori Nishikawa
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.N.); (S.K.); (H.I.); (Y.M.); (K.M.); (K.N.); (Y.T.); (R.T.); (T.A.); (T.M.)
| | - Yohei Toyama
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.N.); (S.K.); (H.I.); (Y.M.); (K.M.); (K.N.); (Y.T.); (R.T.); (T.A.); (T.M.)
| | - Reiko Takahashi
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.N.); (S.K.); (H.I.); (Y.M.); (K.M.); (K.N.); (Y.T.); (R.T.); (T.A.); (T.M.)
| | - Tomoe Arakawa
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.N.); (S.K.); (H.I.); (Y.M.); (K.M.); (K.N.); (Y.T.); (R.T.); (T.A.); (T.M.)
| | - Tomohiro Yasuda
- School of Nursing, Seirei Christopher University, Hamamatsu, Shizuoka 433-8558, Japan;
| | - Akiko Haruyama
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (S.H.); (A.H.); (H.Y.); (S.Y.); (S.T.); (T.I.)
| | - Hiroko Yazawa
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (S.H.); (A.H.); (H.Y.); (S.Y.); (S.T.); (T.I.)
| | - Suomi Yamaguchi
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (S.H.); (A.H.); (H.Y.); (S.Y.); (S.T.); (T.I.)
| | - Shigeru Toyoda
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (S.H.); (A.H.); (H.Y.); (S.Y.); (S.T.); (T.I.)
| | - Ikuko Shibasaki
- Department of Cardiovascular Surgery, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (I.S.); (H.F.)
| | - Takashi Mizushima
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.N.); (S.K.); (H.I.); (Y.M.); (K.M.); (K.N.); (Y.T.); (R.T.); (T.A.); (T.M.)
| | - Hirotsugu Fukuda
- Department of Cardiovascular Surgery, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (I.S.); (H.F.)
| | - Teruo Inoue
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (S.H.); (A.H.); (H.Y.); (S.Y.); (S.T.); (T.I.)
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Paulsen MM, Paur I, Gjestland J, Henriksen C, Varsi C, Tangvik RJ, Andersen LF. Effects of using the MyFood decision support system on hospitalized patients' nutritional status and treatment: A randomized controlled trial. Clin Nutr 2020; 39:3607-3617. [PMID: 32241711 DOI: 10.1016/j.clnu.2020.03.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Compliance to guidelines for disease-related malnutrition is documented as poor. The practice of using paper-based dietary recording forms with manual calculation of the patient's nutritional intake is considered cumbersome, time-consuming and unfeasible among the nurses and does often not lead to appropriate nutritional treatment. We developed the digital decision support system MyFood to deliver a solution to these challenges. MyFood is comprised of an app for patients and a website for nurses and includes functions for dietary recording, evaluation of intake compared to requirements, and a report to nurses including tailored recommendations for nutritional treatment and a nutritional care plan for documentation. The study aimed to investigate the effects of using the MyFood decision support system during hospital stay on adult patients' nutritional status, treatment and hospital length of stay. The main outcome measure was weight change. METHODS The study was a parallel-arm randomized controlled trial. Patients who were allocated to the intervention group used the MyFood app during their hospital stay and the nurses were encouraged to use the MyFood system. Patients who were allocated to the control group received routine care. RESULTS We randomly assigned 100 patients (51.9 ± 14 y) to the intervention group (n = 49) and the control group (n = 51) between August 2018 and February 2019. Losses to follow-up were n = 5 in the intervention group and n = 1 in the control group. No difference was found between the two groups with regard to weight change. Malnutrition risk at discharge was present in 77% of the patients in the intervention group and 94% in the control group (p = 0.019). Nutritional treatment was documented for 81% of the patients in the intervention group and 57% in the control group (p = 0.011). A nutritional care plan was created for 70% of the intervention patients compared to 16% of the control patients (p < 0.001). CONCLUSIONS The intervention had no effect on weight change during hospital stay. A higher proportion of the patients in the control group was malnourished or at risk of malnutrition at hospital discharge compared to the patients in the intervention group. The documentation of nutritional intake, treatment and nutritional care plans was higher for the patients using the MyFood system compared to the control group. This trial was registered at clinicaltrials.gov (NCT03412695).
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Affiliation(s)
- Mari Mohn Paulsen
- Norwegian National Advisory Unit on Disease Related Undernutrition, Division of Cancer Medicine, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372 Oslo, Norway; Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Box 1110 Blindern, 0317 Oslo, Norway.
| | - Ingvild Paur
- Norwegian National Advisory Unit on Disease Related Undernutrition, Division of Cancer Medicine, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372 Oslo, Norway
| | - Johanna Gjestland
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Box 1110 Blindern, 0317 Oslo, Norway; Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Christine Henriksen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Box 1110 Blindern, 0317 Oslo, Norway
| | - Cecilie Varsi
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Aker Hospital, Box 4959 Nydalen, 0424 Oslo, Norway
| | - Randi Julie Tangvik
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Box 7804, 5020 Bergen, Norway
| | - Lene Frost Andersen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Box 1110 Blindern, 0317 Oslo, Norway
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Can Bioelectrical Impedance Analysis and BMI be a Prognostic Tool in Head and Neck Cancer Patients? A Review of the Evidence. Cancers (Basel) 2020; 12:cancers12030557. [PMID: 32121058 PMCID: PMC7139769 DOI: 10.3390/cancers12030557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/23/2020] [Accepted: 02/25/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Malnutrition can significantly affect disease progression and patient survival. The efficiency of weight loss and bioimpedance analysis (BIA)-derived measures in the evaluation of malnutrition, and disease progression and prognosis in patients with head and neck cancer (HNC) are an important area of research. Method: The PubMed database was thoroughly searched, using relative keywords in order to identify clinical trials that investigated the role of BIA-derived measures and weight loss on the disease progression and prognosis of patients with HNC. Twenty-seven studies met the criteria. More specifically, six studies examined the prognostic role of the tissue electrical properties in HNC patients; five examined the role of the tissue electrical properties on identifying malnutrition; four studies looked at the changes in the tissue electrical properties of HNC patients; and 12 examined the prognostic role of weight loss on survival and/or treatment outcomes. Results: Several studies have investigated the role of nutritional status tools on prognosis in HNC patients. Current studies investigating the potential of BIA-derived raw data have shown that phase angle (PA) and capacitance of the cell membrane may be considered prognostic factors of survival. Weight loss may be a prognostic factor for treatment toxicity and survival, despite some conflicting evidence. Conclusions: Further studies are recommended to clarify the role of BIA-derived measures on patients’ nutritional status and the impact of PA on clinical outcomes as well as the prognostic role of weight loss.
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Malnutrition-Inflammation Score VS Phase Angle in the Era of GLIM Criteria: A Cross-Sectional Study among Hemodialysis Patients in UAE. Nutrients 2019; 11:nu11112771. [PMID: 31739568 PMCID: PMC6893836 DOI: 10.3390/nu11112771] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 10/28/2019] [Accepted: 10/31/2019] [Indexed: 12/27/2022] Open
Abstract
(1) Background: Malnutrition is prevalent in hemodialysis (HD) patients and is associated with an increased risk of morbidity and mortality. The aim of this study was to explore the prevalence of malnutrition using the malnutrition-inflammation score (MIS) and phase angle (PhA) and compare their concordance with the new Global Leadership Initiative on Malnutrition (GLIM) criteria for the diagnosis of malnutrition. (2) Methods: Seventy HD patients were assessed. Malnutrition was diagnosed based on the GLIM criteria and MIS questionnaire. The agreement between the diagnostic tools (MIS, PhA derived from the bioelectrical impedance analysis (BIA), and GLIM criteria) was assessed. The optimal gender-specific cutoff points were identified for the PhA according to the GLIM criteria. (3) Results: Almost half of the sample was diagnosed as malnourished according to the MIS (48.57%) and GLIM criteria (54.29%). A fair agreement was observed between the GLIM criteria, MIS (k = 0.202), and PhA (k = 0.279) among the malnourished patients. The PhA had better sensitivity but worse specificity compared to the MIS. The optimum cutoff points of PhA to detect malnutrition according to the GLIM criteria were a PhA value of ≤5.7° for males and ≤3.8° for females. (4) Conclusion: The MIS performed slightly better than PhA in the diagnosis of malnutrition among HD patients within the spectrum of the GLIM criteria.
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Mentella MC, Scaldaferri F, Pizzoferrato M, Gasbarrini A, Miggiano GAD. The Association of Disease Activity, BMI and Phase Angle with Vitamin D Deficiency in Patients with IBD. Nutrients 2019; 11:nu11112583. [PMID: 31717788 PMCID: PMC6893633 DOI: 10.3390/nu11112583] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/15/2019] [Accepted: 10/22/2019] [Indexed: 12/11/2022] Open
Abstract
Hypovitaminosis D is frequently present in inflammatory bowel disease (IBD) with a higher incidence in Crohn’s disease (CD) than in Ulcerative Colitis (UC). Given the involvement of the alimentary tract, many factors can contribute to hypovitaminosis D. The aim of the study was to investigate the association of disease activity, body mass index (BMI) and phase angle with vitamin D deficiency in patients with IBD. A cross-sectional study was conducted on a cohort of 206 IBD patients (October 2016–September 2018). Of these patients, 32.6% were affected by hypovitaminosis D (CD: 38.6%; UC: 25.6%; p < 0.01). Negative and significant associations (p < 0.01) were found between BMI and vitamin D serum levels both in CD and UC patients. BMI represented a determinant of hypovitaminosis D (Odds Ratio (OR) = 1.12, p < 0.01) only in UC patients; phase angle was associated to hypovitaminosis D in both groups (CD: OR = 0.64, p < 0.05; UC: OR = 0.49, p < 0.01). Results of the present study confirm a higher incidence of hypovitaminosis D in patients with CD than in those with UC, and show that nutritional status plays a crucial role in the incidence of vitamin D deficiency in patients with IBD.
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Affiliation(s)
- Maria Chiara Mentella
- UOC di Nutrizione Clinica, Area Medicina Interna, Gastroenterologia e Oncologia Medica, Dipartimento di Scienze Gastroenterologiche, Endocrino—Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
- Correspondence: ; Tel.: +39-06-30154804
| | - Franco Scaldaferri
- UOC di Medicina Interna e Gastroenterologia, Area Medicina Interna, Gastroenterologia e Oncologia Medica, Dipartimento di Scienze Gastroenterologiche, Endocrino—Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.S.); (M.P.); (A.G.)
| | - Marco Pizzoferrato
- UOC di Medicina Interna e Gastroenterologia, Area Medicina Interna, Gastroenterologia e Oncologia Medica, Dipartimento di Scienze Gastroenterologiche, Endocrino—Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.S.); (M.P.); (A.G.)
| | - Antonio Gasbarrini
- UOC di Medicina Interna e Gastroenterologia, Area Medicina Interna, Gastroenterologia e Oncologia Medica, Dipartimento di Scienze Gastroenterologiche, Endocrino—Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.S.); (M.P.); (A.G.)
| | - Giacinto Abele Donato Miggiano
- UOC di Nutrizione Clinica, Area Medicina Interna, Gastroenterologia e Oncologia Medica, Dipartimento di Scienze Gastroenterologiche, Endocrino—Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
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