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Kim HJ, Seong EY, Jung HJ, Song SH. The phase angle before transplantation can predict the status of low muscle mass after kidney transplantation. Clin Exp Nephrol 2024:10.1007/s10157-024-02543-1. [PMID: 39168881 DOI: 10.1007/s10157-024-02543-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/25/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND This study aimed to evaluate the association between phase angle, muscle strength, and muscle mass in patients undergoing kidney transplantation. METHODS Patients whose pre- and follow-up phase angles were measured after kidney transplantation were enrolled. Phase angle and body composition were measured using a multi-frequency bioimpedance analysis device before and at 7 and 14 days and 3, 6, and 12 months after transplantation. Muscle strength was evaluated using handgrip strength (HGS). Low HGS was defined as < 28 kg in males and < 18 kg in females. Low muscle mass was defined as an appendicular lean mass index of < 7.0 kg/m2 in males and < 5.7 kg/m2 in females. RESULTS Eighty-eight patients (mean age 52.3 ± 10.1 years) were analyzed. The mean phase angle of pre-transplantation was 5.0 ± 1.0°. Body fat percentage was significantly higher at 6 and 12 months after transplantation than pre-transplantation (P < 0.0001). Twelve months after kidney transplantation, the prevalence of low HGS decreased (pre-transplantation vs. 12 months post-transplantation: 28.4% vs. 17.0%), and the prevalence of low muscle mass (pre-transplantation vs. 12 months post-transplantation: 21.6% vs. 28.4%) increased. The pre-transplantation phase angle was significantly associated with low muscle mass at 12 months after kidney transplantation (odds ratio [OR]: 0.34; 95% confidence interval [CI]: 0.16-0.72; P = 0.005). The pre-transplantation phase angle was not significantly associated with low HGS (OR: 0.37; 95% CI 0.12-1.17; P = 0.090) 12 months after kidney transplantation. CONCLUSIONS Pre-transplantation phase angle can predict muscle mass status 12 months after kidney transplantation.
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Affiliation(s)
- Hyo Jin Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, South Korea
- Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
- Organ Transplantation Center, Pusan National University Hospital, Busan, South Korea
| | - Eun Young Seong
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, South Korea
- Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
- Organ Transplantation Center, Pusan National University Hospital, Busan, South Korea
| | - Hyuk Jae Jung
- Organ Transplantation Center, Pusan National University Hospital, Busan, South Korea
- Department of Surgery, Pusan National University School of Medicine, Yangsan, South Korea
- Department of Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Sang Heon Song
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, South Korea.
- Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea.
- Organ Transplantation Center, Pusan National University Hospital, Busan, South Korea.
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Kujawowicz K, Mirończuk-Chodakowska I, Cyuńczyk M, Witkowska AM. Identifying Malnutrition Risk in the Elderly: A Single- and Multi-Parameter Approach. Nutrients 2024; 16:2537. [PMID: 39125416 PMCID: PMC11314023 DOI: 10.3390/nu16152537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 07/23/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024] Open
Abstract
Malnutrition is a significant concern affecting the elderly, necessitating a complex assessment. This study aims to deepen the understanding of factors associated with the assessment of malnutrition in the elderly by comparing single- and multi-parameter approaches. In this cross-sectional study, 154 individuals underwent a comprehensive geriatric assessment (CGA). Malnutrition risk was determined using the mini nutritional assessment (MNA). Additional factors assessed included sarcopenia, polypharmacy, depression, appetite, handgrip strength, and gait speed. Phase angle (PA) and body composition were measured using bioelectrical impedance analysis (BIA). The MNA identified a malnutrition risk in 36.8% of individuals. The geriatric depression scale (GDS) and PA demonstrated moderate effectiveness in assessing malnutrition risk, with AUC values of 0.69 (95% CI: 0.60-0.78) and 0.62 (95% CI: 0.54-0.72), respectively. A logistic regression model incorporating handgrip strength, skeletal muscle mass, sarcopenia, osteoporosis, depression, specific antidepressant use, mobility, appetite, and smoking achieved superior performance in predicting malnutrition risk, with an AUC of 0.84 (95% CI: 0.77-0.91). In conclusion, this study demonstrates that integrating multiple parameters into a composite model provides a more accurate and comprehensive assessment of malnutrition risk in elderly adults.
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Affiliation(s)
- Karolina Kujawowicz
- Department of Food Biotechnology, Medical University of Białystok, 15-089 Białystok, Poland; (I.M.-C.); (M.C.); (A.M.W.)
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Ruste M, Chabanol C, Amaz C, Cazenave L, Fellahi JL, Jacquet-Lagrèze M. Postoperative Phase Angle and Prognosis after Cardiac Surgery: A Historical Cohort Study. Anesthesiology 2024; 141:405-407. [PMID: 38833317 DOI: 10.1097/aln.0000000000005024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
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Nishibe T, Dardik A, Akiyama S, Kano M, Fukuda S, Koizumi J, Nishibe M. Reduced Muscle Mass and Muscle Quality in Patients with Intermittent Claudication due to Peripheral Artery Disease. Ann Vasc Surg 2024; 105:275-281. [PMID: 38570014 DOI: 10.1016/j.avsg.2023.12.094] [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: 10/20/2023] [Revised: 12/20/2023] [Accepted: 12/23/2023] [Indexed: 04/05/2024]
Abstract
BACKGROUND Peripheral arterial disease (PAD) is associated with reduced muscle mass and quality, but the effects of leg ischemia caused by PAD on muscle quality remain poorly understood. The purpose of this study was to evaluate leg muscle mass and muscle quality in patients with intermittent claudication due to PAD using bioelectrical impedance analysis (BIA). METHODS One hundred forty-one patients with intermittent claudication due to PAD who visited Tokyo Medical University Hospital from April 2019 to April 2020 were retrospectively analyzed. Leg ischemia was assessed using ankle-brachial pressure index (ABI). The skeletal muscle mass (SMM) assessed leg muscle mass, while the phase angle (PhA) assessed leg muscle quality using BIA. RESULTS A total of 282 legs in 141 patients were included in the analysis. Leg PhA and SMM showed a decreasing trend according to the severity of leg ischemia (borderline/no ischemia: 2.80 ± 0.50 kg/m2, 4.38 ± 0.94°; mild ischemia: 2.83 ± 0.49 kg/m2, 4.33 ± 1.03°; moderate/severe ischemia: 2.50 ± 0.40 kg/m2, 3.89 ± 0. 88°; P < 0.001 and P = 0.020, respectively). The ABI was moderately correlated with leg SMM (B = 0.347, β = 0.134, P < 0.001) and leg PhA (B = 0.577, β = 0.111, P = 0.013) after adjustment for all significant covariates. Leg PhA was moderately correlated with leg SMM (r = 0.318, P < 0.001). CONCLUSIONS Leg ischemia, especially when moderate or severe, has an adverse effect on both muscle mass and quality in the lower extremities and is associated with skeletal muscle myopathy.
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Affiliation(s)
- Toshiya Nishibe
- Faculty of Medical Informatics, Hokkaido Information University, Ebetsu, Hokkaido, Japan; Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan.
| | - Alan Dardik
- Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Shinobu Akiyama
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Masaki Kano
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Shoji Fukuda
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Jun Koizumi
- Department of Radiology, Chiba University School of Medicine, Chiba, Japan
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Rodrigues FG, Bruins MSM, Vliegenthart R, Kremer D, Sotomayor CG, Nolte IM, Douwe J Mulder U, Navis GJ, Heilberg IP, Pol RA, Bakker SJL, de Borst MH, Te Velde-Keyzer CA. Phase angle and donor type are determinants of coronary artery calcification in stable kidney transplant recipients at twelve months after transplantation. Nutr Metab Cardiovasc Dis 2024; 34:1912-1921. [PMID: 38740537 DOI: 10.1016/j.numecd.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 04/03/2024] [Accepted: 04/15/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND AND AIM Coronary artery calcification (CAC) partially explains the excess cardiovascular morbidity and mortality after kidney transplantation. This study aimed to investigate determinants of CAC in stable kidney transplant recipients at 12 months post-transplantation. METHODS AND RESULTS CAC-score was quantified by the Agatston method using non-contrast enhanced computed tomography, and age- and sex-standardized CAC-percentiles were calculated. Univariable and multivariable multinomial logistic regression was performed to study potential determinants of CAC. The independent determinants were included in multivariable multinomial logistic regression adjusting for potential confounders. 203 KTRs (age 54.0 ± 14.7 years, 61.1% male) were included. Participants were categorized into four groups according to CAC percentiles (p = 0 [CAC-score = 0], n = 68; p ≥ 1%-p ≤ 50% [CAC score = 29.0 (4.0-166.0)], n = 31; p > 50 ≤ 75% [CAC score = 101.0 (23.8-348.3)], n = 26; and p>75% [CAC score = 581.0 (148.0-1652)], n = 83). Upon multivariable multinomial logistic regression, patients with a narrower phase angle and patients who had received a graft from a deceased donor had a higher risk of being in the >75th CAC-percentile. CONCLUSIONS This study identifies not only metabolic and transplant-related factors, but also phase angle, a composite marker of cell integrity, as an independent determinant of CAC at 12 months after kidney transplantation. This study offers new perspectives for future research into the value of bioelectrical impedance analysis in relation to vascular calcification in kidney transplant recipients.
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Affiliation(s)
- Fernanda G Rodrigues
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Nutrition Post Graduation Program, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
| | - Megan S M Bruins
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Rozemarijn Vliegenthart
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Daan Kremer
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Camilo G Sotomayor
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ilja M Nolte
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Udo Douwe J Mulder
- Department of Internal Medicine, Division Vascular Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gerjan J Navis
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ita Pfeferman Heilberg
- Nutrition Post Graduation Program, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Nephrology Division, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Robert A Pol
- Department of Vascular and Transplant Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Stephan J L Bakker
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Martin H de Borst
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Charlotte A Te Velde-Keyzer
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Asaoka D, Sugano K, Matsuno K, Shibata N, Sugiyama H, Endo N, Iwase Y, Tajima M, Sakuma N, Inoue M, Nagata M, Mizutani T, Ishii M, Iida S, Miura Y, Nishizaki Y, Yanagisawa N, Nagahara A, Miyauchi K. Association between dietary variety status and sarcopenia as defined by the Asian Working Group for Sarcopenia 2019 consensus in older outpatients at a hospital specializing in geriatric medicine: A cross‑sectional study with baseline data of prospective cohort study (JUSTICE‑TOKYO study). Biomed Rep 2024; 21:123. [PMID: 38978536 PMCID: PMC11229399 DOI: 10.3892/br.2024.1811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/16/2024] [Indexed: 07/10/2024] Open
Abstract
To the best of our knowledge, little is known about the association between dietary variety status and sarcopenia in university-affiliated geriatric hospital in elderly. The present study aimed to investigate, in a multidisciplinary setting, the prevalence of sarcopenia and association between dietary variety status and sarcopenia in older outpatients at Juntendo Tokyo Koto Geriatric Medical Center (Tokyo, Japan). Between October 2020 and December 2021, a cross-sectional study of outpatients aged ≥65 years [458 male (44%) and 584 female (56%); mean age, 78.2±6.1 years] was conducted to assess prevalence of sarcopenia, according to Asian Working Group for Sarcopenia 2019 criteria, and the relationship between dietary variety status and sarcopenia. Patient profile, comorbidities, drug use, neuropsychological data, abdominal symptoms, pulmonary function and dietary variety status were collected. Of 1,042 subjects, there were 223 (21.4%) with [142 male (63.7%) and 81 female (36.3%); mean age, 80.6±6.3 years] and 819 (78.6%) without sarcopenia [316 male (38.6%) and 503 female (61.4%); mean age, 77.6±5.8]. In multivariate analysis, older age, male sex, low body mass index, high Brinkman Index and phase angle, low quality of life, history of daycare use, diabetes mellitus, osteoporosis and low Mini-Mental State Examination and Dietary Variety Score were related to sarcopenia. The prevalence of sarcopenia was higher in than in community-dwelling individuals. Dietary variety status was associated with sarcopenia.
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Affiliation(s)
- Daisuke Asaoka
- Department of Gastroenterology, Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna, Koto, Tokyo 1360075, Japan
| | - Koji Sugano
- Department of Respiratory Medicine, Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna, Koto, Tokyo 1360075, Japan
| | - Kei Matsuno
- Department of Respiratory Medicine, Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna, Koto, Tokyo 1360075, Japan
| | - Nobuto Shibata
- Department of Psychiatry, Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna, Koto, Tokyo 1360075, Japan
| | - Hideki Sugiyama
- Department of Psychiatry, Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna, Koto, Tokyo 1360075, Japan
| | - Noemi Endo
- Department of Psychiatry, Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna, Koto, Tokyo 1360075, Japan
| | - Yoshiyuki Iwase
- Department of Orthopedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna, Koto, Tokyo 1360075, Japan
| | - Miyuki Tajima
- Department of Pharmacy, Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna, Koto, Tokyo 1360075, Japan
| | - Naoko Sakuma
- Department of Pharmacy, Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna, Koto, Tokyo 1360075, Japan
| | - Megumi Inoue
- Department of Pharmacy, Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna, Koto, Tokyo 1360075, Japan
| | - Mariko Nagata
- Department of Pharmacy, Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna, Koto, Tokyo 1360075, Japan
| | - Taeko Mizutani
- Department of Nursing, Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna, Koto, Tokyo 1360075, Japan
| | - Mizuki Ishii
- Department of Nursing, Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna, Koto, Tokyo 1360075, Japan
| | - Sachi Iida
- Department of Nursing, Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna, Koto, Tokyo 1360075, Japan
| | - Yoshiko Miura
- Department of Nutrition, Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna, Koto, Tokyo 1360075, Japan
| | - Yuji Nishizaki
- Medical Technology Innovation Center, Juntendo University, Hongo, Bunkyo, Tokyo 1138421, Japan
| | - Naotake Yanagisawa
- Medical Technology Innovation Center, Juntendo University, Hongo, Bunkyo, Tokyo 1138421, Japan
| | - Akihito Nagahara
- Department of Gastroenterology, Juntendo University School of Medicine, Hongo, Bunkyo, Tokyo 1138421, Japan
| | - Katsumi Miyauchi
- Department of Cardiology, Juntendo Tokyo Koto Geriatric Medical Center, Shinsuna, Koto, Tokyo 1360075, Japan
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Sun B, Sejati PA, Shirai T, Takei M. Long-term phase angle muscle imaging under electrical muscle stimulation (EMS) by phase angle electrical impedance tomography. Physiol Meas 2024; 45:075010. [PMID: 39048107 DOI: 10.1088/1361-6579/ad6749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 07/24/2024] [Indexed: 07/27/2024]
Abstract
Objectives. Phase angle muscle imaging has been proposed by phase angle electrical impedance tomography (ΦEIT) under electrical muscle stimulation (EMS) for long-term monitoring of muscle quality improvement, especially focusing on calf muscles.Approach. In the experiments, twenty-four subjects are randomly assigned either to three groups: control group (CG,n= 8), low voltage intensity of EMS training group (LG,n= 8), and optimal voltage intensity of EMS training group (OG,n= 8).Main results. From the experimental results, phase angle distribution imagesФare cleared reconstructed by ФEIT as four muscle compartments over five weeks experiments, which are called theM1muscle compartments composed of gastrocnemius muscle,M2muscle compartments composed of soleus muscle,M3muscle compartments composed of tibialis-posterior muscle, flexor digitorum longus muscle, and flexor pollicis longus muscle, andM4muscle compartment composed of the tibialis anterior muscle, extensor digitorum longus muscle, and peroneus longus muscle.Фis inversely correlated with age, namely theФdecreases with increasing age. A paired samplest-test was conducted to elucidate the statistical significance of spatial-mean phase angle in all domain <Ф>Ωand in each muscle compartment <Ф>Mwith reference to the conventional phase angle Ф by bioelectrical impedance analysis, muscle grey-scaleGmuscleby ultrasound, and maximal dynamic strengthSMaxby one-repetition maximum test.Significance. From thet-test results, <Ф>Ωhave good correlation with Ф andSMax. In the OG, <ФW5>Ω,ФW5, and (SMax)W5were significantly higher than in the first week (n= 8,p< 0.05). A significant increase in the phase angle of bothM1andM4muscle compartments is observed after five weeks in LG and OG groups. Only the OG group shows a significant increase in the phase angle ofM2muscle compartment after five weeks. However, no significant changes in the spatial-mean phase angle ofM3compartment are observed in each group. In conclusion, ФEIT satisfactorily monitors the response of each compartment in calf muscle to long-term EMS training.
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Affiliation(s)
- Bo Sun
- School of Mechanical and Precision Instrument Engineering, Xi'an University of Technology, Xi'an 710048, People's Republic of China
| | - Prima Asmara Sejati
- Department of Mechanical Engineering, Graduate School of Science and Engineering, Chiba University, Chiba-shi, Japan
- Department of Electrical Engineering and Informatics, Vocational College, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | | | - Masahiro Takei
- Department of Mechanical Engineering, Graduate School of Science and Engineering, Chiba University, Chiba-shi, Japan
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Korzilius JW, van Asseldonk MJMD, Wanten GJA, Zweers-van Essen HEE. Body composition of adults with chronic intestinal failure receiving home parenteral nutrition: A descriptive cohort study. JPEN J Parenter Enteral Nutr 2024; 48:718-725. [PMID: 38850079 DOI: 10.1002/jpen.2658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 04/23/2024] [Accepted: 05/18/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Chronic intestinal failure (CIF) refers to the long-lasting reduction of gut function below the minimum necessary to absorb macronutrients, water, and/or electrolytes. Patients with CIF likely develop various forms of malnutrition and dehydration, yet studies that focus primarily on body composition are lacking. Therefore, this study aimed to evaluate the body composition of adult patients with CIF. METHODS This retrospective descriptive cohort study was performed at the Radboud University Medical Center, a tertiary referral center for CIF treatment in the form of home parenteral nutrition. We collected available bioelectrical impedance analysis (BIA) data from routine care between 2019 and 2023. The primary outcome was body composition, which was evaluated by assessing body mass index (BMI), fat-free mass index (FFMI), and fat percentage (fat%). RESULTS Overall, 147 adult patients with CIF were included with a median (interquartile range) age of 58 (25-68) years; 69% were female. The mean (SD) BMI was 22.1 (4.3) kg/m2, FFMI was 14.2 (1.9) kg/m2 in females and 17.0 (2.0) kg/m2 in males, and fat% was 33.7% (6.8%) in females and 24.6% (6.4%) in males. 63% had an FFMI below references, and 48% had a high fat%. CONCLUSION This study found that most adult patients with CIF have an unfavorable body composition characterized by a high fat% and low FFMI despite having a normal mean BMI. These results highlight the necessity for in-depth nutrition assessment, including BIA measurement. Moreover, future studies should focus on exercise interventions to increase FFMI and improve body composition and function.
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Affiliation(s)
- Julia Wilhelmina Korzilius
- Department of Gastroenterology and Hepatology - Dietetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Geert Jacobus Antonius Wanten
- Department of Gastroenterology and Hepatology - Dietetics, Radboud University Medical Center, Nijmegen, the Netherlands
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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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Shida T, Hatanaka S, Ohta T, Osuka Y, Kojima N, Motokawa K, Iwasaki M, Miyamae F, Okamura T, Hirano H, Awata S, Sasai H. Proposal and validation of an equation to identify sarcopenia using bioelectrical impedance analysis-derived parameters. Nutrition 2024; 124:112453. [PMID: 38669830 DOI: 10.1016/j.nut.2024.112453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 03/29/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVE This study aimed to develop a simpler approach for diagnosing sarcopenia by using only bioelectrical impedance vector analysis parameters. METHODS The study design was a cross-sectional study. The research was conducted based on the Itabashi Longitudinal Study on Aging, a community-based cohort study, with data collected from the 2022 and 2023 surveys in Itabashi Ward, Tokyo, Japan. The development cohort consisted of 1146 participants from the 2022 survey, and the validation cohort included 656 participants from the 2023 survey. Both cohorts were comprised of community-dwelling older adults with similar inclusion criteria. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria. The logistic model utilized height divided by impedance at 50 kHz and phase angle to establish a new regression equation to identify sarcopenia. Regression equations were generated for the development cohort and validated for the validation cohort. Discriminatory ability was assessed using the area under the receiver operating characteristic curve (AUC) for men and women. RESULTS The prevalence of sarcopenia was 20.7% and 14.8% in the development and validation cohort, respectively. The AUC (95% confidence interval) of the logistic model in discriminating sarcopenia was 0.92 (0.88, 0.95) for men and 0.82 (0.78, 0.86) for women in the development cohort and 0.85 (0.78, 0.91) for men and 0.90 (0.86, 0.95) for women in the validation cohort. CONCLUSION The study demonstrated that a simple formula using bioelectrical parameters at 50 kHz proved useful in identifying sarcopenia in the older adult population.
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Affiliation(s)
- Takashi Shida
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
| | - Sho Hatanaka
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Takahisa Ohta
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Yosuke Osuka
- Department of Frailty Research, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Narumi Kojima
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Keiko Motokawa
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Masanori Iwasaki
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan; Department of Preventive Dentistry, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Hokkaido, Japan
| | - Fumiko Miyamae
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Tsuyoshi Okamura
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Hirohiko Hirano
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Shuichi Awata
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Hiroyuki Sasai
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
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11
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Ayala-Guzmán CI, Ortiz-Hernandez L, Escudero Malpica C, Macias Rosas A, Castro Avila JI. Phase Angle and Body Composition as Predictors of Fitness and Athletic Performance in Adolescent Boxers. Pediatr Exerc Sci 2024:1-10. [PMID: 39069282 DOI: 10.1123/pes.2023-0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 04/16/2024] [Accepted: 05/02/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Phase angle (PhA) is an indicator of cellular health, function, and integrity. PhA has been considered an indicator of nutritional and health status, but it is uncertain whether it could be used as a fitness or athletic performance indicator. OBJECTIVE To analyze the relationship between PhA and the fitness and athletic performance of adolescent boxers and to know whether this association is independent of body composition. METHODS Thirty-seven trained youth boxers (15-18 y old) participated in the study. Participants underwent anthropometry and bioelectrical impedance assessments. The following tests were conducted: Fitness-Gram battery; speed, agility, and quickness; ball throws; punch impact force; bench press maximal strength; and vertical and horizontal jumps. Linear regression models were estimated and adjusted by covariates. RESULTS The PhA was related to upper-limb strength. Nevertheless, in linear regression models, after adjusting models by body composition, only PhA remained as a predictor of relative maximal strength. The PhA was not a predictor of speed, agility, and quickness; cardiorespiratory fitness; or lower-limb power, in which adiposity was the main predictor of fitness. CONCLUSIONS In adolescent boxers, PhA can predict upper-limb maximal strength independently of bioelectrical impedance analysis premises. However, compared with mucle mass, PhA is not a better predictor of upper-limb maximal strength.
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Affiliation(s)
- César Iván Ayala-Guzmán
- Doctorado en Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana, Ciudad de México,Mexico
- Universidad del Valle de México campus Coyoacán-Tlalpan, Ciudad de México,Mexico
- Health Care Department, Universidad Autónoma Metropolitana, Mexico City,Mexico
| | - Luis Ortiz-Hernandez
- Universidad del Valle de México campus Coyoacán-Tlalpan, Ciudad de México,Mexico
- Health Care Department, Universidad Autónoma Metropolitana, Mexico City,Mexico
| | - Cristian Escudero Malpica
- Health Care Department, Universidad Autónoma Metropolitana, Mexico City,Mexico
- Professional College of Graduates in Sports Training, Mexico City,Mexico
| | - Alejandro Macias Rosas
- Health Care Department, Universidad Autónoma Metropolitana, Mexico City,Mexico
- Professional College of Graduates in Sports Training, Mexico City,Mexico
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12
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Zanotelli A, Rossi AP, Del Monte L, Vantini G, Stabile G, Urbani S, Giani A, Zoico E, Babbanini A, Fantin F, Zamboni M, Mazzali G. The Role of Combined Muscle Ultrasound and Bioimpedentiometry Parameters for Sarcopenia Diagnosis in a Population of Hospitalized Older Adults. Nutrients 2024; 16:2429. [PMID: 39125310 PMCID: PMC11313821 DOI: 10.3390/nu16152429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 07/22/2024] [Accepted: 07/24/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND For the study of quantitative and qualitative muscle parameters, ultrasound and bioelectric impedance analysis are reliable, non-invasive, and reproducible. The aim of this study was to test the combined role of those techniques for the diagnosis of sarcopenia in a population of hospitalized older males and females. METHODS A total of 70 subjects were recruited, including 10 healthy adults and 60 hospitalized elderly patients with a good level of independence and cooperation, with and without sarcopenia. The rectus femoris cross-sectional area (CSA), thickness, echogenicity, and compressibility were measured with ultrasound echography. The phase angles (PhAs) and skeletal muscle mass were calculated by bioimpedence analysis. The muscle quality index (MQI) was calculated as the product of CSA and PhA. RESULTS Muscle compressibility was greater and PhA was lower in sarcopenic when compared with non-sarcopenic subjects. The threshold values for sarcopenia diagnosis in both sexes of CSA, of PhA, and of the MQI were identified. The obtained CSA values showed an AUC of 0.852 for women and 0.867 for men, PhA of 0.792 in women and 0.898 in men, while MQI was 0.900 for women and 0.969 for men. CONCLUSIONS The newly calculated cut-off values of CSA, PhA, and MQI predicted the presence of sarcopenia with good sensitivity and specificity values. The use of the MQI proved to be more promising than the separate use of CSA and PhA in both male and female subjects.
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Affiliation(s)
- Alfredo Zanotelli
- Section of Geriatric Medicine, Ospedale Santa Maria del Carmine, 38068 Rovereto, Italy;
| | - Andrea P. Rossi
- Division of Geriatrics, Department of Medicine, Ospedale Cà Foncello, 31100 Treviso, Italy
| | - Letizia Del Monte
- Department of Medicine, Geriatrics Division, University of Verona, 37100 Verona, Italy; (L.D.M.); (G.V.); (G.S.); (S.U.); (A.G.); (E.Z.); (M.Z.); (G.M.)
| | - Gianluca Vantini
- Department of Medicine, Geriatrics Division, University of Verona, 37100 Verona, Italy; (L.D.M.); (G.V.); (G.S.); (S.U.); (A.G.); (E.Z.); (M.Z.); (G.M.)
| | - Giovanni Stabile
- Department of Medicine, Geriatrics Division, University of Verona, 37100 Verona, Italy; (L.D.M.); (G.V.); (G.S.); (S.U.); (A.G.); (E.Z.); (M.Z.); (G.M.)
| | - Silvia Urbani
- Department of Medicine, Geriatrics Division, University of Verona, 37100 Verona, Italy; (L.D.M.); (G.V.); (G.S.); (S.U.); (A.G.); (E.Z.); (M.Z.); (G.M.)
| | - Anna Giani
- Department of Medicine, Geriatrics Division, University of Verona, 37100 Verona, Italy; (L.D.M.); (G.V.); (G.S.); (S.U.); (A.G.); (E.Z.); (M.Z.); (G.M.)
| | - Elena Zoico
- Department of Medicine, Geriatrics Division, University of Verona, 37100 Verona, Italy; (L.D.M.); (G.V.); (G.S.); (S.U.); (A.G.); (E.Z.); (M.Z.); (G.M.)
| | - Alessio Babbanini
- Division of Geriatrics, Department of Medicine, Dentistry, Pediatric and Gynecology, Healthy Aging Center, University of Verona, 37126 Verona, Italy;
| | - Francesco Fantin
- Division of Geriatrics, University of Trento, 38100 Trento, Italy;
| | - Mauro Zamboni
- Department of Medicine, Geriatrics Division, University of Verona, 37100 Verona, Italy; (L.D.M.); (G.V.); (G.S.); (S.U.); (A.G.); (E.Z.); (M.Z.); (G.M.)
| | - Gloria Mazzali
- Department of Medicine, Geriatrics Division, University of Verona, 37100 Verona, Italy; (L.D.M.); (G.V.); (G.S.); (S.U.); (A.G.); (E.Z.); (M.Z.); (G.M.)
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13
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Uemura K, Kamitani T, Okamoto H, Yamada M. Longitudinal association of objectively measured physical activity and bioimpedance phase angle in older adults. Clin Nutr ESPEN 2024; 63:631-634. [PMID: 39059486 DOI: 10.1016/j.clnesp.2024.07.021] [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: 03/18/2024] [Revised: 06/25/2024] [Accepted: 07/22/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND & AIMS The benefits of physical activity, including exercise and daily and household chores, on the bioimpedance phase angle remain unclear. We aimed to examine the longitudinal association between objectively measured physical activity and bioimpedance phase angle among community-dwelling older adults. METHODS This community-based cohort study enrolled individuals aged 65 years or older without any disability in the basic activities of daily living. The exposure was physical activity level measured objectively using a tri-axial accelerometer at baseline. The outcome was a whole body phase angle at 50 kHz obtained from a bioelectrical impedance analyzer at a one-year follow-up. The linear regression model was fitted to estimate the continuous associations of physical activity level and phase angle with adjustment of confounders, including age, sex, body mass index, physical performance, and phase angle at baseline. RESULTS The primary analysis included 229 individuals (mean age = 72.6 years [standard deviation = 4.9], 62.9% females). In the multivariable linear regression model, physical activity level at baseline is associated with a greater phase angle at follow-up (mean difference per 1 increase, 0.53° [95%CI, 0.23-0.83]). Subgroup analysis by sex showed similar trends. Restricted cubic spline analysis indicated a linear association between phase angle at follow-up and physical activity level at baseline (p = 0.66 for non-linearity). CONCLUSIONS Higher physical activity level was associated with greater phase angle at one-year follow-up in a linear dose-response manner, independent of demographics, physical performance, and phase angle at baseline, in community-dwelling older adults.
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Affiliation(s)
- Kazuki Uemura
- Graduate School of Rehabilitation Science, Osaka Metropolitan University, Habikino-City, Japan.
| | - Tsukasa Kamitani
- Section of Education for Clinical Research, Kyoto University Hospital, Kyoto, Japan
| | - Hiroshi Okamoto
- Center for Liberal Arts and Sciences, Faculty of Engineering, Toyama Prefectural University, Imizu, Japan
| | - Minoru Yamada
- Faculty of Human Sciences, University of Tsukuba, Tokyo, Japan
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14
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Bennett JP, Cataldi D, Liu YE, Kelly NN, Quon BK, Gonzalez MC, Heymsfield SB, Shepherd JA. Variations in bioelectrical impedance devices impact raw measures comparisons and subsequent prediction of body composition using recommended estimation equations. Clin Nutr ESPEN 2024; 63:540-550. [PMID: 39047869 DOI: 10.1016/j.clnesp.2024.07.009] [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: 02/22/2024] [Revised: 07/03/2024] [Accepted: 07/09/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND & AIMS Bioelectrical impedance analysis (BIA) for body composition estimation is increasingly used in clinical and field settings to guide nutrition and training programs. Due to variations among BIA devices and the proprietary prediction equations used, studies have recommended the use of raw measures of resistance (R) and reactance (Xc) within population-specific equations to predict body composition. OBJECTIVE We compared raw measures from three BIA devices to assess inter-device variation and the impact of differences on body composition estimations. METHODS Raw R, Xc, impedance (Z) parameters were measured on a calibrated phantom and athletes using tetrapolar supine (BIASUP4), octapolar supine (BIASUP8), and octapolar standing (BIASTA8) devices. Measures of R and Xc were compared across devices and graphed using BIA vector analysis (BIVA) and raw parameters were entered into recommended athlete-specific equations for predicting fat-free mass (FFM) and appendicular lean soft tissue (ALST). Whole-body FFM and regional ALST were compared across devices and to a criterion five-compartment (5C) model and dual energy X-ray absorptiometry for ALST. RESULTS Data from 73 (23.2 ± 4.8 y) athletes were included in the analyses. Technical differences were observed between Z (range 12.2-50.1Ω) measures on the calibrated phantom. Differences in whole-body impedance were apparent due to posture (technological) and electrode placement (biological) factors. This resulted in raw measures for all three devices showing greater dehydration on BIVA compared to published norms for athletes using a separate BIA device. Compared to the 5C FFM, significant differences (p < 0.05) were observed on all three equations for BIASUP8 and BIASTA8, with constant error (CE) from -2.7 to -4.6 kg; no difference was observed for BIASUP4 or when device-specific algorithms were used. Published equations resulted in differences as large as 8.8 kg FFM among BIA devices. For ALST, even after a correction in the error of the published empirical equation, all three devices showed significant (p < 0.01) CE from -1.6 to -2.9 kg. CONCLUSIONS Raw bioimpedance measurements differ among devices due to technical, technological, and biological factors, limiting interchangeability of data across BIA systems. Professionals should be aware of these factors when purchasing systems, comparing data to published reference ranges, or when applying published empirical body composition prediction equations.
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Affiliation(s)
- Jonathan P Bennett
- Department of Epidemiology, University of Hawai'i Cancer Center, 701 Ilalo St, Honolulu, HI, 96813, USA.
| | - Devon Cataldi
- Department of Epidemiology, University of Hawai'i Cancer Center, 701 Ilalo St, Honolulu, HI, 96813, USA
| | - Yong En Liu
- Department of Epidemiology, University of Hawai'i Cancer Center, 701 Ilalo St, Honolulu, HI, 96813, USA
| | - Nisa N Kelly
- Department of Epidemiology, University of Hawai'i Cancer Center, 701 Ilalo St, Honolulu, HI, 96813, USA
| | - Brandon K Quon
- Department of Epidemiology, University of Hawai'i Cancer Center, 701 Ilalo St, Honolulu, HI, 96813, USA
| | - Maria Cristina Gonzalez
- Graduate Program in Nutrition and Foods, Federal University of Pelotas, Rua Gomes Carneiro, 01- Centro, 96010-610, Pelotas, Brazil
| | - Steven B Heymsfield
- Pennington Biomedical Research Center, Louisiana State University, 6400 Perkins Rd, Baton Rouge, LA, 70808, USA
| | - John A Shepherd
- Department of Epidemiology, University of Hawai'i Cancer Center, 701 Ilalo St, Honolulu, HI, 96813, USA
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15
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Constantinou C, Jefford J, Zygo M, White J, Dale M, Morris R, Jenkins J. Assessing the nutritional status and impact of a series of nutritional interventions on elderly inpatients using bioelectrical impedance analysis: A service evaluation. J Hum Nutr Diet 2024. [PMID: 39038170 DOI: 10.1111/jhn.13352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 07/08/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND The aim of the study was to use bioelectrical impedance analysis (BIA) to assess nutritional status of elderly patients admitted to hospital and quantitatively measure the impact of the Cardiff and Vale University Health Board (CAVUHB) model ward. Secondary objectives were to assess the feasibility of using BIA in this patient population and compare nutrition risk screening tools against fat-free mass index (FFMI). METHODS A prospective, comparative, single-centre, service evaluation of a 'model ward for nutrition and hydration' undertaken in medical and rehabilitation beds in a large UK teaching hospital. RESULTS A total of 450 BIA measurements were taken using a Bodystat Multiscan 5000 on 162 patients; several patients had repeated measurements during their hospital stay. Patients tolerated the procedure well, but lack of accurate weight, implanted medical devices and tissue viability precluded some participants. CONCLUSIONS BIA is quick, non-invasive, simple to complete and can elicit huge data about an individual's body composition. In a larger cohort of medical admissions, BIA could assist in identifying the sensitivity and specificity of the nutrition screening tools. The collective benefit of a series of nutritional interventions preserved nutritional status better in this elderly inpatient population than usual models of care. Although results were not statistically significant, there is an opportunity with the new model of care to better support frail patients and prevent deconditioning.
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Affiliation(s)
| | - Joanne Jefford
- Cardiff and Vale Local University Health Board, Cardiff, UK
| | - Marzena Zygo
- Cardiff and Vale Local University Health Board, Cardiff, UK
| | - Judith White
- Cardiff and Vale Local University Health Board, Cardiff, UK
| | - Megan Dale
- Cardiff and Vale Local University Health Board, Cardiff, UK
| | - Rhys Morris
- Cardiff and Vale Local University Health Board, Cardiff, UK
| | - Judyth Jenkins
- Cardiff and Vale Local University Health Board, Cardiff, UK
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16
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Mazza E, Maurotti S, Ferro Y, Doria P, Moraca M, Montalcini T, Pujia A. Portable bioimpedance analyzer for remote body composition monitoring: A clinical investigation under controlled conditions. Nutrition 2024; 126:112537. [PMID: 39121809 DOI: 10.1016/j.nut.2024.112537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 06/11/2024] [Accepted: 07/17/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVES In an era when telemedicine is becoming increasingly essential, the development and validation of miniaturized Bioelectrical Impedance Analysis (BIA) devices for accurate and reliable body composition assessment is crucial. This study investigates the BIA Metadieta, a novel miniaturized BIA device, by comparing its performance with that of standard hospital BIA equipment across a diverse demographic. The aim is to enhance remote health monitoring by integrating compact and efficient technology into routine healthcare practices. METHODS A cross-sectional observational study was conducted with 154 participants from the Clinical Nutrition Unit. The study compared resistance (R), reactance (Xc), and phase angle (PhA) measurements obtained from the BIA Metadieta device and a traditional hospital-based BIA device. RESULTS Analysis revealed strong positive correlations between the BIA Metadieta and the hospital-based device for R (r = 0.988, P < 0.001), Xc (r = 0.946, P < 0.001), and PhA (r = 0.929, P < 0.001), indicating the miniaturized device's high accuracy and reliability. These correlations were consistent across different genders and BMI categories, demonstrating the device's versatility. CONCLUSIONS The BIA Metadieta device, with its miniaturized form factor, represents a significant step forward in the field of remote health monitoring, providing a reliable, accurate, and accessible means for assessing body composition.
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Affiliation(s)
- Elisa Mazza
- Department of Clinical and Experimental Medicine, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Samantha Maurotti
- Department of Clinical and Experimental Medicine, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Yvelise Ferro
- Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy.
| | - Paola Doria
- Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Marta Moraca
- Clinical Nutrition Unit, AOU "Renato Dulbecco", Catanzaro, Italy
| | - Tiziana Montalcini
- Department of Clinical and Experimental Medicine, University "Magna Græcia" of Catanzaro, Catanzaro, Italy; Research Center for the Prevention and Treatment of Metabolic Diseases (CR METDIS), University Magna Græcia, Catanzaro, Italy
| | - Arturo Pujia
- Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy; Research Center for the Prevention and Treatment of Metabolic Diseases (CR METDIS), University Magna Græcia, Catanzaro, Italy
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17
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Porciello G, Coluccia S, Vitale S, Palumbo E, Luongo A, Grimaldi M, Pica R, Prete M, Calabrese I, Cubisino S, Montagnese C, Falzone L, Martinuzzo V, Poletto L, Rotondo E, Di Gennaro P, De Laurentiis M, D’Aiuto M, Rinaldo M, Thomas G, Messina F, Catalano F, Ferraù F, Montesarchio V, Serraino D, Crispo A, Libra M, Celentano E, Augustin LSA. Baseline Association between Healthy Eating Index-2015 and Health-Related Quality of Life in Breast Cancer Patients Enrolled in a Randomized Trial. Cancers (Basel) 2024; 16:2576. [PMID: 39061215 PMCID: PMC11274909 DOI: 10.3390/cancers16142576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Health-related quality of life (HRQoL) represents one of the most concerning aspects for cancer patients. The Healthy Eating Index (HEI) is an a priori diet quality index directly associated with health outcomes and HRQoL in cancer survivors in North American populations. We evaluated, in a Mediterranean population, the baseline associations between HEI-2015 and HRQoL in 492 women with breast cancer recruited in a DEDiCa lifestyle trial. Dietary data were obtained from 7-day food records; HRQoL was assessed through the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ C30) and the C30 Summary Score (SumSc). Analysis of variance and multivariable linear and log-gamma regression models were performed. Mean and standard deviation for HEI-2015 score was 68.8 ± 11.2; SumSc was 81.5 ± 12.9. Women with lower HEI-2015 score had higher BMI, were more frequently exposed to tobacco smoke and had fewer years of education. Patients with a HEI-2015 score greater than 68.7 (median value) showed a significant increase in SumSc of 4% (p = 0.02). HEI-2015 components also associated with SumSc were beans and greens (β = 1.04; p = 0.02). Weak associations were found for total vegetables and saturated fats. Higher diet quality in breast cancer survivors was associated with higher overall HRQoL in this cross-sectional analysis.
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Affiliation(s)
- Giuseppe Porciello
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (S.C.); (E.P.); (A.L.); (M.G.); (R.P.); (M.P.); (E.R.); (E.C.); (L.S.A.A.)
| | - Sergio Coluccia
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (S.C.); (E.P.); (A.L.); (M.G.); (R.P.); (M.P.); (E.R.); (E.C.); (L.S.A.A.)
| | - Sara Vitale
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (S.C.); (E.P.); (A.L.); (M.G.); (R.P.); (M.P.); (E.R.); (E.C.); (L.S.A.A.)
| | - Elvira Palumbo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (S.C.); (E.P.); (A.L.); (M.G.); (R.P.); (M.P.); (E.R.); (E.C.); (L.S.A.A.)
| | - Assunta Luongo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (S.C.); (E.P.); (A.L.); (M.G.); (R.P.); (M.P.); (E.R.); (E.C.); (L.S.A.A.)
| | - Maria Grimaldi
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (S.C.); (E.P.); (A.L.); (M.G.); (R.P.); (M.P.); (E.R.); (E.C.); (L.S.A.A.)
| | - Rosa Pica
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (S.C.); (E.P.); (A.L.); (M.G.); (R.P.); (M.P.); (E.R.); (E.C.); (L.S.A.A.)
| | - Melania Prete
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (S.C.); (E.P.); (A.L.); (M.G.); (R.P.); (M.P.); (E.R.); (E.C.); (L.S.A.A.)
| | - Ilaria Calabrese
- Healthcare Direction, “A. Cardarelli” Hospital, 80131 Naples, Italy;
| | - Serena Cubisino
- Humanitas Istituto Clinico Catanese, 95045 Misterbianco, Italy;
| | | | - Luca Falzone
- Department of Biomedical and Biotechnological Sciences, Oncologic, Clinical and General Pathology Section, University of Catania, 95124 Catania, Italy;
| | - Valentina Martinuzzo
- Cancer Epidemiology Unit, National Cancer Institute, CRO, IRCCS, 33081 Aviano, Italy; (V.M.); (L.P.); (D.S.)
| | - Luigina Poletto
- Cancer Epidemiology Unit, National Cancer Institute, CRO, IRCCS, 33081 Aviano, Italy; (V.M.); (L.P.); (D.S.)
| | - Emanuela Rotondo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (S.C.); (E.P.); (A.L.); (M.G.); (R.P.); (M.P.); (E.R.); (E.C.); (L.S.A.A.)
| | - Piergiacomo Di Gennaro
- Medical Statistics Unit, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Michelino De Laurentiis
- Department of Breast and Thoracic Oncology, Division of Breast Medical Oncology, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy;
| | | | | | | | | | | | | | - Vincenzo Montesarchio
- UOC Oncologia, AORN dei Colli (Monaldi-Cotugno-CTO), 80131 Naples, Italy; (V.M.); (M.L.)
| | - Diego Serraino
- Cancer Epidemiology Unit, National Cancer Institute, CRO, IRCCS, 33081 Aviano, Italy; (V.M.); (L.P.); (D.S.)
| | - Anna Crispo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (S.C.); (E.P.); (A.L.); (M.G.); (R.P.); (M.P.); (E.R.); (E.C.); (L.S.A.A.)
| | - Massimo Libra
- UOC Oncologia, AORN dei Colli (Monaldi-Cotugno-CTO), 80131 Naples, Italy; (V.M.); (M.L.)
| | - Egidio Celentano
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (S.C.); (E.P.); (A.L.); (M.G.); (R.P.); (M.P.); (E.R.); (E.C.); (L.S.A.A.)
| | - Livia S. A. Augustin
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (S.C.); (E.P.); (A.L.); (M.G.); (R.P.); (M.P.); (E.R.); (E.C.); (L.S.A.A.)
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Jin Q, Zhang J, Jin J, Zhang J, Fei S, Liu Y, Xu Z, Shi Y. Preoperative body composition measured by bioelectrical impedance analysis can predict pancreatic fistula after pancreatic surgery. Nutr Clin Pract 2024. [PMID: 39010727 DOI: 10.1002/ncp.11192] [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: 02/29/2024] [Revised: 06/23/2024] [Accepted: 06/25/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Postoperative pancreatic fistula (POPF) remains one of the most severe complications after pancreatic surgery. The methods for predicting pancreatic fistula are limited. We aimed to investigate the predictive value of body composition parameters measured by preoperative bioelectrical impedance analysis (BIA) on the development of POPF. METHODS A total of 168 consecutive patients undergoing pancreatic surgery from March 2022 to December 2022 at our institution were included in the study and randomly assigned at a 3:2 ratio to the training group and the validation group. All data, including previously reported risk factors for POPF and parameters measured by BIA, were collected. Risk factors were analyzed by univariable and multivariable logistic regression analysis. A prediction model was established to predict the development of POPF based on these parameters. RESULTS POPF occurred in 41 of 168 (24.4%) patients. In the training group of 101 enrolled patients, visceral fat area (VFA) (odds ratio [OR] = 1.077, P = 0.001) and fat mass index (FMI) (OR = 0.628, P = 0.027) were found to be independently associated with POPF according to multivariable analysis. A prediction model including VFA and FMI was established to predict the development of POPF with an area under the receiver operating characteristic curve (AUC) of 0.753. The efficacy of the prediction model was also confirmed in the internal validation group (AUC 0.785, 95% CI 0.659-0.911). CONCLUSIONS Preoperative assessment of body fat distribution by BIA can predict the risk of POPF after pancreatic surgery.
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Affiliation(s)
- Qianwen Jin
- Department of Clinical Nutrition, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jun Zhang
- Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Research Institute of Pancreatic Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jiabin Jin
- Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Research Institute of Pancreatic Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jiaqiang Zhang
- Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Research Institute of Pancreatic Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Si Fei
- Department of Clinical Nutrition, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yang Liu
- Department of Clinical Nutrition, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Zhiwei Xu
- Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Research Institute of Pancreatic Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yongmei Shi
- Department of Clinical Nutrition, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Department of Clinical Nutrition, College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
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19
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Yang J, Yu J, Kim J, Park E. Association between Physical Activity and Phase Angle Obtained via Bioelectrical Impedance Analysis in South Korean Adults Stratified by Sex. Nutrients 2024; 16:2136. [PMID: 38999883 PMCID: PMC11242964 DOI: 10.3390/nu16132136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/28/2024] [Accepted: 07/02/2024] [Indexed: 07/14/2024] Open
Abstract
This cross-sectional study aimed to examine the association of various aspects of physical activity, including intensity, duration, type, and purpose, with the phase angle (PhA), an objective indicator of health, in Korean adults after stratification by sex. Data from the 2022 Korean National Health and Nutrition Examination Survey, a nationwide, representative, population-based survey, were used. In total, 3996 participants were included in the study. Participants self-reported their weekly intensity, frequency, duration of engagement in physical activity. PhA was categorized into two groups on the basis of sex-specific averages. Multiple logistic regression analysis was used to investigate the relationship between physical activity and PhA, and proportional odds logistic regression analysis was performed to determine the association between physical activity and different subclasses of PhA. A positive association was found between sufficiently active aerobic physical activity and PhA compared with inactive physical activity (sufficiently active, male: odds ratio = 1.952, 95% confidence interval = 1.373-2.776; female: odds ratio = 1.333, 95% confidence interval = 1.019-1.745). This association was further strengthened when aerobic physical activity was accompanied by muscle-strengthening activity (sufficiently active with muscle-strengthening activity, male: aOR = 2.318, 95% CI = 1.512-3.554; female: aOR = 1.762, 95% CI = 1.215-2.556) and vigorous-intensity activities (sufficiently active with sufficient vigorous-intensity activity, male: aOR = 2.785, 95% CI = 1.647-4.709; female: aOR = 2.505, 95% CI = 1.441-4.356) and when there was more leisure-time physical activity than occupational physical activity (sufficiently active with more leisure-time physical activity, male: aOR = 2.158, 95% CI = 1.483-3.140; female: aOR = 1.457, 95% CI = 1.078-1.969). Furthermore, the inclusion of muscle-strengthening activity made a significant difference in the values of PhA for males with insufficiently active physical activity (aOR = 2.679, 95% CI = 1.560-4.602). For females with highly active physical activity (aOR = 1.521, 95% CI = 1.068-2.166), the inclusion of muscle-strengthening and vigorous-intensity activities were significantly associated with higher values for PhA. This study can be utilized to provide specific suggestions for better health programs and can change perception that only occupational physical activity is enough. This study also indicated that PhA can be used for personalized health assessments.
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Affiliation(s)
- Jiwon Yang
- Medical Courses, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Jiho Yu
- Medical Courses, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Jinhyun Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul 03722, Republic of Korea
- Department of Psychiatry, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Euncheol Park
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul 03722, Republic of Korea
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20
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Ricarte JRO, Nogueira MDDA, Firmino MAD, de Oliveira LFN, Valentim AB, Martins GDS, Dantas ACP, Matias NSL, Rocha EVDS, Almondes KGDS, Maia CSC. Phase angle and anthropometric indicators of cardiometabolic risk in children and adolescents. Eur J Clin Nutr 2024; 78:639-646. [PMID: 38632332 DOI: 10.1038/s41430-024-01439-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/19/2024]
Abstract
RATIONALE/OBJECTIVE The phase angle (PhA) is a measurement obtained from the resistance and reactance found in the bioelectrical impedance examination and is useful in assessing nutritional status and in assessing cardiometabolic diseases. Therefore, the objective was to correlate the phase angle to the anthropometric variables of cardiometabolic risk (CMR) in children and adolescents. SUBJECTS/METHODS Weight, height, body mass index (BMI), waist circumference (WC) and neck circumference (NC), waist-to-height ratio (WHtR), and PhA of 1231 children and adolescents aged between 5 and 18 years were assessed. PhA was assessed in tertiles and CMR was identified using the anthropometric variables BMI, WC, NC, and WHtR. Linear regression models were used to verify the association between PhA tertiles and CMR anthropometric variables, stratified by sex. RESULTS No relationship was found between PhA and CMR variables in children. In adolescents, lower values of NC (β = -0.019, p = 0.005) and BMI (β = -0.025, p = 0.023) were found in boys, WC (β = -0.017, p = 0.020), WHtR (β = -0.017, p = 0.020), NC (β = -0.011, p = 0.027) and BMI (β = -0.026, p = 0.009) in girls when they were in tertile 1 when compared to tertile 3 of the PhA, even after adjusting for age. CONCLUSION The PhA was directly associated with CMR in the assessed adolescents.
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Affiliation(s)
- Juliana Raissa Oliveira Ricarte
- Nutritionist. Master's degree. Ph.D student from the Graduate Program in Public Health, State University of Ceará, Fortaleza - CE, Brazil
| | - Maria Dinara de Araújo Nogueira
- Nutritionist. Master's degree. Ph.D student from the Graduate Program in Public Health, State University of Ceará, Fortaleza - CE, Brazil
| | - Matheus Aragão Dias Firmino
- Nutritionist. Master's student in the Graduate Program in Nutrition and Health, State University of Ceará, Fortaleza - CE, Brazil
| | - Luis Felipe Nunes de Oliveira
- Nutritionist. Master's student in the Graduate Program in Nutrition and Health, State University of Ceará, Fortaleza - CE, Brazil
| | - Ashley Brito Valentim
- Nutritionist. Master's student in the Graduate Program in Nutrition and Health, State University of Ceará, Fortaleza - CE, Brazil
| | - Géssica de Souza Martins
- Nutritionist. Master's degree. Ph.D student from the Graduate Program in Public Health, State University of Ceará, Fortaleza - CE, Brazil
| | - Ana Cecília Pereira Dantas
- Undergraduate Student in the Bachelor's program in Nutrition, State University of Ceará, Fortaleza - CE, Brazil
| | - Nayeli Silva Lima Matias
- Undergraduate Student in the Bachelor's program in Nutrition, State University of Ceará, Fortaleza - CE, Brazil
| | | | - Kaluce Gonçalves de Sousa Almondes
- Nutritionist. Ph.D. Researcher at the study and research Group on Micronutrients and Chronic Diseases, State University of Ceará, Fortaleza - CE, Brazil
| | - Carla Soraya Costa Maia
- Nutritionist. Ph.D. Faculty member in the Graduate Programs in Nutrition and Health, and Public Health, State University of Ceará, Fortaleza - CE, Brazil.
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21
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Zhang J, Xu Z, Fu Y, Chen L. Association between phase angle and diabetic peripheral neuropathy in Type 2 diabetes patients. Endocrine 2024; 85:196-205. [PMID: 38367144 DOI: 10.1007/s12020-024-03689-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/06/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Diabetic peripheral neuropathy (DPN), the very prevalent microvascular complication of type 2 diabetes mellitus (T2DM), severely threatens the quality of life of diabetic patients. Thus, prevention of DPN is extremely important for public health, and the identification of potential biomarkers may help with early prevention. Our work determined the association between phase angles (PhAs) and the risk of DPN in T2DM patients. MATERIALS AND METHODS This cross-sectional study recruited 697 T2DM patients from the Third Affiliated Hospital of Soochow University. All patients were divided into the non-diabetic peripheral neuropathy group and diabetic peripheral neuropathy group, and the DPN group was further divided into low, medium, and high diabetic foot ulcer risk groups according to vibration perception threshold results. Using univariate and multivariate logistic regression analyses continuously, the relationship between PhAs (arms, legs, trunk, and whole body) and the risk of DPN were evaluated. Further analysis was conducted on different subgroups of the study population. RESULTS After adjusting for the potential covariates, multivariate logistic regression analyses indicated that PhAs of the arms, legs, and whole body correlated inversely with the risk of DPN. However, the PhA of the trunk had no significant correlation with DPN. According to the stratified subgroup analysis, the negative association between PhA of the whole body and the risk of DPN remained significant in the sex and BMI group except for participants with BMI ≥ 28 kg/m². CONCLUSIONS For the first time, PhAs were acknowledged to be independently associated with DPN. Further exploration is needed to explain the findings.
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Affiliation(s)
- Junli Zhang
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Zhenghui Xu
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Yu Fu
- Department of Clinical Nutrition, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Lu Chen
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China.
- Department of Clinical Nutrition, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China.
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22
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Carretero Gómez J, González Gónzalez P, Galeano Fernández TF, Córdoba Bueno S, Boyero Calvo N, Salgado Cardoso B, Arévalo Lorido JC. Bioelectrical impedance-derived phase angle (PhA) in people living with obesity: Role in sarcopenia and comorbidities. Nutr Metab Cardiovasc Dis 2024:S0939-4753(24)00242-4. [PMID: 39069470 DOI: 10.1016/j.numecd.2024.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 06/17/2024] [Accepted: 06/18/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND AND AIM Obesity is characterized by alterations in fat and muscle mass. Phase angle (PhA) is considered an index of muscle mass, and is related to comorbidities in SO. This work aimed to assess the relationship between PhA, muscle mass, inflammation, and comorbidities in obesity. METHODS AND RESULTS We included 198 outpatients with obesity (BMI≥30) divided into tertiles according to PhA distribution (<5°, 5°-6°, >7°). Body composition was analyzed using bioimpedance (Tanita MC-780P Multi-Frequency Segmental Body Composition Analyzer). Quantitative variables were compared using the Kruskal-Wallis test and qualitative variables using the chi-square test. A correspondence analysis was built to show the influence of qualitative variables on subjects in each tertile. Patients in the lowest tertile had the lowest skeletal muscle mass and appendicular skeletal muscle mass index (ASMI); the highest inflammatory index (albumin and derived neutrophil-to-lymphocyte ratio, Alb-dNLR); and the highest percentage of individuals with a history of type 2 diabetes mellitus (T2DM), chronic kidney disease (CKD), and heart failure (HF). The correspondence analysis showed an association between the lowest tertile and presence of HF with preserved ejection fraction (HFpEF) and CKD. On the logistic regression model, ASMI (OR 0.9, 95%CI 0.85-0.95, p = 0.0004), Alb-dNLR (OR 1.04, 95%CI 1.04-16.4, p = 0.04) and HFpEF and T2DM were significantly associated with the lowest PhA. CONCLUSIONS Identifying high-risk individuals living with obesity is a priority. These results show that lower PhA is related to inflammation, poorer skeletal muscle mass and consequently, their impact on obesity-related comorbidities and clinical outcomes.
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Affiliation(s)
- Juana Carretero Gómez
- Internal Medicine Department, University Hospital Complex of Badajoz, Avda de Elvas, S/N. 06085, Badajoz, Spain.
| | - Patricia González Gónzalez
- Internal Medicine Department, University Hospital Complex of Badajoz, Avda de Elvas, S/N. 06085, Badajoz, Spain
| | | | - Sonia Córdoba Bueno
- Internal Medicine Department, University Hospital Complex of Badajoz, Avda de Elvas, S/N. 06085, Badajoz, Spain
| | - Natalia Boyero Calvo
- Internal Medicine Department, University Hospital Complex of Badajoz, Avda de Elvas, S/N. 06085, Badajoz, Spain
| | - Belén Salgado Cardoso
- Internal Medicine Department, University Hospital Complex of Badajoz, Avda de Elvas, S/N. 06085, Badajoz, Spain
| | - José Carlos Arévalo Lorido
- Internal Medicine Department, University Hospital Complex of Badajoz, Avda de Elvas, S/N. 06085, Badajoz, Spain
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23
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Ferreira GOC, Ferrari G, Langer RD, Cossio-Bolaños M, Gomez-Campos R, Lázari E, Moraes AM. Phase angle and its determinants among adolescents: influence of body composition and physical fitness level. Sci Rep 2024; 14:13697. [PMID: 38871752 DOI: 10.1038/s41598-024-62546-6] [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: 03/04/2024] [Accepted: 05/17/2024] [Indexed: 06/15/2024] Open
Abstract
To examine the association between levels of physical fitness, parameters of body composition and phase angle (PhA) amongst adolescents. A total of 152 adolescents (84 girls) aged 11-16 years were included in this study. Weight and height were measured and the body mass index (BMI) was calculated. Bioelectrical impedance analysis (BIA) provided resistance and reactance parameters to calculate fat-free mass (FFM), PhA and fat mass (%FM). The following physical fitness variables were analysed: flexibility, abdominal muscular endurance, upper and lower limb explosive strength, agility, speed and cardiorespiratory fitness. Generalized Linear Models were applied to verify differences across sexes. Stepwise linear regression was used to establish an association between the variables studied. The study established an association between PhA and weight, FFM, BMI, FM, %FM and medicine ball throw (MBT) for girls. As for the boys, an association was verified between PhA and weight, FFM, BMI, standing long jump (SLJ), MBT and the three allometric VO2peak variables analyzed. An association was found between PhA and the boys' 4-m shuttle run test (4SRT) and 20-m sprint test (20SRT). Boys showed a greater phase angle than girls; In girls, BMI and %FM, were determinant of 32.4% (r = 0.57). PhA variability which is influenced by physical fitness, body composition and, therefore, the tissues electrical conductivity. Furthermore, boys' height, FFM, upper limb strength, and agility account for 58.4% (r = 0.76) PhA variability. There was a positive correlation between the physical fitness tests and the PhA.
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Affiliation(s)
- Giovana O C Ferreira
- Department of Sports Science, Pontifical Catholic University of Campinas, Campinas, Brazil
| | - Gerson Ferrari
- Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile (USACH), Santiago, Chile
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago, Chile
| | - Raquel D Langer
- School of Medical Sciences, Growth and Development Laboratory - Center for Investigation in Pediatrics (CIPED), University of Campinas, Campinas, Brazil
| | | | | | - Evandro Lázari
- School of Applied Sciences, University of Campinas, Campinas, Brazil
| | - Anderson M Moraes
- School of Physical Education, Pontifical Catholic University of Campinas, Rua Prof. Dr. Euryclides De Jesus Zerbini, 1516, Campinas, 13083-9, Brazil.
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24
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Zhu J, Yang Y, Zhao Y, Qin G, Su X. Using structural equation modeling to examine correlations between health-related physical fitness and cell health among Chinese college students. BMC Public Health 2024; 24:1557. [PMID: 38858758 PMCID: PMC11165770 DOI: 10.1186/s12889-024-19067-8] [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: 02/26/2024] [Accepted: 06/05/2024] [Indexed: 06/12/2024] Open
Abstract
INTRODUCTION College students' physical fitness is likely to be directly related to their cells' health. However, there is a lack of literature on whether the relationship between cell health and college students' physical fitness is direct or indirect. This study used a structural equation modeling (SEM) approach to investigate the connection between cell health and college students' physical fitness. METHODS This cross-sectional study collected data from 838 volunteers (502 males and 336 females, average age of 18.74 ± 1.5 years) who were college students from the Shandong province of China in July 2023. Initially, we obtained anthropometric measurements and conducted physical fitness tests on the students. Then, we performed Pearson correlation analysis and principal component analysis to screen variables and explore potentially influencing factors. Finally, we examined associations between the variables and determined whether there were direct or indirect influences among factors using SEM. RESULTS The results revealed a significant correlation between the cell health factor and the muscle strength factor (path coefficient = 0.97; p < 0.001) as well as the fat obesity factor (path coefficient = -0.52; p < 0.001). The cardiovascular factor exhibited a weak correlation with the cell health factor (path coefficient = 0.11; p < 0.01). Moreover, the cardiovascular factor acted as a mediating variable between the muscle strength factor and the cell health factor, with a positive correlation observed between the muscle strength factor and the cell health factor (path coefficient = 0.40; p < 0.001). CONCLUSION These findings suggest that cell health is indicative of muscle strength and cardiorespiratory fitness. Our findings demonstrate that assessing the cell health of college students can be a valuable method for evaluating their overall health.
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Affiliation(s)
- Jian Zhu
- Physical Education Department, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Yi Yang
- College of Physical Education, Hengxing University, Qingdao, China.
| | - Yanmin Zhao
- Department of Physical Education, China University of Petroleum (East China), Qingdao, China
| | - Guoyang Qin
- College of Physical Education, Shandong Normal University, Jinan, China
| | - Xin Su
- Department of Physical Education, Shenzhen Polytechnic, Shenzhen, China.
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25
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Abdelbaset R, Shawky SM, Abdullah MAA, Morsy OE, Yahia YA, Ghallab YH, Matboli M, Ismail Y. A new label free spiral sensor using impedance spectroscopy to characterize hepatocellular carcinoma in tissue and serum samples. Sci Rep 2024; 14:13155. [PMID: 38849386 PMCID: PMC11161506 DOI: 10.1038/s41598-024-63141-5] [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: 01/04/2024] [Accepted: 05/24/2024] [Indexed: 06/09/2024] Open
Abstract
Hepatocellular carcinoma (HCC) stands as the most prevalent form of primary liver cancer, predominantly affecting patients with chronic liver diseases such as hepatitis B or C-induced cirrhosis. Diagnosis typically involves blood tests (assessing liver functions and HCC biomarkers), imaging procedures such as Computed Tomography (CT) and Magnetic Resonance Imaging (MRI), and liver biopsies requiring the removal of liver tissue for laboratory analysis. However, these diagnostic methods either entail lengthy lab processes, require expensive imaging equipment, or involve invasive techniques like liver biopsies. Hence, there exists a crucial need for rapid, cost-effective, and noninvasive techniques to characterize HCC, whether in serum or tissue samples. In this study, we developed a spiral sensor implemented on a printed circuit board (PCB) technology that utilizes impedance spectroscopy and applied it to 24 tissues and sera samples as proof of concept. This newly devised circuit has successfully characterized HCC and normal tissue and serum samples. Utilizing the distinct dielectric properties between HCC cells and serum samples versus the normal samples across a specific frequency range, the differentiation between normal and HCC samples is achieved. Moreover, the sensor effectively characterizes two HCC grades and distinguishes cirrhotic/non-cirrhotic samples from tissue specimens. In addition, the sensor distinguishes cirrhotic/non-cirrhotic samples from serum specimens. This pioneering study introduces Electrical Impedance Spectroscopy (EIS) spiral sensor for diagnosing HCC and liver cirrhosis in clinical serum-an innovative, low-cost, rapid (< 2 min), and precise PCB-based technology without elaborate sample preparation, offering a novel non-labeled screening approach for disease staging and liver conditions.
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Affiliation(s)
- Reda Abdelbaset
- Biomedical Engineering Department, Helwan University, Cairo, 11795, Egypt
- Centre of Nanoelectronics and Devices (CND), The American University in Cairo (AUC), New Cairo, 11835, Egypt
- Centre of Nanoelectronics and Devices (CND), Zewail City of Science and Technology, Giza, 12588, Egypt
| | - Sherif M Shawky
- Biochemistry Department, Faculty of Pharmacy, Misr University for Science and Technology, Giza, 12566, Egypt
- Center of Genomics, Helmy Institute, Zewail City of Science and Technology, Giza, 12588, Egypt
| | - Mohammed A A Abdullah
- Centre of Nanoelectronics and Devices (CND), The American University in Cairo (AUC), New Cairo, 11835, Egypt.
- Centre of Nanoelectronics and Devices (CND), Zewail City of Science and Technology, Giza, 12588, Egypt.
| | - Omar E Morsy
- Centre of Nanoelectronics and Devices (CND), The American University in Cairo (AUC), New Cairo, 11835, Egypt
- Centre of Nanoelectronics and Devices (CND), Zewail City of Science and Technology, Giza, 12588, Egypt
| | - Yahia A Yahia
- Biochemistry Department, Faculty of Pharmacy, Misr University for Science and Technology, Giza, 12566, Egypt
| | - Yehya H Ghallab
- Biomedical Engineering Department, Helwan University, Cairo, 11795, Egypt
- Centre of Nanoelectronics and Devices (CND), The American University in Cairo (AUC), New Cairo, 11835, Egypt
- Centre of Nanoelectronics and Devices (CND), Zewail City of Science and Technology, Giza, 12588, Egypt
| | - Marwa Matboli
- Biochemistry and Molecular Biology Department, Faculty of Medicine, Ain Shams University, Cairo, 11591, Egypt
| | - Yehea Ismail
- Centre of Nanoelectronics and Devices (CND), The American University in Cairo (AUC), New Cairo, 11835, Egypt
- Centre of Nanoelectronics and Devices (CND), Zewail City of Science and Technology, Giza, 12588, Egypt
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26
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Sandini M, Gianotti L, Paiella S, Bernasconi DP, Roccamatisi L, Famularo S, Donadon M, Di Lucca G, Cereda M, Baccalini E, Capretti G, Nappo G, Casirati A, Braga M, Zerbi A, Torzilli G, Bassi C, Salvia R, Cereda E, Caccialanza R. Predicting the Risk of Morbidity by GLIM-Based Nutritional Assessment and Body Composition Analysis in Oncologic Abdominal Surgery in the Context of Enhanced Recovery Programs : The PHase Angle Value in Abdominal Surgery (PHAVAS) Study. Ann Surg Oncol 2024; 31:3995-4004. [PMID: 38520580 PMCID: PMC11076333 DOI: 10.1245/s10434-024-15143-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/19/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Preoperative nutritional status and body structure affect short-term prognosis in patients undergoing major oncologic surgery. Bioimpedance vectorial analysis (BIVA) is a reliable tool to assess body composition. Low BIVA-derived phase angle (PA) indicates a decline of cell membrane integrity and function. The aim was to study the association between perioperative PA variations and postoperative morbidity following major oncologic upper-GI surgery. PATIENTS AND METHODS Between 2019 and 2022 we prospectively performed BIVA in patients undergoing surgical resection for pancreatic, hepatic, and gastric malignancies on the day before surgery and on postoperative day (POD) 1. Malnutrition was defined as per the Global Leadership Initiative on Malnutrition criteria. The PA variation (ΔPA) between POD1 and preoperatively was considered as a marker for morbidity. Uni and multivariable logistic regression models were applied. RESULTS Overall, 542 patients with a mean age of 64.6 years were analyzed, 279 (51.5%) underwent pancreatic, 201 (37.1%) underwent hepatobiliary, and 62 (11.4%) underwent gastric resections. The prevalence of preoperative malnutrition was 16.6%. The overall morbidity rate was 53.3%, 59% in those with ΔPA < -0.5 versus 46% when ΔPA ≥ -0.5. Age [odds ratio (OR) 1.11; 95% confidence interval (CI) (1.00; 1.22)], pancreatic resections [OR 2.27; 95% CI (1.24; 4.18)], estimated blood loss (OR 1.20; 95% CI (1.03; 1.39)], malnutrition [OR 1.77; 95% CI (1.27; 2.45)], and ΔPA [OR 1.59; 95% CI (1.54; 1.65)] were independently associated with postoperative complications in the multivariate analysis. CONCLUSIONS Patients with preoperative malnutrition were significantly more likely to develop postoperative morbidity. Moreover, a decrease in PA on POD1 was independently associated with a 13% increase in the absolute risk of complications. Whether proactive interventions may reduce the downward shift of PA and the complication rate need further investigation.
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Affiliation(s)
- Marta Sandini
- Department of Medical, Surgical, and Neurologic Sciences, University of Siena, Siena, Italy
- Surgical Oncology Unit, Policlinico Le Scotte, Siena, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- HPB Unit, Fondazione IRCCS San Gerardo Hospital, Monza, Italy
| | - Luca Gianotti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
- HPB Unit, Fondazione IRCCS San Gerardo Hospital, Monza, Italy.
| | - Salvatore Paiella
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Davide P Bernasconi
- School of Medicine and Surgery, Bicocca Bioinformatics Biostatistics and Bioimaging Centre - B4, Milano - Bicocca University, Monza, Italy
| | - Linda Roccamatisi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- HPB Unit, Fondazione IRCCS San Gerardo Hospital, Monza, Italy
| | - Simone Famularo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Matteo Donadon
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
- Department of Surgery, University Maggiore Hospital della Carità, Novara, Italy
| | - Gabriele Di Lucca
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- HPB Unit, Fondazione IRCCS San Gerardo Hospital, Monza, Italy
| | - Marco Cereda
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- HPB Unit, Fondazione IRCCS San Gerardo Hospital, Monza, Italy
| | - Edoardo Baccalini
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- HPB Unit, Fondazione IRCCS San Gerardo Hospital, Monza, Italy
| | - Giovanni Capretti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Pancreatic Surgery, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Gennaro Nappo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Pancreatic Surgery, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Amanda Casirati
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Braga
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- HPB Unit, Fondazione IRCCS San Gerardo Hospital, Monza, Italy
| | - Alessandro Zerbi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Pancreatic Surgery, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Guido Torzilli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Claudio Bassi
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Roberto Salvia
- General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona Hospital, Verona, Italy
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Dong X, Bi B, Hu Y, Wang L, Liu X, Li W, Li M, Xiang T, Li S, Wu H. Body composition characteristics and influencing factors of different parts of sarcopenia in elderly people: A community-based cross-sectional survey. Aging Med (Milton) 2024; 7:384-392. [PMID: 38975318 PMCID: PMC11222755 DOI: 10.1002/agm2.12327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/20/2024] [Accepted: 05/30/2024] [Indexed: 07/09/2024] Open
Abstract
Objectives This study aims to describe the differences in body composition among different body parts of the elderly in the community and its relationship with sarcopenia. Methods Elderly people aged ≥65 underwent bioelectric impedance analysis testing and were categorized into a sarcopenia group, possible sarcopenia group, and control group. The characteristics of body composition indicators in different parts and their relationship with different stages of sarcopenia were analyzed. Results The sarcopenia group illustrated the lowest values of FFM, FFM%, BFM, BFM%, ICW, and limb PhA, along with higher ECW/TBW in the trunk and left leg compared to the control group. The possible sarcopenia group showed lower FFM% in limbs and trunk, and higher BFM% compared to the control group. Gender differences in elderly body composition were observed, with an increase in BFM% in various body parts posing a risk factor for possible sarcopenia in elderly males, whereas an increase in BFM% except in the left arm was a protective factor for sarcopenia in elderly females. Conclusion The body composition of the elderly in the community varied significantly in different stages of sarcopenia and genders, which correlated with sarcopenia.
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Affiliation(s)
- Xinying Dong
- Department of Child, Adolescent Health and Maternal Care, School of Public HealthCapital Medical UniversityBeijingChina
| | - Bingqing Bi
- School of Public HealthCapital Medical UniversityBeijingChina
| | - Yifei Hu
- Department of Child, Adolescent Health and Maternal Care, School of Public HealthCapital Medical UniversityBeijingChina
| | - Li Wang
- Fangzhuang Community Health CenterCapital Medical UniversityBeijingChina
| | - Xinying Liu
- Fangzhuang Community Health CenterCapital Medical UniversityBeijingChina
| | - Wentao Li
- School of General Practice and Continuing EducationCapital Medical UniversityBeijingChina
| | - Mingyue Li
- School of General Practice and Continuing EducationCapital Medical UniversityBeijingChina
| | - Tong Xiang
- School of General Practice and Continuing EducationCapital Medical UniversityBeijingChina
| | - Shugang Li
- School of General Practice and Continuing EducationCapital Medical UniversityBeijingChina
| | - Hao Wu
- School of General Practice and Continuing EducationCapital Medical UniversityBeijingChina
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Vaduva P, Esvan M, Thibault R. Characteristics and outcome of patients referred to a specialized outpatient clinic for the management of malnutrition: A retrospective audit. Clin Nutr ESPEN 2024; 61:266-273. [PMID: 38777442 DOI: 10.1016/j.clnesp.2024.03.014] [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: 10/27/2023] [Revised: 03/05/2024] [Accepted: 03/10/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND & AIMS Insufficient screening and management of malnutrition leads to increase morbidity and mortality. AIMS to evaluate the characteristics and clinical outcomes of malnourished patients referred to a specialized outpatient clinic for the management of malnutrition (primary); to compare the latter according to malnutrition severity; to determine the factors associated with severe malnutrition and mortality; to compare the consistency of the decided medical nutrition therapy with the European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines (secondary). METHODS This retrospective, observational study included malnourished adults referred for the first time to the specialized nutrition consultation of a teaching University Hospital during 50 months. Malnutrition was diagnosed according to the Global Leadership Initiative on Malnutrition criteria, including body composition assessment by bioimpedance analysis. STATISTICS Chi2 or Fisher, Student or Wilcoxon rank-sum tests; multivariable logistic regression to assess the factors associated with severe malnutrition and mortality. RESULTS 108 malnourished adults were included: 74% had severe malnutrition. The main secondary diagnosis was digestive cancer (48.2%). During the follow-up (median = 70 days) after the first nutritional consultation, 11% of patients were admitted at hospital, 19% had infections and 23.1% died, without any difference according to malnutrition severity. Severely malnourished patients had lower body mass index, a smaller fat mass index (FMI) (4.6 ± 1.8 vs 6.0 ± 2.5 kg/m2; p = 0.01), and a higher level of total body water (64.7 ± 7.1 vs 60.6 ± 5.4%; p = 0.02), compared to moderately malnourished individuals. A low FMI (odds ratio = 0.72 [0.54-0.96]) was the only factor significantly associated with severe malnutrition. We did not find any factor associated with mortality. There was a moderate consistency (47.1%) between the decided medical nutrition therapy and the ESPEN guidelines of nutritional care. CONCLUSIONS Adults referred for the first time to a specialized nutritional consultation present mostly with severe malnutrition and are at risk for significant complications, leading to a high mortality rate. In this population, a low FMI is associated with severe malnutrition. An earlier diagnosis and care of malnutrition and an earlier referral to clinical nutrition units would improve outcomes.
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Affiliation(s)
- Patricia Vaduva
- Department of Endocrinology Diabetology Nutrition, Nutrition Support Team, Home Parenteral Nutrition Centre, CHU Rennes, Rennes, France.
| | - Maxime Esvan
- Clinical Investigation Center - CIC Inserm 1414, CHU Rennes, Rennes, France.
| | - Ronan Thibault
- Department of Endocrinology Diabetology Nutrition, Nutrition Support Team, Home Parenteral Nutrition Centre, CHU Rennes, Rennes, France; Nutrition Metabolism Cancer Institute (NuMeCan), Univ Rennes, INSERM, INRAE, Rennes, France.
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Ito Y, Yoshimura Y, Nagano F, Matsumoto A, Wakabayashi H. Association of Phase Angle Dynamics with Sarcopenia and Activities of Daily Living in Osteoporotic Fracture Patients. Ann Geriatr Med Res 2024; 28:192-200. [PMID: 38486468 PMCID: PMC11217650 DOI: 10.4235/agmr.23.0212] [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: 12/21/2023] [Revised: 02/23/2024] [Accepted: 03/12/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND This study aimed to determine whether changes in phase angle during rehabilitation are associated with clinical outcomes such as activities of daily living (ADL), skeletal muscle mass index (SMI), and strength in patients with osteoporotic fractures. METHODS This retrospective observational study included patients with osteoporotic fractures admitted to convalescent rehabilitation wards. Changes in phase angle were defined as the difference between the phase angle values at discharge and on admission. The primary outcome was the Functional Independence Measure motor (FIM-motor) score at discharge. The secondary outcomes were SMI and handgrip strength at discharge. We used multivariate analysis to adjust for confounding factors and examine the association between changes in the phase angle and outcomes. RESULTS We analyzed a total of 115 patients (97 women, mean age of 81.0±10.0 years), with a median change in phase angle of 0° during hospitalization. We observed increased phase angles in 49 patients (43%), with a median increase of 0.2°. Multiple regression analysis showed that changes in phase angle were independently associated with FIM-motor score at discharge (β=0.238, p=0.027). Changes in phase angle were not significantly associated with SMI (β=0.059, p=0.599) or handgrip strength (β=-0.032, p=0.773) at discharge. CONCLUSION An increased phase angle during rehabilitation was positively associated with ADL improvement in patients with osteoporotic fractures. These findings may help clinicians make informed decisions regarding patient care and treatment strategies for better outcomes.
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Affiliation(s)
- Yusuke Ito
- Department of Rehabilitation, Beppu Rehabilitation Center, Oita, Japan
| | - Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Fumihiko Nagano
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Ayaka Matsumoto
- Department of Pharmacy, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
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Yen HC, Chuang HJ, Hsiao WL, Tsai YC, Hsu PM, Chen WS, Han YY. Assessing the impact of early progressive mobilization on moderate-to-severe traumatic brain injury: a randomized controlled trial. Crit Care 2024; 28:172. [PMID: 38778416 PMCID: PMC11112875 DOI: 10.1186/s13054-024-04940-0] [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: 02/26/2024] [Accepted: 05/04/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Traumatic brain injury (TBI) is a major cause of neurodisability worldwide, with notably high disability rates among moderately severe TBI cases. Extensive previous research emphasizes the critical need for early initiation of rehabilitation interventions for these cases. However, the optimal timing and methodology of early mobilization in TBI remain to be conclusively determined. Therefore, we explored the impact of early progressive mobilization (EPM) protocols on the functional outcomes of ICU-admitted patients with moderate to severe TBI. METHODS This randomized controlled trial was conducted at a trauma ICU of a medical center; 65 patients were randomly assigned to either the EPM group or the early progressive upright positioning (EPUP) group. The EPM group received early out-of-bed mobilization therapy within seven days after injury, while the EPUP group underwent early in-bed upright position rehabilitation. The primary outcome was the Perme ICU Mobility Score and secondary outcomes included Functional Independence Measure motor domain (FIM-motor) score, phase angle (PhA), skeletal muscle index (SMI), the length of stay in the intensive care unit (ICU), and duration of ventilation. RESULTS Among 65 randomized patients, 33 were assigned to EPM and 32 to EPUP group. The EPM group significantly outperformed the EPUP group in the Perme ICU Mobility and FIM-motor scores, with a notably shorter ICU stay by 5.9 days (p < 0.001) and ventilation duration by 6.7 days (p = 0.001). However, no significant differences were observed in PhAs. CONCLUSION The early progressive out-of-bed mobilization protocol can enhance mobility and functional outcomes and shorten ICU stay and ventilation duration of patients with moderate-to-severe TBI. Our study's results support further investigation of EPM through larger, randomized clinical trials. Clinical trial registration ClinicalTrials.gov NCT04810273 . Registered 13 March 2021.
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Affiliation(s)
| | | | | | | | - Po-Min Hsu
- National Taiwan University Hospital, Taipei, Taiwan
| | | | - Yin-Yi Han
- National Taiwan University Hospital, Taipei, Taiwan.
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Oliveira Silvino V, Raffaela Barbosa Barros K, Machado Brito F, Matheus Dias Magalhães F, Augusto Ferreira Carioca A, César Carneiro Loureiro A, Salvador Veras-Silva A, Daniel Motta Drummond M, Antonio Pereira Dos Santos M. Phase angle as an indicator of body composition and physical performance in handball players. BMC Sports Sci Med Rehabil 2024; 16:114. [PMID: 38773478 PMCID: PMC11107023 DOI: 10.1186/s13102-024-00899-1] [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: 10/31/2023] [Accepted: 05/07/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Phase angle (PhA), obtained from the bioimpedance analysis, is widely used in clinical situations and in sports. This study evaluated the association between PhA with body composition and physical performance of handball athletes. METHODS 43 national-level players (22.19 ± 3.86 years) of both sexes were evaluated regarding anthropometry, body composition, squat (SJ) and countermovement (CMJ) jumps, handgrip strength, and cardiorespiratory fitness. RESULTS We verified a correlation between PhA of the whole body and fat-free mass (r = 0.511), body mass index (r = 0.307), and body fat % (r = -0.303). There was a positive correlation between PhA of the whole body and SJ (r = 0.376), CMJ (r = 0.419), and handgrip for the dominant hand (r = 0.448). Moreover, PhA of the upper limbs was more strongly correlated with handgrip for the dominant (r = 0.630) and non-dominant hand (r = 0.575) compared to PhA of the whole body considering both sexes. Similarly, segmental PhA had a stronger significant correlation with SJ (r = 0.402) and handgrip for the dominant hand (r = 0.482) in males, as well as CMJ (r = 0.602) in females, compared to PhA of the whole body. CONCLUSION PhA of the whole body was positively related to fat-free mass, body mass index, body fat %, and lower- and upper-limbs strength in handball athletes. Segmental PhA might be used as a tool for estimating lower and upper limbs performance considering the sex, in preference to the PhA of the whole body.
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Affiliation(s)
- Valmir Oliveira Silvino
- Department of Biophysics and Physiology, Federal University of Piaui, 3700 Pedro Freitas Avenue, Teresina, 64018000, Piauí, Brazil.
- Nucleus of Study in Physiology Applied to Performance and Health (NEFADS), Federal University of Piaui, Teresina, Piauí, Brazil.
- Rede Nordeste de Biotecnologia (RENORBIO), Federal University of Piauí, Teresina, Piauí, Brazil.
| | - Kelly Raffaela Barbosa Barros
- Department of Biophysics and Physiology, Federal University of Piaui, 3700 Pedro Freitas Avenue, Teresina, 64018000, Piauí, Brazil
- Nucleus of Study in Physiology Applied to Performance and Health (NEFADS), Federal University of Piaui, Teresina, Piauí, Brazil
| | - Felipe Machado Brito
- Department of Biophysics and Physiology, Federal University of Piaui, 3700 Pedro Freitas Avenue, Teresina, 64018000, Piauí, Brazil
- Nucleus of Study in Physiology Applied to Performance and Health (NEFADS), Federal University of Piaui, Teresina, Piauí, Brazil
| | - Francisco Matheus Dias Magalhães
- Department of Biophysics and Physiology, Federal University of Piaui, 3700 Pedro Freitas Avenue, Teresina, 64018000, Piauí, Brazil
- Nucleus of Study in Physiology Applied to Performance and Health (NEFADS), Federal University of Piaui, Teresina, Piauí, Brazil
| | | | | | - Acácio Salvador Veras-Silva
- Department of Biophysics and Physiology, Federal University of Piaui, 3700 Pedro Freitas Avenue, Teresina, 64018000, Piauí, Brazil
| | - Marcos Daniel Motta Drummond
- Department of Physical Education, Physiotherapy and Occupational Therapy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marcos Antonio Pereira Dos Santos
- Department of Biophysics and Physiology, Federal University of Piaui, 3700 Pedro Freitas Avenue, Teresina, 64018000, Piauí, Brazil
- Nucleus of Study in Physiology Applied to Performance and Health (NEFADS), Federal University of Piaui, Teresina, Piauí, Brazil
- Rede Nordeste de Biotecnologia (RENORBIO), Federal University of Piauí, Teresina, Piauí, Brazil
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Prete M, Ballarin G, Porciello G, Arianna A, Luongo A, Belli V, Scalfi L, Celentano E. Bioelectrical impedance analysis-derived phase angle (PhA) in lung cancer patients: a systematic review. BMC Cancer 2024; 24:608. [PMID: 38769506 PMCID: PMC11106952 DOI: 10.1186/s12885-024-12378-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/13/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Lung cancer is the second most diagnosed cancer in the world. Up to 84% of diagnosed patients have malnutrition, which can negatively affect quality of life and survival and may worsen with neoadjuvant treatment. Bioelectrical Impedance Analysis-Derived Phase Angle (PhA) in these patients could be a valid tool to assess the nutritional status in order to improve their condition. METHODS This review provides an update on PhA assessment in lung cancer patients over the past twenty years. We searched PubMed, Embase, Scopus, Web of Science, and Cochrane, for articles regarding the PhA obtained from Bioelectrical Impedance Analysis in lung cancer patients. The authors independently performed a literature search: sample size, patient population, study type, study dates, survival and interventions were evaluated. The final review included 11 studies from different countries. RESULTS Eight studies only considered patients with lung cancer, while three studies considered patients with different kind of cancer, including lung. Correlation data between PhA and age are conflicting. In patients undergoing clinical treatment and patients undergoing surgical treatment lower PhA was observed. A lower PhA is associated with a shorter survival. In three studies emerged a relationship between Karnofski Performance Status and Handgrip Strenght with PhA. From one study, univariate logistic regression analysis showed that higher PhA values represent a protective factor for sarcopenia. CONCLUSION Our research underlined interesting, but not conclusive, results on this topic; however more researches are needed to understand the clinical meaning of PhA.
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Affiliation(s)
- Melania Prete
- Division of Radiotherapy, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, 80131, Italy
| | - Giada Ballarin
- Department of Medical, Movement Sciences and Wellbeing, University of Naples "Parthenope", Naples, 80133, Italy
| | - Giuseppe Porciello
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, 80131, Italy.
| | - Aniello Arianna
- Department of Public Health, Federico II University Hospital, Via Pansini 5, Naples, 80131, Italy
| | - Assunta Luongo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, 80131, Italy
| | - Valentina Belli
- Scientific Direction, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, 80131, Italy
| | - Luca Scalfi
- Department of Public Health, Federico II University Hospital, Via Pansini 5, Naples, 80131, Italy
| | - Egidio Celentano
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, 80131, Italy
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Musijowska M, Kwilosz E. Association between Physical Activity Level, Body Composition, and Phase Angle in University Students from Bioelectrical Impedance Analysis (BIA). J Clin Med 2024; 13:2743. [PMID: 38792285 PMCID: PMC11121990 DOI: 10.3390/jcm13102743] [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: 03/15/2024] [Revised: 04/23/2024] [Accepted: 04/27/2024] [Indexed: 05/26/2024] Open
Abstract
Background: The aim of this study is to determine the relationship between selected components of body composition and the phase angle specified by bioelectrical impedance analysis, depending on the level of physical activity among students. Materials and Methods: The study group consisted of 484 university students from Krosno. The diagnostic survey method (IPAQ-SF), measurements of highs, and analysis of body composition components (BIA) were used. The relationship between variables was determined using the χ2 test, the V-Kramer coefficient, and Spearman's rho coefficient. Results: University students in physical education demonstrated the highest level of physical activity and the lowest incidence of excessive body mass. Among the participants, 28.1% did not engage in any physical activity, or their level was insufficient. The PhA level was correlated with lean body mass and muscle mass. The correlation between higher levels of PA and PhA values was statistically significant, as was the relationship between self-assessment of physical fitness and the level of PA determined by IPAQ-SF. Conclusions: Preventive actions and educational programs, especially about spending leisure time in active ways, should be particularly targeted at students of disciplines with a significant amount of sedentary classes.
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Affiliation(s)
- Monika Musijowska
- Department of Physical Education, State University of Applied Sciences in Krosno, Rynek 1, 38-400 Krosno, Poland
| | - Edyta Kwilosz
- Department of Nursing, State University of Applied Sciences in Krosno, St. Kazimierza Wielkiego 6, 38-400 Krosno, Poland
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Khatun S, Ogawa M, Uchizawa A, Hoshi D, Tamai S, Momma R, Kondo E, Watanabe K, Sagayama H. Glycated hemoglobin (HbA1c) is independently associated with the bioelectrical impedance phase angle in junior sumo wrestlers: A pilot study. Physiol Rep 2024; 12:e16045. [PMID: 38740565 PMCID: PMC11090887 DOI: 10.14814/phy2.16045] [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: 03/07/2024] [Revised: 04/26/2024] [Accepted: 04/26/2024] [Indexed: 05/16/2024] Open
Abstract
The study explores the relationship between phase angle (PhA), an indicator of cellular health, and metabolic health parameters among junior sumo wrestlers in Japan. Given the demanding lifestyle and high-energy diets of sumo wrestlers that predispose them to metabolic syndrome post-retirement, this study focuses on a younger cohort. The primary aim is to evaluate if PhA could serve as an early indicator of metabolic health issues within this unique demographic. A total of 14 sumo wrestlers aged 9-17 years were assessed to determine the relationship between PhA and various metabolic markers, including glycated hemoglobin (HbA1c), using a TANITA MC-780A-N body composition analyzer and standard blood tests. Bivariate regression analysis and Pearson's correlation revealed a negative relationship between PhA and HbA1c even after adjusting for age and weight (ß = -0.496, r2 = 0.776, r = -0.756, p = 0.004). The results indicate a significant negative relationship between PhA and HbA1c levels, suggesting that lower PhA values, which indicate poorer cellular integrity, are associated with higher HbA1c levels, signifying impaired glycemic control. These findings underscore the potential of PhA as a valuable biomarker for monitoring metabolic health in young sumo wrestlers, with implications for early intervention and management strategies.
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Affiliation(s)
- Suraiya Khatun
- Doctoral Program in Sports Medicine, Graduate School of Comprehensive Human SciencesUniversity of TsukubaIbarakiJapan
| | - Miori Ogawa
- Department of PediatricsJapanese Red Cross Nasu HospitalTochigiJapan
- Institute of Health and Sports SciencesUniversity of TsukubaIbarakiJapan
| | - Akiko Uchizawa
- Institute of Health and Sports SciencesUniversity of TsukubaIbarakiJapan
- Japan Society for the Promotion of ScienceTokyoJapan
| | - Daisuke Hoshi
- Human Informatics and Interaction Research InstituteNational Institute of Advanced Industrial Science and TechnologyTsukubaIbarakiJapan
| | - Shinsuke Tamai
- Department of Sport Science and ResearchJapan Institute of Sports SciencesTokyoJapan
| | - Reiko Momma
- Department of Sport Science and ResearchJapan Institute of Sports SciencesTokyoJapan
| | - Emi Kondo
- Institute of Health and Sports SciencesUniversity of TsukubaIbarakiJapan
- Japan Society for the Promotion of ScienceTokyoJapan
| | - Koichi Watanabe
- Institute of Health and Sports SciencesUniversity of TsukubaIbarakiJapan
| | - Hiroyuki Sagayama
- Institute of Health and Sports SciencesUniversity of TsukubaIbarakiJapan
- Advanced Research Initiative for Human High Performance (ARIHHP)University of TsukubaTsukubaJapan
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Santos S, Melo F, Fernandes O, Parraca JA. The effect of Ashtanga-Vinyasa Yoga method on air force pilots' operational performance. Front Public Health 2024; 12:1334880. [PMID: 38751579 PMCID: PMC11094342 DOI: 10.3389/fpubh.2024.1334880] [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] [Accepted: 04/15/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction In today's military landscape, optimizing performance and bolstering physical health and mental resilience are critical objectives. Introducing a 12-week Ashtanga Vinyasa Yoga Supta Method (AVYSM) to the training protocol of military trained Airforce pilots, we aim to assesses the feasibility and impact of the method. Materials and equipment Borg Scale assesses the intensity level of physical activity during the intervention. Flight simulator data gauges operational performance responses. Postural control responses are measured using a force platform, stress responses are monitored via heart monitor, and handgrip dynamometry will measure strength. Respiratory capacity is assessed using a spirometer, body composition is evaluated using impedance balance, and aviation-related questionnaires are administered before and after the intervention period. Methods In a randomized controlled trial, the totality of pilots from the "Masters in Military Aeronautics: aviator pilot specialist" course at the Portuguese Air Force Academy (PAA) were randomly assigned to the yoga intervention or the waiting list control groups, with participants providing written informed consent. The control group followed protocolized course classes for 12 weeks, while the intervention group integrated two weekly one-hour yoga sessions into their course. Results The PAA has approved the implementation of this intervention protocol at Airbase 11 in Beja, highlighting its significance for the organization's policy makers. We hypothesize that this method will enhance operational performance and, subsequently, elevate flight safety. Discussion This research's potential extends beyond the PAA, as it can be adapted for use in Airforce departments of other nations and various military contexts. Clinical trial registration Évora University research ethics committee-approval number 21050. Study registered on ClinicalTrials.gov under identifier NCT05821270, registered on April 19, 2023.
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Affiliation(s)
- Sara Santos
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, Évora, Portugal
| | - Filipe Melo
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, Évora, Portugal
- Universidade de Lisboa Faculdade de Motricidade Humana: Cruz Quebrada, Lisboa, Portugal
| | - Orlando Fernandes
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, Évora, Portugal
| | - José Alberto Parraca
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, Évora, Portugal
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Zuo J, Zhou D, Zhang L, Zhou X, Gao X, Hou W, Wang C, Jiang P, Wang X. Comparison of bioelectrical impedance analysis and computed tomography for the assessment of muscle mass in patients with gastric cancer. Nutrition 2024; 121:112363. [PMID: 38359703 DOI: 10.1016/j.nut.2024.112363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 01/09/2024] [Accepted: 01/18/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Low muscle mass was significantly correlated with poor clinical outcomes in cancer patients. This study aimed to compare the differences between bioelectrical impedance analysis (BIA) and computed tomography (CT) in measuring skeletal muscle mass and detecting low muscle mass in patients with gastric cancer (GC). METHOD This cross-sectional study included a total of 302 consecutive patients diagnosed with GC at our institution from October 2021 to March 2023. CT images were analyzed at the L3 level to obtain the cross-sectional area of skeletal muscle, which was subsequently used for calculating whole-body skeletal muscle mass via the Shen equation and skeletal muscle tissue density. BIA was utilized to measure skeletal muscle mass using the manufacturer's proprietary algorithms. Skeletal muscle mass (kg) was divided by height squared (m2) to obtain skeletal muscle index (SMI, kg/m2). Pearson's correlation coefficient was performed to assess the correlation between SMI measured by BIA and CT. The agreement between the two methods was assessed using Bland-Altman analyses. The clinically acceptable agreement was defined as the 95% limits of agreement (LOA) for the percentage bias falling within ± 10%. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of BIA in identifying low muscle mass. RESULTS A total of 59 patients (19.5%) were identified as having low muscle mass based on CT analysis, whereas only 19 patients (6.3%) met the criteria for low muscle mass according to BIA analysis. BIA-measured SMI showed a strong positive correlation with CT-measured SMI in all patients (r = 0.715, P < 0.001). With Bland-Altman analysis, there was a significant mean bias of 1.18 ± 0.96 kg/m2 (95% CI 1.07-1.29, P < 0.001) between SMI measured by BIA and CT. The 95% LOA for the percentage bias ranged from -7.98 to 33.92%, which exceeded the clinically acceptable range of ± 10%. A significant difference was observed in the mean bias of SMI measured by BIA and CT between patients with and without GLIM malnutrition (1.42 ± 0.91 kg/m2 versus 0.98 ± 0.96 kg/m2, P < 0.001). The cut-off values for BIA-measured SMI in identifying low muscle mass using CT as the reference were 10.11 kg/m2 for males and 8.71 kg/m2 for females (male: AUC = 0.840, 95% CI: 0.772-0.908; female: AUC = 0.721, 95% CI: 0.598-0.843). CONCLUSIONS Despite a significant correlation, the values of skeletal muscle mass obtained BIA and CT cannot be used interchangeably. The BIA method may overestimate skeletal muscle mass in GC patients compared to CT, especially among those with GLIM malnutrition, leading to an underestimation of low muscle mass prevalence.
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Affiliation(s)
- Junbo Zuo
- Department of General Surgery, The Affiliated Jinling Hospital of Nanjing Medical University, Nanjing, China; Department of General Surgery, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Da Zhou
- Department of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Li Zhang
- Department of General Surgery, The Affiliated Jinling Hospital of Nanjing Medical University, Nanjing, China; Department of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xiaodong Zhou
- Department of General Surgery, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Xuejin Gao
- Department of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Wenji Hou
- Department of General Surgery, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Chen Wang
- Department of General Surgery, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Pengcheng Jiang
- Department of General Surgery, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Xinying Wang
- Department of General Surgery, The Affiliated Jinling Hospital of Nanjing Medical University, Nanjing, China; Department of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
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Han JM, Kim DH, Lee BC. Association between the Thickness or Area of the Temporal Muscle and Skeletal Muscle Mass in Bioimpedance Analysis. Gerontology 2024; 70:823-830. [PMID: 38657583 PMCID: PMC11309061 DOI: 10.1159/000539063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 04/22/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Sarcopenia associated with stroke can significantly impact patient prognosis; however, the current standard diagnostic methods for sarcopenia are rarely used in stroke patients. Therefore, the aim of the current study was to investigate whether the temporal muscle thickness (TMT) or area (TMA) could serve as a surrogate marker for measuring skeletal muscle mass. METHODS This retrospective chart review study was conducted on 244 participants from March 2018 to February 2020. The TMT and TMA were measured at the supraorbital roof level using brain CT or T1-weighted MR imaging obtained from participants. The skeletal muscle mass and skeletal muscle index (SMI) and whole-body phase angle (WBPA) at 50 kHz were collected. Pearson correlation analysis was used to assess the relationship between the TMT or TMA and the results of the bioimpedance analysis. RESULTS The mean TMT showed significant positive correlations with skeletal muscle mass (male, r = 0.520; female, r = 0.706), SMI (male, r = 0.426; female, r = 0.582), and WBPA (male, r = 0.295; female, r = 0.232). The mean TMA showed significant positive correlations with skeletal muscle mass (male, r = 0.490; female, r = 0.657), SMI (male, r = 0.289; female, r = 0.473), and WBPA (male, r = 0.232; female, r = 0.243). CONCLUSION We observed moderate to strong positive correlations between body composition analysis measured by BIA and TMT or TMA, suggesting that TMT or TMA could serve as a reliable surrogate marker for identifying low skeletal muscle mass in cerebrovascular disease.
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Affiliation(s)
- Jee Myung Han
- Department of Physical Medicine and Rehabilitation, Chung-Ang University Hospital, Seoul, South Korea
| | - Du Hwan Kim
- Department of Physical Medicine and Rehabilitation, Chung-Ang University Hospital, Seoul, South Korea
| | - Byung Chan Lee
- Department of Physical Medicine and Rehabilitation, Chung-Ang University Hospital, Seoul, South Korea
- Biomedical Research Institute, Chung-Ang University Hospital, Seoul, South Korea
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Salazar-Solarte AM, Torres-Canchala L, Carrera-Gil F, Quimbayo-Wilches DM. Pulmonary function and body composition parameters of children with cystic fibrosis from a hight complexity institution between 2015 and 2018. Pediatr Neonatol 2024:S1875-9572(24)00047-0. [PMID: 38658270 DOI: 10.1016/j.pedneo.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 10/25/2023] [Accepted: 11/10/2023] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND An adequate nutritional status in patients with cystic fibrosis correlates with higher survival and better pulmonary function. Body mass index (BMI) is an anthropometric indicator with independent association with pulmonary function, and it can hide alterations of nutritional status in cystic fibrosis. OBJECTIVE To determine the relationship of lung function with BMI and body composition parameters in children with cystic fibrosis in a Hight Complexity institution between 2015 and 2018. MATERIALS AND METHODS It was an observational study with analytical, cross-sectional, and retrospective scope, including 33 patients between 5 and 17 years old. Spearman's test was applied to evaluate correlation of FEV1 (forced expiratory volume in first second) with BMI and five body composition parameters by bioelectrical impedance using InbodyS10 equipment. Statistical significance was considered with p < 0.05. RESULTS Positive correlation was obtained between FEV1 and appendicular skeletal muscle mass between lung function and percentage of fat-free mass (p = 0.006) and phase angle (p = 0.001). Percent fat mass had a negative correlation with FEV1 (p = 0.007). BMI and fat free mass index did not correlate with lung function (p = 0.085). CONCLUSIONS Appendicular skeletal muscle mass correlated better than BMI with lung function in children with cystic fibrosis. It is recommended to perform anthropometric follow-up by BMI complemented with body composition study in children with cystic fibrosis. Analyses with larger populations are required to standardize its use.
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Affiliation(s)
- Aura María Salazar-Solarte
- Pediatrics Department, Hospital Universitario Fundación Valle del Lili, Cali, Colombia; Faculty of Health Sciences, Universidad Icesi, Cali, Colombia; Interdisciplinary Research Group in Epidemiology and Public Health, Universidad Libre, Seccional, Cali, Colombia.
| | | | - Frank Carrera-Gil
- Faculty of Health Sciences, Pontificia Universidad Javeriana, Cali, Colombia
| | - Diana María Quimbayo-Wilches
- Pediatrics Department, Hospital Universitario Fundación Valle del Lili, Cali, Colombia; Faculty of Health Sciences, Universidad Icesi, Cali, Colombia; Pediatrics and Gastroenterology Department. Hospital Universitario Fundación Valle del Lili, Cali, Colombia
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de Mateo Silleras B, Barrera Ortega S, Carreño Enciso L, de la Cruz Marcos S, Redondo del Río P. Prevalence of Malnutrition in a Group of Institutionalized Psychogeriatric Patients Using Different Diagnostic Criteria. Nutrients 2024; 16:1116. [PMID: 38674807 PMCID: PMC11053945 DOI: 10.3390/nu16081116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/01/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
Malnutrition (MN) is a highly prevalent condition in the elderly. It is associated with functional impairment, disability, frailty, and sarcopenia. The aim was to analyze the capacity of GLIM and ESPEN criteria to diagnose MN in a sample of institutionalized psychogeriatric patients. Clinical and anthropometric data were collected in a cross-sectional study. Patients' frailty, dependence, functional capacity, MNA, hand-grip strength (HS), and sarcopenia were evaluated. Body composition (BC) was estimated by conventional bioimpedance analysis. MN diagnosis was established using the ESPEN and the GLIM criteria based on fat-free mass index (GLIM-FFMI), appendicular skeletal muscle mass index (GLIM-ASMMI), skeletal muscle mass index (GLIM-SMMI), and HS (mGLIM). Ninety-two patients (57.6% men; mean age: 79.4 years) were studied. Depending on the diagnosis criteria, MN prevalence was between 25% (ESPEN) and 41.3% (GLIM-SMMI). Agreement between ESPEN and all GLIM criteria was poor, but it was excellent between all GLIM criteria (kappa > 0.8). Phenotypic criteria carried more weight in the diagnosis of MN than etiological ones. Depending on the parameter used, the prevalence of reduced muscle mass was notably different. Differences in BMI, BC, inflammation, and albumin are detected by the GLIM-FFMI criteria in the MN and non-MN subjects. Also, this criterion is the only one that identified differences in phase angle (PhA) between these groups. In the elderly, PhA can be very useful to monitor nutritional status.
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Affiliation(s)
- Beatriz de Mateo Silleras
- Department of Nutrition and Food Science, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain; (B.d.M.S.); (L.C.E.); (P.R.d.R.)
- Spanish Society of Community Nutrition (SENC), 08029 Barcelona, Spain
| | - Sara Barrera Ortega
- Psycho-Geriatric Area, Assistance Center of San Juan de Dios, 34005 Palencia, Spain;
| | - Laura Carreño Enciso
- Department of Nutrition and Food Science, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain; (B.d.M.S.); (L.C.E.); (P.R.d.R.)
| | - Sandra de la Cruz Marcos
- Department of Nutrition and Food Science, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain; (B.d.M.S.); (L.C.E.); (P.R.d.R.)
| | - Paz Redondo del Río
- Department of Nutrition and Food Science, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain; (B.d.M.S.); (L.C.E.); (P.R.d.R.)
- Spanish Society of Community Nutrition (SENC), 08029 Barcelona, Spain
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Oliveira LDA, Ventura JC, Hauschild DB, Moreno YMF. Phase angle as a prognostic indicator in critically ill children: A systematic review. Nutr Clin Pract 2024; 39:385-395. [PMID: 37221576 DOI: 10.1002/ncp.11011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 03/22/2023] [Accepted: 04/16/2023] [Indexed: 05/25/2023] Open
Abstract
Phase angle (PhA) may reflect the integrity of cellular membranes, hydration status, and total body cell mass. Studies have shown that PhA can be used as a good predictor for evaluation of disease severity in critically ill adults. However, there is a lack of studies assessing the association between PhA and clinical outcomes in critically ill children. This systematic review described the association between PhA at pediatric intensive care unit (PICU) admission with clinical outcomes in critically ill children. The search was conducted using PubMed/Medline, Scopus, Web of Science, EMBASE and LILACS until July 22, 2022. Studies that evaluate the association between PhA at PICU admission in critically ill children and clinical outcomes were eligible. Data regarding population, study design, setting, bioelectrical impedance analysis (BIA) protocol used, PhA classification, and outcome analysis were extracted. Risk of bias was assessed by Newcastle-Ottawa Scale. Among the 4669 articles screened, five prospective studies were included. The studies have shown association between lower values of PhA at PICU admission with longer PICU and hospital length of stay, duration of mechanical ventilation, septic shock, and higher mortality risk. Small sample size, different clinical conditions, and methodological differences of the studies regarding BIA equipment and cutoffs of PhA were observed. Although the studies have limitations, the PhA has a potential role in predicting clinical outcomes in critically ill children. Larger studies with standardized PhA protocols and other relevant clinical outcomes are necessary.
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Affiliation(s)
- Luna D A Oliveira
- Graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Julia C Ventura
- Graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Daniela B Hauschild
- Graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Yara M F Moreno
- Graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, Brazil
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Talani C, Astradsson T, Farnebo L, Mäkitie A, Ehrsson YT, Laurell G. Pretreatment fat-free mass index correlates with early death in patients with head and neck squamous cell carcinoma. Head Neck 2024; 46:808-818. [PMID: 38193618 DOI: 10.1002/hed.27628] [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: 07/31/2023] [Revised: 11/27/2023] [Accepted: 12/23/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND A significant proportion of patients with head and neck squamous cell carcinoma (HNSCC) are malnourished at diagnosis. In this study, we investigated how pretreatment body mass index (BMI) and fat-free mass index (FFMI) correlate with early death, and whether these measurements are useful markers of prognosis for risk stratification of head and neck cancer patients. METHODS Patients (n = 404) with newly diagnosed, curable HNSCC and WHO performance status 0-2 were prospectively included and met with a study representative before treatment initiation, as well as up to four follow-up visits. All patients provided an estimate of body weight at 6 months prior to diagnosis. Bioelectrical impedance analysis (BIA) was performed for all patients before treatment initiation. RESULTS Most patients had oropharyngeal (46%), oral cavity (28%), or laryngeal cancer (12%). Forty-five (11%) patients met the standardized criteria for malnutrition according to the Global Leadership Initiative on Malnutrition (GLIM) at diagnosis. FFMI at diagnosis was lower in patients who died within 6 and 12 months after the start of treatment than in patients who survived these time points (p = 0.035 and p = 0.005, respectively). CONCLUSIONS In this study, pretreatment FFMI was an independent prognostic factor for death within 6 and 12 months after the start of treatment in patients with HNSCC. Pretreatment BMI was not an independent risk factor for death within 6 and 12 months after treatment termination. Thus, FFMI may be useful for risk stratification of patients with head and neck cancer.
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Affiliation(s)
- Charbél Talani
- Faculty of Medicine and Health Sciences, Department of Biomedical and Clinical Sciences, Division of Sensory Organs and Communication, Linköping University, Linköping, Sweden
- Department of Otorhinolaryngology in Linköping, Anaesthetics, Operations and Specialty Surgery Center, Region Östergötland, Linköping, Sweden
| | | | - Lovisa Farnebo
- Faculty of Medicine and Health Sciences, Department of Biomedical and Clinical Sciences, Division of Sensory Organs and Communication, Linköping University, Linköping, Sweden
- Department of Otorhinolaryngology in Linköping, Anaesthetics, Operations and Specialty Surgery Center, Region Östergötland, Linköping, Sweden
| | - Antti Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Program in Systems Oncology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute and Karolinska Hospital, Stockholm, Sweden
| | | | - Göran Laurell
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Kalmpourtzidou A, Di Napoli I, Vincenti A, De Giuseppe R, Casali PM, Tomasinelli CE, Ferrara F, Tursi F, Cena H. Epicardial fat and insulin resistance in healthy older adults: a cross-sectional analysis. GeroScience 2024; 46:2123-2137. [PMID: 37857994 PMCID: PMC10828363 DOI: 10.1007/s11357-023-00972-6] [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: 07/11/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023] Open
Abstract
Insulin resistance (IR) and cardiovascular diseases (CVD) are relevant concerns in the elderly population; as the world's population ages, IR and CVD are two universal public health problems. While a link between IR a CVD has been established, the mediating mechanisms are uncertain and rigorous investigations are needed to fully elucidate them. The study aimed at assessing the relationship between epicardial fat (EF), an indicator of cardiovascular risk, and IR in Italian free-living elderly (n = 89). Baseline data from a previous cohort was used. Anthropometric measurements, EF, and IR-related variables, including the HOMA-IR index and other biochemical parameters were obtained. The correlation between EF and IR was explored. Further analysis was conducted to identify significant differences regarding IR variables among EF quartiles. EF correlated positively with glucose levels in females, males and the total population. The pairwise comparison among EF quartiles showed significant differences in glucose levels, HOMA-IR index, triglycerides, and total cholesterol levels. To our knowledge, this is the only study assessing the relationship between EF and IR in healthy elderly, while most of the studies have investigated EF and IR in diseased populations. Further research with a longitudinal approach should be conducted to design concrete conclusions about this relationship.
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Affiliation(s)
- Aliki Kalmpourtzidou
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100, Pavia, Italy
| | - Ilaria Di Napoli
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100, Pavia, Italy
| | - Alessandra Vincenti
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100, Pavia, Italy
| | - Rachele De Giuseppe
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100, Pavia, Italy.
| | - Pietro Mariano Casali
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Chiara Elena Tomasinelli
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100, Pavia, Italy
| | - Fulvio Ferrara
- Laboratory Medicine Department - Centro Diagnostico Italiano, Milan, Italy
| | - Francesco Tursi
- Complife Italia s.r.l., Piazzale Siena 11, 20146, Milano, Italy
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100, Pavia, Italy
- Clinical Nutrition and Dietetic Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, 27100, Pavia, Italy
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Lopes MMGD, Sousa IM, Queiroz SA, Bezerra MRO, Gonzalez MC, Fayh APT. Bioelectrical impedance vector analysis is different according to the comorbidity burden in post-acute myocardial infarction. Nutr Clin Pract 2024; 39:450-458. [PMID: 37740504 DOI: 10.1002/ncp.11074] [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: 04/27/2023] [Revised: 08/01/2023] [Accepted: 08/20/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND The prevalence of a high comorbidity burden in patients who suffered an acute myocardial infarction (AMI) is increasing with the aging population, and the nutrition status also may be a predictor of clinical outcomes for these patients. This study aimed to investigate the relationship between the comorbidity burden and the characteristics of the bioelectrical impedance vector analysis (BIVA) in patients post-AMI. METHODS This prospective observational cohort study was conducted with adult patients who were hospitalized with AMI. Pre-existing comorbidities were assessed by the Charlson comorbidity index (CCI) adjusted by age, and anthropometric and BIVA characteristics were evaluated after the hemodynamic stabilization. All patients were followed-up until hospital discharge, and their length of stay was observed. RESULTS A total of 184 patients (75% were males; mean age, 60.2 ± 12.3 years) were included. The most common comorbidities were dyslipidemia (73.9%), hypertension (62%), and type 2 diabetes (34.2%). A higher CCI (≥3) was associated with sex (P = 0.008) and age (P < 0.001). Regarding BIVA, statistically significant differences were detected between sex (P < 0.001), age (P < 0.001), and CCI (P = 0.003), with longer vectors in female, older adults, and those with CCI ≥ 3. CONCLUSION Finding a relationship between BIVA and CCI suggests the first identified coherent differences, potentially correlated with diseases, representing a first contribution to support this type of assessment. Therefore, with BIVA, healthcare professionals may monitor abnormalities and adopt preventive nutrition care measures on patients post-AMI to improve their clinical status.
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Affiliation(s)
- Marcia M G D Lopes
- Department of Nutrition, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Applied Sciences to Women's Health, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Iasmin M Sousa
- Health Sciences Center, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Sandra Azevedo Queiroz
- Department of Nutrition, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Mara R O Bezerra
- Department of Nutrition, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Maria Cristina Gonzalez
- Department of Health and Behavior, Catholic University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Ana Paula Trussardi Fayh
- Health Sciences Center, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Department of Nutrition, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Liu S, Zhang S, Cheng X, Wu D, Chen J, Liang W, Qian S, Zhang J, Jiang F. A meta-analysis on the impact of resistance training on phase angle in middle-aged and older individuals. Arch Gerontol Geriatr 2024; 119:105318. [PMID: 38194828 DOI: 10.1016/j.archger.2023.105318] [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: 10/04/2023] [Revised: 12/14/2023] [Accepted: 12/17/2023] [Indexed: 01/11/2024]
Abstract
PURPOSE To determine the impact of resistance training (RT) on phase angle (PhA) in middle-aged and older individuals via meta-analysis, explore effects in subgroups, and identify optimal RT protocol. MATERIALS AND METHODS We searched five databases using predefined criteria, assessed literature quality per Cochrane 5.1 Handbook, and used Revman 5.3 for effect size aggregation, bias assessment, sensitivity analysis, and subgroup analysis. RESULTS RT improved PhA in middle-aged and older individuals (d = 0.34, 95 % CI: 0.27-0.40, P < 0.05). Effective subgroups included Suspension (d = 0.62, 95 % CI: 0.33-0.90, P < 0.05), free-weights and machine (d = 0.36, 95 % CI: 0.28-0.45, P < 0.05), equipment training (d = 0.24, 95 % CI: 0.13-0.36, P < 0.05), and moderate-intensity RT (d = 0.34, 95 % CI: 0.27-0.42, P < 0.05). RT was conducted 2-3 times/week (d = 0.20, 95 % CI: 0.01-0.38, P < 0.05) or (d = 0.38, 95 % CI: 0.30-0.47, P < 0.05). PhA improved after 8 weeks (d = 0.37, 95 % CI: 0.23-0.51, P < 0.05), 12 weeks (d = 0.35, 95 % CI: 0.26-0.44, P < 0.05), and ≥ 24 weeks (d = 0.26, 95 % CI: 0.11-0.41, P < 0.05) of RT in aged and older individuals. Low- and high-intensity RT, elastic band training, and weekly exercises did not significantly improve PhA. CONCLUSIONS RT enhances PhA in middle-aged and older adults. For optimal results, we recommend 2-3 weekly sessions of free weights and machine training lasting at least 8 weeks.
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Affiliation(s)
- Siqi Liu
- School of Physical Education, Hunan Normal University, Changsha, 410012, China
| | - Siqing Zhang
- School of Physical Education, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Xuejing Cheng
- School of Physical Education, Hunan Normal University, Changsha, 410012, China
| | - Danting Wu
- Department of Physical Education, Tongji University, Shanghai, 200092, China
| | - Jiongxun Chen
- School of Physical Education, Hunan Normal University, Changsha, 410012, China
| | - Wenqi Liang
- School of Physical Education & Sports Science, South China Normal University, Guangzhou, 510006, China
| | - Siyu Qian
- School of Physical Education, Hunan Normal University, Changsha, 410012, China
| | - Jisheng Zhang
- School of Physical Education, Hunan Normal University, Changsha, 410012, China.
| | - Fanglin Jiang
- School of Physical Education, Hunan Normal University, Changsha, 410012, China.
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Kim NY, Jung Y, Hong SB, Ahn JH, Choi SI, Kim YW. Low Phase Angle and Skeletal Muscle Index Increase Hospital-Acquired Infections During Stroke Rehabilitation. J Am Med Dir Assoc 2024; 25:683-689.e1. [PMID: 38163642 DOI: 10.1016/j.jamda.2023.11.021] [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: 05/13/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES Sarcopenia is common in patients with stroke and may increase the risk of medical complications such as infection. However, assessing sarcopenia in stroke patients with consciousness disturbance, aphasia or severe paralysis is challenging. This study aimed to investigate whether a combined assessment of phase angle (PhA) and skeletal muscle index (SMI), estimated using bioelectrical impedance analysis, was associated with 2 common nosocomial infections, hospital-acquired pneumonia (HAP) and urinary tract infection (UTI), during inpatient stroke rehabilitation. DESIGN Single-center retrospective observational study. SETTINGS AND PARTICIPANTS A total of 1068 patients with stroke admitted to a rehabilitation hospital between January 2016 and September 2019 were analyzed. METHODS The study variables included demographic characteristics, comorbidities, stroke severity, blood chemistry and urine analysis, SMI, and PhA obtained using bioelectrical impedance analysis. Patients were classified as normal, low PhA only, low SMI only, and low PhA + SMI. Multivariate Cox proportional analysis was used to determine the variables associated with HAP and UTI. RESULTS A combination of low PhA + SMI was observed in 429 (40.2%) patients. Over a median follow-up duration of 46 days, HAP occurred in 187 patients (17.5%) and UTI occurred in 155 patients (14.5%). The low PhA + SMI group showed a significantly higher incidence of HAP and UTI than the normal group (32.6% vs 4.6%, P < .001, for HAP; 20.7% vs 6.2%, P < .001, for UTI). In multivariate Cox analyses, low PhA and SMI were associated with significantly higher rates of HAP [hazard ratio (HR) 3.36, 95% CI 1.796-6.304, P < .001] and UTI (HR 1.71, 95% CI 1.002-2.947, P < .05) after adjusting for confounding variables. CONCLUSIONS AND IMPLICATIONS Combination of low PhA + SMI was independently associated with a higher risk of HAP and UTI in stroke patients who underwent inpatient rehabilitation. Measuring PhA and SMI using bioelectrical impedance analysis might be helpful in establishing care plans in these population.
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Affiliation(s)
- Na Young Kim
- Department of Rehabilitation Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea.
| | - Yusang Jung
- Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Been Hong
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Jeong Hyeon Ahn
- Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Ick Choi
- Department of Rehabilitation Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Yong Wook Kim
- Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Bongiolo AM, Machado MJ, Lazarotto BA, Rupp MLC, Dal-Pizzol F, Pires MMDS. PHASE ANGLE AS A PREDICTOR OF MUSCLE MASS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE. ARQUIVOS DE GASTROENTEROLOGIA 2024; 61:e23095. [PMID: 38451661 DOI: 10.1590/s0004-2803.246102023-95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/13/2023] [Indexed: 03/08/2024]
Abstract
BACKGROUND Malnutrition/sarcopenia is frequent in patients with inflammatory bowel diseases (IBD), and results in muscle catabolism, impacting treatment response, postoperative complications, and quality of life. OBJECTIVE This study aims to assess whether the phase angle (PhA) is a parameter for predicting reduced muscle mass in patients with IBD. METHODS Adult patients with IBD were included in this cross-sectional study. For the estimation of muscle mass and the calculation of the PhA, we used bioelectrical impedance analysis (BIA). Crohn's disease (CD) and ulcerative colitis (UC) activity scores were defined using the Harvey-Bradshaw index and partial Mayo score, respectively. The area under the ROC curve was calculated to identify the PhA cut-off point for reduced muscle mass. RESULTS The sample consisted of 145 patients, with 39 (26.9%) with IBD in the active phase. There was a correlation of the PhA with skeletal muscle mass (SMM) (rs 0.35, P<0.001) and with the skeletal muscle mass index (SMI) (rs 0.427, P<0.001), and the associations remained in the most active form (moderate or severe) of IBD. The ROC curve analysis indicated that the cut-offs points of the PhA ≤5.042 for female and PhA ≤6.079 for male can be used to predict muscle mass reduction. CONCLUSION The PhA can be considered a predictor of muscle mass reduction in IBD patients, and we can use it for screening and monitoring the evolution of malnutrition. BACKGROUND • This study aims to assess whether the phase angle is a parameter for predicting reduced muscle mass in patients with inflammatory bowel disease. BACKGROUND • There was a correlation of the phase angle with skeletal muscle mass and the associations remained in disease activity. BACKGROUND • The ROC curve analysis indicated that the cut-off point of the PhA ≤5.042° for women and PhA ≤6,079° for men can be used to predict muscle mass reduction. BACKGROUND • The phase angle can be considered a predictor of muscle mass reduction in inflammatory bowel disease.
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Affiliation(s)
- Angela Martinha Bongiolo
- Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Ciências Médicas, Florianópolis, SC, Brasil
| | - Marcos José Machado
- Universidade Federal de Santa Catarina, Departamento de Análises Clínicas, Florianópolis, SC, Brasil
| | - Bruno Ayala Lazarotto
- Universidade Federal de Santa Catarina, Faculdade de Medicina, Florianópolis, SC, Brasil
| | | | - Felipe Dal-Pizzol
- Universidade do Extremo Sul Catarinense, Programa de Pós-Graduação em Ciências da Saúde, Laboratório de Fisiopatologia Experimental, Unidade de Ciências da Saúde, Criciúma, SC, Brasil
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47
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Sanson G, Doriguzzi L, Garbari P, Ruggiero MJ, Valentinuzzo I, Mettulio T, Stolfa E, Fisicaro M, Vecchiet S, Mazzaro E, Zanetti M, Fabiani A. The severity of early fluid overload assessed by bioelectrical vector impedance as an independent risk factor for longer patient care after cardiac surgery. Clin Nutr 2024; 43:803-814. [PMID: 38350288 DOI: 10.1016/j.clnu.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/03/2024] [Accepted: 02/06/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND AND AIMS Fluid overload is a common postoperative complication in patients undergoing cardiac surgery. Although this condition is notably associated with relevant adverse outcomes, assessment of hydration status in clinical practice is challenging. Bioelectrical impedance vector analysis (BIVA) has emerged as a potentially effective method to monitor hydration changes, but the available evidence in critically ill patients undergoing cardiac surgery is limited and sometimes conflicting. The aim of this study was to explore by mean of BIVA the evolution over time of hydration status and its impact on relevant outcomes. METHODS Prospective observational study enrolling 130 patients undergoing cardiac surgery. Height normalized impedance was calculated both before surgery (baseline) and in the first five postoperative days. Relevant clinical and laboratory data were collected daily close to BIVA measurements. Length of mechanical ventilation (MV), intensive care unit (ICU) and hospital stay exceeding the 75th percentile of the study population were considered as study endpoints. RESULTS Compared to baseline, a significant reduction in impedance was found at first postoperative day, demonstrating a relevant fluid overload. An adjusted impedance at first postoperative day shorter than the best respective threshold was associated to longer MV (7.4 times), ICU stay (4.7 times) and hospital stay (5.6 times). A significant change in impedance and phase angle was documented throughout the observation days (p < 0.001), without returning to the baseline value. The co-existence of low impedance and high plasma osmolarity increased significantly the risk of incurring the study outcomes. CONCLUSIONS In patients with cardiac surgery-induced fluid overload, recovery to baseline conditions occurs slowly. A relevant early fluid overload should be considered predictive for longer time of MV, ICU and total hospital stay.
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Affiliation(s)
- Gianfranco Sanson
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, Trieste, Italy.
| | - Lisa Doriguzzi
- Cardiac Surgery Unit, Azienda Sanitaria Universitaria Giuliano-Isontina, Strada di Fiume 447, Trieste, Italy.
| | - Pierpaolo Garbari
- Cardiac Surgery Unit, Azienda Sanitaria Universitaria Giuliano-Isontina, Strada di Fiume 447, Trieste, Italy.
| | - Maria Josè Ruggiero
- Cardiac Surgery Unit, Azienda Sanitaria Universitaria Giuliano-Isontina, Strada di Fiume 447, Trieste, Italy.
| | - Ilaria Valentinuzzo
- Cardiac Surgery Unit, Azienda Sanitaria Universitaria Giuliano-Isontina, Strada di Fiume 447, Trieste, Italy.
| | - Tanja Mettulio
- Cardiac Surgery Unit, Azienda Sanitaria Universitaria Giuliano-Isontina, Strada di Fiume 447, Trieste, Italy.
| | - Elisa Stolfa
- Cardiac Surgery Unit, Azienda Sanitaria Universitaria Giuliano-Isontina, Strada di Fiume 447, Trieste, Italy.
| | - Manuela Fisicaro
- Cardiac Surgery Unit, Azienda Sanitaria Universitaria Giuliano-Isontina, Strada di Fiume 447, Trieste, Italy.
| | - Sara Vecchiet
- Cardiac Surgery Unit, Azienda Sanitaria Universitaria Giuliano-Isontina, Strada di Fiume 447, Trieste, Italy.
| | - Enzo Mazzaro
- Cardiac Surgery Unit, Azienda Sanitaria Universitaria Giuliano-Isontina, Strada di Fiume 447, Trieste, Italy.
| | - Michela Zanetti
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, Trieste, Italy.
| | - Adam Fabiani
- Cardiac Surgery Unit, Azienda Sanitaria Universitaria Giuliano-Isontina, Strada di Fiume 447, Trieste, Italy.
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Hatanaka S, Osuka Y, Kojima N, Motokawa K, Hayakawa M, Mikami Y, Iwasaki M, Inagaki H, Miyamae F, Okamura T, Hirano H, Awata S, Sasai H. Relationship between phase angle and lower-extremity function in older adults: Itabashi Longitudinal Study on Aging. Nutrition 2024; 119:112289. [PMID: 38104512 DOI: 10.1016/j.nut.2023.112289] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/24/2023] [Accepted: 10/29/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE Evaluating muscle quality instead of its mass has gained attention in diagnosing sarcopenia. The aim of this study was to examine whether phase angle (PhA) as a bioelectrical impedance analysis (BIA)-derived muscle quality indicator is associated with overall lower extremity function better than appendicular skeletal muscle mass index (ASMI) in community-dwelling older adults. METHODS This cross-sectional study used data from the Itabashi Longitudinal Study on Aging, a community-based cohort study. A sex-stratified multivariate logistic regression analysis was conducted using PhA and ASMI as exposures, and low physical function defined as short physical performance battery score <10 as the outcome, adjusted for age, being overweight, knee pain, and non-communicable diseases. Discrimination of low physical function was compared using the receiver operating characteristic curve. RESULTS This study included 1464 participants (age 76 [73-80] y; 757 women), with 58 men (8%) and 66 women (9%) exhibiting low physical function. The multivariate odds ratio (OR; 95% confidence interval [CI]) for low physical function among the highest quartile, compared with the lowest quartile were significant in PhA in multiple sites (e.g., OR, 0.09; 95% CI, 0.03-0.32] for men and 0.12; 95% CI, 0.04-0.33 for women in the left leg) but not in ASMI (OR, 0.51; 95% CI, 0.19-1.34 for men and 0.56; 95% CI, 0.21-1.47 for women). Legs and whole-body PhA outperformed the ASMI in discriminating low physical function (P < 0.001). CONCLUSION PhA reflected physical function better than ASMI; using PhA instead of ASMI in BIA-based morphometric evaluation may add information on low physical function and enhance the diagnostic value of sarcopenia.
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Affiliation(s)
- Sho Hatanaka
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan; Integrated Research Initiative for Living Well with Dementia, Tokyo Metropolitan Institute for Geriatrics and Gerontology
| | - Yosuke Osuka
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan; Department of Frailty Research, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Narumi Kojima
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Keiko Motokawa
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Misato Hayakawa
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan; Integrated Research Initiative for Living Well with Dementia, Tokyo Metropolitan Institute for Geriatrics and Gerontology
| | - Yurie Mikami
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Masanori Iwasaki
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan; Department of Preventive Dentistry, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Hokkaido, Japan
| | - Hiroki Inagaki
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Fumiko Miyamae
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Tsuyoshi Okamura
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Hirohiko Hirano
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Shuichi Awata
- Integrated Research Initiative for Living Well with Dementia, Tokyo Metropolitan Institute for Geriatrics and Gerontology
| | - Hiroyuki Sasai
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
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49
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Pedro da Costa Pereira J, Santana Costa JH, Gomes de Miranda BL, de Sousa Rebouças A, Denise de Lima Bezerra A, Gomes Dantas Lopes MM, Trussardi Fayh AP. Prognostic value of overhydration and bioelectrical impedance vector on short- and long-term outcomes in hospitalized patients with cancer. Clin Nutr 2024; 43:756-764. [PMID: 38335800 DOI: 10.1016/j.clnu.2024.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/03/2024] [Accepted: 01/19/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND & AIMS Water, an essential component of body composition, appears to be a significant predictor of adverse outcomes in clinical populations, despite being frequently underexplored. Bioelectrical impedance analysis (BIA) and vector analysis (BIVA) are easy and cost-effective bedside tools for estimating body composition, particularly water content. Therefore, our study aimed to assess the impact of hydration and fluid status using both BIA and BIVA on outcomes in hospitalized patients with cancer. METHODS A prospective cohort study involving hospitalized individuals with cancer was conducted. Total body water (TBW) was estimated using BIA. Extracellular-water/TBW (ECW/TBW) and ECW/intracellular-water (ECW/ICW) ratios were calculated. BIVA ellipses vectors were constructed to enhance our analysis of hydration status. Participants were followed during their hospital stay and up to six months after discharge to assess outcomes, including in-hospital mortality, 6-month non-elective rehospitalization, and 6-month mortality. RESULTS TBW, ECW/TBW, ECW/ICW ratios, and BIVA plots were not associated with non-elective rehospitalization during the follow-up period. However, TBW and an elevated ECW/ICW ratio were independent predictors of in-hospital mortality [hazard ratio (HR): 1.07 (1.01; 1.13) p = 0.020; HR: 4.23 (1.69; 10.58) p = 0.002]. Elevated ratios ECW/TBW and ECW/ICW were independent predictors of 6-month mortality [HR: 1.87 (1.10; 3.21) p = 0.022; HR: 2.49 (1.37; 4.51) p = 0.003]. BIVA vectors for in-hospital and 6-month mortality shifted significantly to the right, leading to cachexia and overhydration quadrants (p < 0.05). CONCLUSION Abnormalities related to overhydration were important predictors of short- and long-term mortality in hospitalized patients with cancer.
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Affiliation(s)
- Jarson Pedro da Costa Pereira
- Postgraduate Program in Nutrition and Public Health, Department of Nutrition, Federal University of Pernambuco, Recife, PE, Brazil
| | | | - Bruna Luisa Gomes de Miranda
- Postgraduate Program in Nutrition, Health Science Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Amanda de Sousa Rebouças
- Postgraduate Program in Health Science, Health Science Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Agnes Denise de Lima Bezerra
- Postgraduate Program in Health Science, Health Science Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Márcia Marília Gomes Dantas Lopes
- Department of Nutrition, Federal University of Rio Grande do Norte, Natal, RN, Brazil; Postgraduate Program in Applied Sciences to Women's Health, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Ana Paula Trussardi Fayh
- Department of Nutrition, Federal University of Rio Grande do Norte, Natal, RN, Brazil; Postgraduate Program in Nutrition, Health Science Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil; Postgraduate Program in Health Science, Health Science Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil; PesqClin Lab, Onofre Lopes University Hospital, Brazilian Company of Hospital Services (EBSERH), Federal University of Rio Grande do Norte, Natal, Brazil.
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50
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Barrea L, Caprio M, Camajani E, Verde L, Perrini S, Cignarelli A, Prodam F, Gambineri A, Isidori AM, Colao A, Giorgino F, Aimaretti G, Muscogiuri G. Ketogenic nutritional therapy (KeNuT)-a multi-step dietary model with meal replacements for the management of obesity and its related metabolic disorders: a consensus statement from the working group of the Club of the Italian Society of Endocrinology (SIE)-diet therapies in endocrinology and metabolism. J Endocrinol Invest 2024; 47:487-500. [PMID: 38238506 PMCID: PMC10904420 DOI: 10.1007/s40618-023-02258-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/22/2023] [Indexed: 03/02/2024]
Abstract
PURPOSE The ketogenic nutritional therapy (KeNuT) is an effective dietary treatment for patients with obesity and obesity-related comorbidities, including type 2 diabetes, dyslipidaemia, hypertension, coronary artery disease, and some type of cancers. However, to date an official document on the correct prescription of the ketogenic diet, validated by authoritative societies in nutrition or endocrine sciences, is missing. It is important to emphasize that the ketogenic nutritional therapy requires proper medical supervision for patient selection, due to the complex biochemical implications of ketosis and the need for a strict therapeutic compliance, and an experienced nutritionist for proper personalization of the whole nutritional protocol. METHODS This practical guide provides an update of main clinical indications and contraindications of ketogenic nutritional therapy with meal replacements and its mechanisms of action. In addition, the various phases of the protocol involving meal replacements, its monitoring, clinical management and potential side effects, are also discussed. CONCLUSION This practical guide will help the healthcare provider to acquire the necessary skills to provide a comprehensive care of patients with overweight, obesity and obesity-related diseases, using a multistep ketogenic dietary treatment, recognized by the Club of the Italian Society of Endocrinology (SIE)-Diet Therapies in Endocrinology and Metabolism.
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Affiliation(s)
- L Barrea
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Centro Direzionale, Via Porzio Isola F2, 80143, Naples, Italy
| | - M Caprio
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele, Rome, Italy.
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, 00166, Rome, Italy.
| | - E Camajani
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele, Rome, Italy
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, 00166, Rome, Italy
| | - L Verde
- Department of Public Health, University "Federico II" of Naples, 80138, Naples, Italy
| | - S Perrini
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - A Cignarelli
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - F Prodam
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, 28100, Novara, Italy
- Department of Health Sciences, University of Piemonte Orientale, 28100, Novara, Italy
| | - A Gambineri
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - A M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - A Colao
- Dipartimento di Medicina Clinica e Chirurgia, Endocrinologia, Unità di Diabetologia e Andrologia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Centro Italiano per la Cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Naples, Italy
- Cattedra Unesco "Educazione Alla Salute e Allo Sviluppo Sostenibile", Università degli Studi di Napoli Federico II, Naples, Italy
| | - F Giorgino
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - G Aimaretti
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, 28100, Novara, Italy
| | - G Muscogiuri
- Dipartimento di Medicina Clinica e Chirurgia, Endocrinologia, Unità di Diabetologia e Andrologia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
- Centro Italiano per la Cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Naples, Italy.
- Cattedra Unesco "Educazione Alla Salute e Allo Sviluppo Sostenibile", Università degli Studi di Napoli Federico II, Naples, Italy.
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