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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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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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Kerstein JS, Klepper CM, Finnan EG, Mills KI. Nutrition for critically ill children with congenital heart disease. Nutr Clin Pract 2023; 38 Suppl 2:S158-S173. [PMID: 37721463 DOI: 10.1002/ncp.11046] [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: 03/20/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 09/19/2023] Open
Abstract
Children with congenital heart disease often require admission to the cardiac intensive care unit at some point in their lives, either after elective surgical or catheter-based procedures or during times of acute critical illness. Meeting both the macronutrient and micronutrient needs of children in the cardiac intensive care unit requires complex decision-making when considering gastrointestinal perfusion, vasoactive support, and fluid balance goals. Although nutrition guidelines exist for critically ill children, these cannot always be extrapolated to children with congenital heart disease. Children with congenital heart disease may also suffer unique circumstances, such as chylothoraces, heart failure, and the need for mechanical circulatory support, which greatly impact nutrition delivery. Guidelines for neonates and children with heart disease continue to be developed. We provide a synthesized narrative review of current literature and considerations for nutrition evaluation and management of critically ill children with congenital heart disease.
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Affiliation(s)
- Jason S Kerstein
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusettes, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusettes, USA
| | - Corie M Klepper
- Department of Pediatrics, Harvard Medical School, Boston, Massachusettes, USA
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusettes, USA
| | - Emily G Finnan
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusettes, USA
| | - Kimberly I Mills
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusettes, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusettes, USA
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Fernández-Jiménez R, Martín-Masot R, Cornejo-Pareja I, Vegas-Aguilar IM, Herrador-López M, Tinahones FJ, Navas-López VM, Bellido-Guerrero D, García-Almeida JM. Phase angle as a marker of outcome in hospitalized pediatric patients. A systematic review of the evidence (GRADE) with meta-analysis. Rev Endocr Metab Disord 2023; 24:751-765. [PMID: 37486555 PMCID: PMC10404571 DOI: 10.1007/s11154-023-09817-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 07/25/2023]
Abstract
Phase angle (PhA) is a valuable tool for evaluating the nutritional and inflammatory status, which can accompany acute and severe disorders. PhA is a cellular health biomarker, whose value is particularly substantial due to the negative consequences of these situations in the pediatric population. Relevant literature was collected with the aim of comprehensively analysing the evidence on the association between an altered PhA can serve as a predictive-marker for mortality and poor-outcomes in at-risk-pediatric patients. Understanding this relationship could have significant implications for identifying high-risk individuals and implementing timely interventions. A systematic review with meta-analysis was conducted in the primary electronic databases from inception until January 2023. Overall, four studies with a total of 740 patients were eligible for our analysis. Evidence demonstrates that PhA is associated with nutritional status, reflecting undernutrition and changes in body composition related to illness. This review suggests that PhA can indeed be used as an indicator of nutritional status and a tool for predicting prognosis, including mortality and poor-outcomes, in hospitalized pediatric patients. A low PhA was associated with a significant mortality risk [RR:1.51;95%CI (1.22-1.88),p = 0.0002;I2 = 0%,(p = 0.99)] and an increased complications risk [OR:8.17;95%CI (2.44-27.4),p = 0.0007;I2 = 44%,(p = 0.18)]. These findings highlight the importance of taking a comprehensive approach to clinical nutrition, integrating multiple evaluation aspects to establish an accurate diagnosis and personalized therapeutic plans. While PhA emerges as a valuable tool for assessing the risk of malnutrition and as a prognostic-indicator for poor-outcomes in pediatric patients. Further future studies are needed to focus on investigating this relationship in larger and diverse population to strengthen the evidence base.
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Affiliation(s)
- Rocío Fernández-Jiménez
- Department of Endocrinology and Nutrition, Virgen de la Victoria Hospital (IBIMA), Malaga University, Campus Teatinos S/N 29010, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga-Plataforma BIONAND (IBIMA), Virgen de la Victoria University Hospital, 29010 Málaga, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 29010 Málaga, Spain
| | - Rafael Martín-Masot
- Instituto de Investigación Biomédica de Málaga-Plataforma BIONAND (IBIMA), Virgen de la Victoria University Hospital, 29010 Málaga, Spain
- Pediatric Gastroenterology and Nutrition Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Isabel Cornejo-Pareja
- Department of Endocrinology and Nutrition, Virgen de la Victoria Hospital (IBIMA), Malaga University, Campus Teatinos S/N 29010, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga-Plataforma BIONAND (IBIMA), Virgen de la Victoria University Hospital, 29010 Málaga, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 29010 Málaga, Spain
| | - Isabel M. Vegas-Aguilar
- Department of Endocrinology and Nutrition, Virgen de la Victoria Hospital (IBIMA), Malaga University, Campus Teatinos S/N 29010, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga-Plataforma BIONAND (IBIMA), Virgen de la Victoria University Hospital, 29010 Málaga, Spain
| | - Marta Herrador-López
- Instituto de Investigación Biomédica de Málaga-Plataforma BIONAND (IBIMA), Virgen de la Victoria University Hospital, 29010 Málaga, Spain
- Pediatric Gastroenterology and Nutrition Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Francisco J. Tinahones
- Department of Endocrinology and Nutrition, Virgen de la Victoria Hospital (IBIMA), Malaga University, Campus Teatinos S/N 29010, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga-Plataforma BIONAND (IBIMA), Virgen de la Victoria University Hospital, 29010 Málaga, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 29010 Málaga, Spain
| | - Víctor Manuel Navas-López
- Instituto de Investigación Biomédica de Málaga-Plataforma BIONAND (IBIMA), Virgen de la Victoria University Hospital, 29010 Málaga, Spain
- Pediatric Gastroenterology and Nutrition Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Diego Bellido-Guerrero
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Ferrol, La Coruña, Ferrol, Spain
| | - José Manuel García-Almeida
- Department of Endocrinology and Nutrition, Virgen de la Victoria Hospital (IBIMA), Malaga University, Campus Teatinos S/N 29010, Malaga, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 29010 Málaga, Spain
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Franco-Oliva A, Ávila-Nava A, Rodríguez-Aguilar EA, Trujillo-Mercado A, García-Guzmán AD, Pinzón-Navarro BA, Fuentes-Servín J, Guevara-Cruz M, Medina-Vera I. Association between phase angle and the nutritional status in pediatric populations: a systematic review. Front Nutr 2023; 10:1142545. [PMID: 37415913 PMCID: PMC10320581 DOI: 10.3389/fnut.2023.1142545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/30/2023] [Indexed: 07/08/2023] Open
Abstract
Background and aims Malnutrition is prevalent in pediatric populations with any disease, and it is also related to changes in body composition. In addition, recent studies have documented relationships between these changes and phase angle (PhA), an important parameter of functional nutritional assessment. PhA could be a new marker of nutritional status. Many studies have generated information about the association between PhA and malnutrition in various pathologies, although the vast majority of this information is from adult populations. In this systematic review, we answered the following question: What is the association between PhA and the nutritional status in pediatric populations? Methods We performed a systematic search of the Medline/PubMed and Latin American and Caribbean Health Sciences Literature databases (LILACS) databases for studies published up to October 2022. The inclusion criteria were pediatric subjects, which reported the relationship between PhA and the nutritional status with any objective nutritional indicator, and PhA was measured by electric impedance and reported at 50 kHz. We synthesized data from the studies that reported cutoff analysis of PhA with receiver operating characteristic (ROC) curves, mean PhA values presented by nutritional status strata, and correlations between PhA and nutritional status indicators. We assessed the risk of bias by using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and the Quality Assessment for Diagnostic Accuracy Studies. Results Of the 126 studies we identified, 15 met the inclusion criteria. The included studies reported the association between PhA and objective indicators of nutritional status, including weight-for-age z-score (WAZ) <-1 standard deviation (SD) for malnutrition, height-for-age z-score (HAZ) for malnutrition-stunting, body mass index (BMI) for the starvation state, body mass index z-score (BMIz) and BMI for malnutrition, mid-upper arm circumference (MUAC) <11 cm for severe acute malnutrition (SAM), and fat-free mass index z-score (FFMIz) <-2 z-score for moderate malnutrition, among others. The report of these associations between PhA and nutritional status was based on cutoff points generated with ROC curve analysis or comparison of mean PhA values, which were reported stratified by the presence or absence of malnutrition, and correlations between PhA and anthropometric indicators for the evaluation of the nutritional status in the pediatric population. It was difficult to compare the studies due to the heterogeneity of the bioelectrical impedance analysis models used, how PhA was reported (standardized, percentiles, or degrees), and the anthropometric indicators used to diagnose malnutrition. Conclusion The early identification of malnutrition is relevant to establish the correct nutritional treatment; PhA appears to be a sensitive indicator of nutritional status and is easy to obtain. Although the results of this review are inadequate to establish PhA cutoff points associated with malnutrition in pediatric populations, in most of the studies, there was an association between PhA and objective indicators of nutritional status. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022362413, identifier: PROSPERO 2022 CRD42022362413.
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Affiliation(s)
- Andrea Franco-Oliva
- Departamento de Metodología de la Investigación, Instituto Nacional de Pediatría, Ciudad de México, Mexico
| | - Azalia Ávila-Nava
- Hospital Regional de Alta Especialidad de la Península de Yucatán, Mérida, Mexico
| | | | - Ander Trujillo-Mercado
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ciudad de México, Mexico
| | - Alda Daniela García-Guzmán
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ciudad de México, Mexico
- Servicio de Oncología Médica, Instituto Nacional de Pediatría, Ciudad de México, Mexico
| | - Beatriz Adriana Pinzón-Navarro
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ciudad de México, Mexico
- Servicio de Gastroenterología y Nutrición Pediátrica, Instituto Nacional de Pediatría, Ciudad de México, Mexico
| | - Jimena Fuentes-Servín
- Departamento de Metodología de la Investigación, Instituto Nacional de Pediatría, Ciudad de México, Mexico
| | - Martha Guevara-Cruz
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ciudad de México, Mexico
- Departamento de Fisiología de la Nutrición, Instituto Nacional de Nutrición y Ciencias Médicas Salvador Zubirán, Ciudad de México, Mexico
| | - Isabel Medina-Vera
- Departamento de Metodología de la Investigación, Instituto Nacional de Pediatría, Ciudad de México, Mexico
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ciudad de México, Mexico
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Marinier MC, Ogunsola AS, Elkins JM. Whole-body phase angle correlates with pre-operative markers in total joint arthroplasty. JOURNAL OF ELECTRICAL BIOIMPEDANCE 2023; 14:60-65. [PMID: 38162816 PMCID: PMC10750321 DOI: 10.2478/joeb-2023-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Indexed: 01/03/2024]
Abstract
Background Bioimpedance derived whole body phase angle (ϕ), a measure of cellular integrity, has been identified as an independent marker of morbidity and mortality in many medical and surgical specialties. While similar measures of water homeostasis like extracellular edema (EE) have been associated with pre-operative risk, ϕ has not been studied in orthopaedics, despite potential to serve as a pre-operative marker. This study aims to identify relationships between ϕ, EE, and body composition metrics, laboratory values, patient reported outcomes, and comorbidities. Methods Multi-frequency bioimpedance analysis (BIA) records, laboratory values, and patient reported outcomes of adult patients presenting to an academic arthroplasty clinic were retrospectively reviewed. Correlation coefficients between ϕ, EE, and reviewed information were conducted. Results ϕ was significantly correlated (p<0.001) most positively with measures of lean tissue such as skeletal muscle mass (r=0.48), appendicular skeletal muscle index (r=0.39), lean body mass (r=0.43), and dry lean mass (r=0.47), while it held negative correlations (p<0.001) with age (r= -0.55), and body fat mass (r= -0.11). ϕ was not correlated with body mass index (BMI, p = 0.204). In contrast, EE demonstrated its strongest positive correlations (p<0.001) with body fat mass (r=0.32), age (r=0.50), and BMI (r=0.26), and its strongest negative correlations (p<0.001) with serum albumin (r= -0.37) and total protein (r= -0.23). Conclusions Based on their associations with markers of health and fitness, BIA determined ϕ and EE demonstrate relationships to markers currently implemented in orthopaedic practice. This likely indicates that ϕ has potential as a comprehensive surrogate for several commonly used markers to quantify pre-operative risk. In the future, ϕ may aid in developing risk-stratifications for intervention and prevention of complications.
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Affiliation(s)
- Michael C. Marinier
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA USA
| | - Ayobami S. Ogunsola
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA USA
| | - Jacob M. Elkins
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA USA
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Farr BJ, Bechard LJ, Rice-Townsend SE, Mehta NM. Bio-impedance spectroscopy for total body water assessment in pediatric surgical patients: A single center pilot cohort study. J Pediatr Surg 2022; 57:962-966. [PMID: 35940939 DOI: 10.1016/j.jpedsurg.2022.07.014] [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: 02/15/2022] [Revised: 06/23/2022] [Accepted: 07/12/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Excess peri‑operative fluid administration is associated with higher morbidity and mortality. We aimed to examine the feasibility of bio-impedance spectroscopy (BIS) to record serial peri‑operative fluid volumes in the pediatric surgical population. METHODS Children who underwent major elective general surgery from March 2019 to March 2020 were included. Total body water (TBW) assessment by BIS was recorded prior to surgery and on subsequent post-operative days (POD). We recorded the duration, tolerance and completion of each BIS assessment. We used Spearman coefficient and Bland Altman analysis to examine correlation and agreement between fluid balance (FB) in ml/kg calculated from intake/output (IO) recording and measured by BIS. RESULTS 20 (87%) of 23 consented patients, median age 2.5 (1-17) years and 13 (65%) male, completed pre-operative and post-operative measurements, and were included in the analysis. Median time required for BIS assessments was 10 (5-15) minutes, and there were no recorded side effects or intolerance. The correlation coefficient for fluid balance measurements on POD 1 between BIS and IO methods was 0.59 (p = 0.01); mean bias (limits) of agreement was 26 (111 to 163) mL/kg. The trend in TBW measured by BIS declined from POD 1-3, while the recorded FB increased. CONCLUSION Bedside BIS is feasible and well-tolerated. Despite moderate correlation between fluid balance assessment by BIS and IO on POD 1, the wide limits of agreement between values from these methods preclude their use interchangeably. The role of BIS in assessment of fluid status in the pediatric surgical population should be further examined. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Bethany J Farr
- Department of Surgery, Boston Children's Hospital, Boston, MA, United States.
| | - Lori J Bechard
- Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Samuel E Rice-Townsend
- Department of Surgery, Boston Children's Hospital, Boston, MA, United States; Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, United States
| | - Nilesh M Mehta
- Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
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Mattiello R, Mundstock E, Ziegelmann PK. Brazilian Reference Percentiles for Bioimpedance Phase Angle of Healthy Individuals. Front Nutr 2022; 9:912840. [PMID: 35873414 PMCID: PMC9298610 DOI: 10.3389/fnut.2022.912840] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/19/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives The present study was designed to estimate phase angle percentile curves for a broad age range of healthy individuals. Methods This is a cross-sectional study of healthy Brazilian individuals aged five to 80. InBodyS10 was used to assess phase angle. Reference curves were stratified by sex and estimated using Generalized additive models for location, scale, and shape as a continuous function of age. The phase angle determinants analyzed were physical activity, age, BMI, and SES variables. Results Data were analyzed from 2,146 individuals, 1,189 (55.2%) of whom were female. In both sexes, the phase angles showed a similar pattern (an increasing trend from childhood to the teenage phase, followed by stabilization during adult ages and a decrease in old adults). In female, the relationship between phase angle and age were associated with BMI and family income. In the male, the relationship between phase angle and age were associated with skin color and family income. Conclusions To the best of our knowledge, it is the first attempt to apply the GAMLSS technique to estimate phase angle percentiles in a healthy population covering most of the life cycle. We also showed that there are different phase angle determinants according to sex.
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Affiliation(s)
- Rita Mattiello
- Programa de Pós-graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.,Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
| | - Eduardo Mundstock
- Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, Brazil.,Secretaria da Educação, Esporte e Lazer de Canela, Canela, Brazil
| | - Patrícia Klarmann Ziegelmann
- Programa de Pós-graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil
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Xiong ZH, Zheng XM, Zhang GY, Wu MJ, Qu Y. The Use of Bioelectrical Impedance Analysis Measures for Predicting Clinical Outcomes in Critically Ill Children. Front Nutr 2022; 9:847480. [PMID: 35734373 PMCID: PMC9207466 DOI: 10.3389/fnut.2022.847480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background The study aimed to investigate the association of bioelectrical impedance analysis (BIA) for predicting clinical outcomes in critically ill children. Methods This single-center prospective observational study included patients admitted to a mixed Pediatric Intensive Care Unit (PICU). All patients underwent anthropometric measurement and BIA measurements in the first 24 h of admission. The patients were classified into different groups based on body mass index (BMI) for age. Electronic hospital medical records were reviewed to collect clinical data for each patient. All the obtained data were analyzed by the statistical methods. Results There were 231 patients enrolled in our study, of which 31.6% were diagnosed with malnutrition. The phase angle (PhA) of 90-day survivors was significantly higher than that of the non-survivors (4.3° ± 1.1°vs. 3.1° ± 0.9°, P = 0.02). The age-adjusted Spearman partial correlation analysis showed a weak negative correlation between PhA and duration of medical ventilation (rs = -0.42, P < 0.05). Furthermore, length of stay in PICU has a very weak correlation with ECW/TBW (rs = 0.29, P < 0.05), and a negative correlation with protein (rs = -0.27, P < 0.05). Multivariate analysis found that PhA was a significant predictor associated with the 90-day mortality when it was adjusted for PRISM III score (adjusted OR = 1.51, CI: 1.10–2.07, p = 0.01). The area under the ROC (AUROC) of PhA for predicting 90-day mortality was 0.69 (95% CI: 0.53–0.85, p < 0.05), and the cutoff value of PhA was 3.0°, with a sensitivity and specificity of 83 and 53%, respectively. Conclusion BIA-derived PhA was found to be an independent predictor of 90-day mortality among critically ill children. A low PhA was associated with a prolonged duration of medical ventilation.
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Affiliation(s)
- Zi-Hong Xiong
- Department of Pediatric Intensive Care Unit, Chengdu Women’s and Children’s Central Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Ministry of Education), Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xue-Mei Zheng
- University of Electronic Science and Technology of China, Chengdu, China
| | - Guo-Ying Zhang
- Department of Pediatric Intensive Care Unit, Chengdu Women’s and Children’s Central Hospital, University of Electronic Science and Technology of China, Chengdu, China
- *Correspondence: Guo-Ying Zhang,
| | - Meng-Jun Wu
- Department of Anesthesiology, Chengdu Women’s and Children’s Central Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yi Qu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Ministry of Education), Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
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10
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Queiroz SA, Gonzalez MC, da Silva AMB, Costa JKDA, de Oliveira CDR, de Sousa IM, Fayh APT. Is the standardized phase angle a predictor of short and long-term adverse cardiovascular events in acute myocardial infarction patients? A cohort study. Nutrition 2022; 103-104:111774. [DOI: 10.1016/j.nut.2022.111774] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 05/27/2022] [Accepted: 06/06/2022] [Indexed: 11/25/2022]
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11
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Orsso CE, Gonzalez MC, Maisch MJ, Haqq AM, Prado CM. Using bioelectrical impedance analysis in children and adolescents: Pressing issues. Eur J Clin Nutr 2022; 76:659-665. [PMID: 34620999 DOI: 10.1038/s41430-021-01018-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/06/2021] [Accepted: 09/21/2021] [Indexed: 11/08/2022]
Abstract
Single- and multifrequency bioelectrical impedance analysis (BIA) has gained popularity as a tool to assess body composition and health status of children and adolescents, but many questions and misconceptions remain. This review addresses pressing issues researchers and health care providers may encounter when using BIA in the young population. The importance of choosing population-specific and device-specific equations to estimate body composition as well as the use of BIA in longitudinal analyses are discussed. When specific equations are not available, raw bioimpedance values (i.e., resistance, reactance, and impedance) can be used to compute bioimpedance parameters, such as phase angle, impedance ratio, and bioelectrical impedance vector analysis. As interpreting these parameters is challenging, suggestions are provided on the use of reference data, cut-off points, and adjustment factors. Furthermore, unsolved technical and analytical issues are listed. Based on existing issues and potential for future development, a greater interaction between industry and academic researchers to improve the validity of BIA measurements among children and adolescents across their developmental stages is encouraged.
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Affiliation(s)
- Camila E Orsso
- Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, University of Alberta, 4-002 Li Ka Shing Centre for Health Innovation, Edmonton, AB, T6G 2E1, Canada.
| | - Maria Cristina Gonzalez
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas, R. Gonçalves Chaves 377, Pelotas, RS, 96010280, Brazil
- Pennington Biomedical Research Center, LSU System, 6400 Perkins Road, Baton Rouge, LA, 70808, USA
| | | | - Andrea M Haqq
- Department of Pediatrics & Department of Agricultural, Food and Nutritional Science, University of Alberta, 1C4 Walter C. Mackenzie Health Sciences Center, Edmonton, AB, T6G 2B7, Canada
| | - Carla M Prado
- Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, University of Alberta, 4-002 Li Ka Shing Centre for Health Innovation, Edmonton, AB, T6G 2E1, Canada
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12
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Feasibility of bioimpedance spectroscopy and long-term functional assessment in critically ill children. Clin Nutr ESPEN 2022; 47:405-409. [PMID: 35063234 DOI: 10.1016/j.clnesp.2021.12.009] [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: 09/10/2021] [Revised: 11/15/2021] [Accepted: 12/10/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND & AIMS Lean body mass loss due to critical illness in childhood could be detrimental to long term outcomes, including functional status and quality of life. We describe the feasibility of body composition assessment by bioimpedance spectroscopy (BIS) in the pediatric intensive care unit (PICU), and functional status and quality of life assessments up to 6 months following admission in a cohort of mechanically ventilated, critically ill children. METHODS We conducted a prospective, observational pilot study in a multidisciplinary PICU. Children aged 1 month to 18 years who required mechanical ventilation, with expected stay in the PICU of at least 5 days were included. We examined the feasibility of consenting, enrolling, and completing baseline and 6-month assessments of BIS variables, Functional Status Scale (FSS), and Pediatric Quality of Life (Peds QL), in eligible patients. RESULTS Of 32 patients approached, 23 (72%) completed baseline assessments [median (IQR) age 3.4 (1.0, 7.8) years, 14 (61%) male]; 6-month assessments were completed in 15 (65%) enrolled patients. Mean (SD) phase angle at study enrollment was 2.95 (0.93) and the impedance ratio was 0.90 (0.03). Phase angle (rs = -0.58, p = 0.03) and impedance ratio (rs = 0.61, p = 0.02) by BIS were significantly correlated with total FSS at PICU discharge. Median total FSS and FSS tech (feeding and respiratory domains of FSS) scores improved from enrollment [16 (13, 26) and 8 (7, 10)] to 6 months [6 (6, 9) and 2 (2, 4), respectively, p < 0.001]. Median Peds QL total, physical summary and psychosocial summary scores were not significantly different between PICU discharge and 6 months after PICU admission. Correlations between the total 6-month FSS and a) phase angle (-0.45, p = 0.197) and b) impedance ratio (0.56, p = 0.096) at PICU discharge were not significant. CONCLUSIONS We have demonstrated the feasibility of obtaining bedside BIS measurements in the PICU, and functional and quality of life assessments remotely following PICU discharge. Body composition and long-term assessment of functional outcomes and quality of life must be incorporated in nutrition trials in critically ill children.
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13
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Marinier MC, Ogunsola AS, Elkins JM. Body Composition Changes in the Immediate Peri-operative Period Following Total Joint Arthroplasty. JOURNAL OF ELECTRICAL BIOIMPEDANCE 2022; 13:39-44. [PMID: 36196241 PMCID: PMC9487908 DOI: 10.2478/joeb-2022-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/26/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Bioimpedance analysis (BIA) is a readily available tool to assess body composition in a clinical setting. BIA has received little attention in orthopaedics and namely joint arthroplasty. This study aims to quantify changes in body composition in the immediate peri-operative period following total joint arthroplasty. METHODS Adults scheduled for elective total joint arthroplasty were recruited to participate. Patients underwent BIA scans in the immediate peri-operative period: pre-operative on their day of surgery, post-operative day 0, and post-operative day 1. RESULTS 67 patients were enrolled to undergo BIA scans. Mean age was 62.64 ± 10.28 years old, and 49.2% were females. The all-supine cohort exhibited a 0.36 ± 0.61 kg increase in dry lean mass (p < 0.001) and 1.30 ± 2.14 kg increase in lean body mass on postoperative day 0 (p < 0.001). Patients received to 1.16 ± 0.58 kg of fluid mass, on average. CONCLUSION BIA is a rapid, portable tool that allows for body composition analysis of an inpatient surgical population. This study demonstrated that BIA can detect net fluid changes and may approximate implant mass following total joint arthroplasty. This may aid surgeons in interpreting post-operative body composition changes.
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Affiliation(s)
- Michael C. Marinier
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IAUSA
| | - Ayobami S. Ogunsola
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IAUSA
| | - Jacob M. Elkins
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IAUSA
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14
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Katsura N, Yamashita M, Ishihara T. Extracellular water to total body water ratio may mediate the association between phase angle and mortality in patients with cancer cachexia: A single-center, retrospective study. Clin Nutr ESPEN 2021; 46:193-199. [PMID: 34857195 DOI: 10.1016/j.clnesp.2021.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND & AIMS Recently, prognostic factors for cancer cachexia patients have been reported. We hypothesized that phase angle (PhA), which is measured by bioelectrical impedance analysis (BIA), might be a promising marker for assessing the nutritional status and prognosis of cancer patients. This study aimed to evaluate the predictive utility of PhA, which is mediated by several BIA factors and other anthropometric parameters, such as calf circumference, for the prognosis of cancer cachexia patients. METHODS Consecutive patients (114, both outpatients and inpatients) with an unselected stage of cancer cachexia were recruited between July 2018 and December 2019 in Fujita Health University Hospital for this retrospective cohort study. Their mean age was 74.0 years (standard deviation, 8.5); among the total, 70 were men and 44 women. A time-dependent Cox proportional-hazards regression analysis (adjusted for age and sex) was performed to assess the following: 1) the association between potential mediators and mortality; 2) the association between five PhAs and statistically significant mediators from 1); and 3) the association between the five PhAs and mortality. Finally, Kaplan-Meier survival curves were constructed and compared between the two groups based on the patients' median baseline ratio of extracellular water (ECW) to total body water (TBW) using a log-rank test. RESULTS The ECW/TBW ratio (hazard ratio [HR] per 1-interquartile range [IQR] increase: 2.87; 95% confidence interval [CI]: 1.46, 5.46; p < 0.001) and skeletal muscle mass index (HR per 1-IQR increase: 0.67; 95% CI: 0.51, 0.89; p = 0.001) were associated with mortality. All five PhAs were associated with the ECW/TBW ratio (p < 0.001). Before adjustment for the ECW/TBW ratio, all five PhAs were associated with mortality (p < 0.001); only the association of the PhAs of the left arm and the trunk retained the statistical significance after adjusting for confounders (p < 0.05). The median survival times in the low (370 days; 95% CI: 168, not calculated) and high ECW/TBW groups (101 days; 95% CI: 61, 219) differed significantly (p < 0.001). CONCLUSIONS The association between PhA and mortality in cancer cachexia patients was largely mediated by the ECW/TBW ratio. We believe that adjusting PhA for the ECW/TBW ratio may improve the prognostication of cancer patients with cachexia, ultimately improving their palliative care.
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Affiliation(s)
- Nagato Katsura
- Department of Surgery and Palliative Care, Fujita Health University, 1-98 Dengakugakubo, Toyoake, Aichi, 470-1192, Japan.
| | - Michinori Yamashita
- Department of Surgery and Palliative Care, Fujita Health University, 1-98 Dengakugakubo, Toyoake, Aichi, 470-1192, Japan.
| | - Takuma Ishihara
- Innovative and Clinical Research Promotion Center, Gifu University Hospital, Gifu University, 1-1 Yanagido, Gifu City, Gifu, 501-1194, Japan.
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15
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Howe CA, Corrigan RJ, Djalali M, McManaway C, Grbcich A, Aidoo GS. Feasibility of Using Bioelectrical Impedance Analysis for Assessing Youth Weight and Health Status: Preliminary Findings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10094. [PMID: 34639395 PMCID: PMC8507857 DOI: 10.3390/ijerph181910094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 12/02/2022]
Abstract
Background. This study assessed the accuracy of bioimpedance analysis (BIA) for measuring body composition and resting metabolic rate (RMR) in fasted and non-fasted state and the prospect of using phase angle (PA) to indicate cellular health in youth. Methods. BIA body composition, RMR, and hydration measures were compared to dual-energy x-ray absorptiometry (DXA), MedGem metabolic analyzer, and urine specific gravity, respectively, at baseline in a fasted state using one-way ANOVAs. Repeated BIAs at 0, 30, 60, 90, and 120 min post-prandial were compared to baseline using repeated-measures ANOVA. Correlations were used to assess the relationship among PA and health (blood lipids and glucose, resting BP) and fitness (grip strength and a 3 min step test) measures. Results. BIA scans (N = 58; 11.4 ± 2.9 y) measured lower body fat % (BF%) in healthy weight youth (BMI < 85th percentile; 16.4 ± 1.1 vs. 25.1 ± 1.0%) and lower visceral adipose tissue (VAT) in males (44.5 ± 2.9 vs. 34.1 ± 6.0 cm2) than DXA and higher RMR in all youth (1244 ± 41 vs. 1104 ± 39 kcals/day), healthy weight (1231 ± 48 vs. 1049 ± 44 kcals/day), and teens (1541 ± 62 vs. 1234 ± 72 kcals/day) than MedGem. Compared to baseline, immediate post-prandial values were significantly higher for BF% (21.4 ± 1.4 vs. 22.0 ± 1.4%) and VAT (45.4 ± 6.1 vs. 46.2 ± 6.2 cm2). PA was significantly correlated with BF% (r = -0.33; p = 0.01), fat-free mass (r = 0.59; p < 0.001), grip strength (r = 0.56; p < 0.001). Conclusions. While more data are needed to confirm these preliminary findings, the results suggest caution is necessary in using BIA to assess aspects of youth health and weight status, especially in males, healthy weight, and teens. However, these preliminary findings do indicate that phase angle maybe be a valuable, non-invasive tool for identifying youth who are heading towards obesity and/or obesity-related health consequences.
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Affiliation(s)
- Cheryl A. Howe
- School of Applied Health Sciences and Wellness, Ohio University, Athens, OH 45701, USA; (C.M.); (A.G.); (G.S.A.)
| | - Riley J. Corrigan
- Honors Tutorial College, Ohio University, Athens, OH 45701, USA; (R.J.C.); (M.D.)
| | - Maya Djalali
- Honors Tutorial College, Ohio University, Athens, OH 45701, USA; (R.J.C.); (M.D.)
| | - Chris McManaway
- School of Applied Health Sciences and Wellness, Ohio University, Athens, OH 45701, USA; (C.M.); (A.G.); (G.S.A.)
| | - Alexandra Grbcich
- School of Applied Health Sciences and Wellness, Ohio University, Athens, OH 45701, USA; (C.M.); (A.G.); (G.S.A.)
| | - Grace Sam Aidoo
- School of Applied Health Sciences and Wellness, Ohio University, Athens, OH 45701, USA; (C.M.); (A.G.); (G.S.A.)
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16
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Bioelectrical spectroscopy impedance phase angle is not associated with nutritional status in a stable cohort of paediatric inflammatory bowel disease patients. Clin Nutr ESPEN 2021; 44:276-281. [PMID: 34330479 DOI: 10.1016/j.clnesp.2021.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 06/02/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND & AIMS Nutritional assessment in paediatric inflammatory bowel disease (IBD) is key to supporting growth whilst minimising adiposity. Bedside assessment using bioelectrical impedance spectroscopy (BIS) has previous identified patients with declining cellular and nutritional health. We aimed to assess BIS measures in stable paediatric IBD patient. METHODS Stable IBD patients were recruited at routine hospital visits. All patients underwent BIS, anthropometry and disease activity assessment. Multivariable regression and receiver operator curve (ROC) analyses were undertaken to assess the utility of BIS phase angle 50 KHz (PA-50) and 200/5 KHz impedance ratio (IR) in nutritional assessment. RESULTS There were 140 study visits from 97 patients, mean age 14.49 years, 62.9% Crohn's disease. Mean BMI Z-score (BMIZ) was 0.31 (range -2.97 to 3.99), 33% of patients were overweight (BMIZ>1) and 13.8% of patients were underweight (BMIZ < -1). Crohn's disease patients had a lower mean BMIZ score 0.14, compared to ulcerative colitis, 0.68, p = 0.007. There was no relationship between PA-50 and BMIZ or disease activity. IR was not related to disease activity but was negatively related to BMIZ in a multivariable regression, accounting for age, sex and disease subtype (beta -0.331, p = 0.001). ROC analyses did not identify a clinically useful cut off for either PA-50 or IR to identify patients with active disease, biologic use or BMIZ>1 or < -1. CONCLUSION BIS appears to have limited added value in nutritional assessment of stable paediatric IBD patients. Nearly 1/3 patients were overweight and personalised approach to supplementation is vital to avoid overnutrition.
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17
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Macena MDL, Silva Júnior AED, Praxedes DRS, Leite FMDB, Silva Neto LGR, Pureza IRDOM, Florêncio TMDMT, Bueno NB. Association between phase angle and height-to-age index classifications of children under five years of age. Clin Nutr ESPEN 2021; 44:367-371. [PMID: 34330491 DOI: 10.1016/j.clnesp.2021.05.013] [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: 01/12/2021] [Revised: 05/04/2021] [Accepted: 05/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND & AIMS The phase angle (PA) has been used as an indicator of prognosis and nutritional status because it reflects the integrity of the individuals' cellular function. In contrast to the investigations that assessed acute malnutrition (weight deficit) and PA in children, studies that evaluated the relationship of this indicator with stunting (height deficit) are still scarce and inconclusive. Thus, we aim to investigate whether there are differences in PA according to the classifications of the height-for-age (H/A) index of children under five years of age. METHODS This is a cross-sectional study carried out in a nutritional recovery center, in households, and in a daycare center in Maceió-Alagoas, Brazil. Anthropometric data were collected, and resistance and reactance were obtained through the use of tetrapolar electrical bioimpedance, from children aged 2-5 years. The PA and the percentage of body fat were calculated. Children were divided into 3 groups: adequate H/A, at-risk of stunting and stunted. Analysis of covariance for the main outcome was performed using age, sex, and the body mass index-to-age as covariates, and the H/A classification as the exposure. RESULTS The mean children's PA in the adequate H/A group was 3.9° [95% CI 3.6-4.2], while in the group at-risk of stunting and stunted it was 4.5° [95% CI 4.3-4.7] and 4.6° [95% CI 4.4-4.8], respectively, showing statistical difference (p < 0.01). CONCLUSION In the present sample, stunted children have higher PA values than children with adequate H/A.
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Affiliation(s)
- Mateus de Lima Macena
- Faculdade de Nutrição, Universidade Federal de Alagoas, Maceió, Alagoas, 57072-970, Brazil.
| | | | | | | | | | | | | | - Nassib Bezerra Bueno
- Faculdade de Nutrição, Universidade Federal de Alagoas, Maceió, Alagoas, 57072-970, Brazil.
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18
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Obayashi H, Ikuta Y, Fujishita H, Fukuhara K, Sakamitsu T, Ushio K, Kimura H, Adachi N. The relevance of whole or segmental body bioelectrical impedance phase angle and physical performance in adolescent athletes. Physiol Meas 2021; 42. [PMID: 33690189 DOI: 10.1088/1361-6579/abed35] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/09/2021] [Indexed: 12/11/2022]
Abstract
Objective. The physical condition of athletes can be assessed easily and quantitatively using objective indicators. Bioelectrical impedance measures the phase angle (PA), representing hydration and cell function, and is a potential clinical indicator of physical condition. This study aimed to investigate the association between PA and physical performance in adolescent athletes.Approach. Overall, 170 adolescent athletes underwent a sports medical check-up, including body composition measurements and physical performance tests. Whole-body and segmental PAs (arm and leg) were determined based on body composition values. Isometric grip power and knee isokinetic muscle strength were measured as parameters of muscle strength. Counter movement jump height and squat jump height were measured as jump parameters. Associations between PA and each muscle strength or jump parameters were analysed using Pearson product-moment correlation coefficient or Spearman's rank correlation coefficient.Main results. Whole-body and upper limb PAs were highly correlated with grip power (r= 0.70-0.80). Whole-body and lower limb PAs were correlated with knee isokinetic muscle strength (r= 0.43-0.59). Whole and all segmental PAs were correlated with counter movement jump height (r= 0.46-0.57) and squat jump height (r= 0.42-0.52).Significance. PA can be used to monitor physical condition and sports performance in adolescent athletes. Segmental PAs can help assess the condition of the corresponding body part.
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Affiliation(s)
- Hiromune Obayashi
- Hiroshima University Hospital Sports Medical Center, Hiroshima City, Hiroshima, Japan.,Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima City, Hiroshima, Japan
| | - Yasunari Ikuta
- Hiroshima University Hospital Sports Medical Center, Hiroshima City, Hiroshima, Japan.,Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan
| | - Hironori Fujishita
- Hiroshima University Hospital Sports Medical Center, Hiroshima City, Hiroshima, Japan.,Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima City, Hiroshima, Japan
| | - Koki Fukuhara
- Hiroshima University Hospital Sports Medical Center, Hiroshima City, Hiroshima, Japan.,Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima City, Hiroshima, Japan
| | - Tetsuhiko Sakamitsu
- Hiroshima University Hospital Sports Medical Center, Hiroshima City, Hiroshima, Japan.,Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima City, Hiroshima, Japan
| | - Kai Ushio
- Hiroshima University Hospital Sports Medical Center, Hiroshima City, Hiroshima, Japan.,Hiroshima University Hospital Department of Rehabilitation, Hiroshima City, Hiroshima, Japan
| | - Hiroaki Kimura
- Hiroshima University Hospital Sports Medical Center, Hiroshima City, Hiroshima, Japan.,Hiroshima University Hospital Department of Rehabilitation, Hiroshima City, Hiroshima, Japan
| | - Nobuo Adachi
- Hiroshima University Hospital Sports Medical Center, Hiroshima City, Hiroshima, Japan.,Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan
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19
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Bourdon C, Bartels RH, Chimwezi E, Kool J, Chidzalo K, Perot L, Brals D, Bandsma RHJ, Boele van Hensbroek M, Voskuijl WP. The clinical use of longitudinal bio-electrical impedance vector analysis in assessing stabilization of children with severe acute malnutrition. Clin Nutr 2020; 40:2078-2090. [PMID: 33097306 DOI: 10.1016/j.clnu.2020.09.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 08/31/2020] [Accepted: 09/22/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Severe Acute Malnutrition (SAM) in children is determined using anthropometry. However, bio-electrical impedance (BI) analysis could improve the estimation of altered body composition linked to edema and/or loss of lean body mass in children with SAM. We aimed to assess: 1) the changes in BI parameters during clinical stabilization and 2) whether BI parameters add prognostic value for clinical outcome beyond the use of anthropometry. METHODS This prospective observational study enrolled children, aged 6-60 months, that were admitted at Queen Elizabeth Central Hospital in Blantyre, Malawi, for complicated SAM (i.e., having either severe wasting or edematous SAM with a complicating illness). Height, weight, mid-upper arm circumference (MUAC), and BI were measured on admission and after clinical stabilization. BI measures were derived from height-adjusted indices of resistance (R/H), reactance (Xc/H), and phase angle (PA) and considered to reflect body fluids and soft tissue in BI vector analysis (BIVA). RESULTS We studied 183 children with SAM (55% edematous; age 23.0 ± 12.0 months; 54% male) and 42 community participants (age 20.1 ± 12.3 months; male 62%). Compared to community participants, the BIVA of children with edematous SAM were short with low PA and positioned low on the hydration axis which reflects severe fluid retention. In contrast, children with severe wasting had elongated vectors with a PA that was higher than children with edematous SAM but lower than community participants. Their BIVA position fell within the top right quadrant linked to leanness and dehydration. BIVA from severely wasted and edematous SAM patients differed between groups and from community children both at admission and after stabilization (p < 0.001). Vector position shifted during treatment only in children with edematous SAM (p < 0.001) and showed a upward translation suggestive of fluid loss. While PA was lower in children with SAM, PA did not contribute more than anthropometry alone towards explaining mortality, length of stay, or time-to-discharge or time-to-mortality. The variability and heterogeneity in BI measures was high and their overall added predictive value for prognosis of individual children was low. CONCLUSIONS BIVA did not add prognostic value over using anthropometry alone to predict clinical outcome. Several implementation challenges need to be optimized. Thus, in low-resource settings, the routine use of BI in the management of pediatric malnutrition is questionable without improved implementation.
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Affiliation(s)
- Céline Bourdon
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Canada; The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
| | - Rosalie H Bartels
- Global Child Health Group, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, the Netherlands; Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Emmanuel Chimwezi
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya; Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Jacintha Kool
- Department of Pediatrics, Center for Liver, Digestive and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Katherine Chidzalo
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya; Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Lyric Perot
- Woodrow Wilson School of Public and International Affairs, Princeton University, NJ, USA
| | - Daniella Brals
- Amsterdam Institute for Global Health and Development, Department of Global Health, Amsterdam University Medical Centres, Amsterdam, the Netherlands.
| | - Robert H J Bandsma
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Canada; The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya; Department of Pediatrics, Center for Liver, Digestive and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Biomedical Sciences, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Michael Boele van Hensbroek
- Global Child Health Group, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Wieger P Voskuijl
- The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya; Global Child Health Group, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, the Netherlands; Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi; Amsterdam Institute for Global Health and Development, Department of Global Health, Amsterdam University Medical Centres, Amsterdam, the Netherlands
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20
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Associação do estado nutricional e os desfechos clínicos em cirurgia cardíaca pediátrica. ACTA PAUL ENFERM 2020. [DOI: 10.37689/acta-ape/2020ao00835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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21
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Girma T, Kæstel P, Mølgaard C, Ritz C, Andersen GS, Michaelsen KF, Friis H, Wells JC. Utility of bio-electrical impedance vector analysis for monitoring treatment of severe acute malnutrition in children. Clin Nutr 2020; 40:624-631. [PMID: 32698958 DOI: 10.1016/j.clnu.2020.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/02/2020] [Accepted: 06/09/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND & AIMS Change in hydration is common in children with severe acute malnutrition (SAM) including during treatment, but is difficult to assess. We investigated the utility of bio-electrical impedance vector analysis (BIVA), a quick non-invasive method, for indexing hydration during treatment. METHODS We studied 350 children 0·5-14 years of age with SAM (mid-upper arm circumference <11·0 cm or weight-for-height <70% of median, and/or nutritional oedema) admitted to a hospital nutrition unit, but excluded medically unstable patients. Weight, height (H), resistance (R), reactance (Xc) and phase angle (PA) were measured and oedema assessed. Similar data were collected from 120 healthy infants and preschool/school children for comparison. Means of height-adjusted vectors (R/H, Xc/H) from SAM children were interpreted using tolerance and confidence ellipses of corresponding parameters from the healthy children. RESULTS SAM children with oedema were less wasted than those without (p < 0·001), but had BIVA parameters that differed more from those of healthy children (P < 0·05) than those non-oedematous. Initially, both oedematous and non-oedematous SAM children had mean vectors outside the reference 95% tolerance ellipse. During treatment, mean vectors migrated differently in the two SAM groups, indicating fluid loss in oedematous patients, and tissue accretion in non-oedematous patients. At admission, R/H was lower (oedematous) or higher (non-oedematous) among children who died than those who exited the hospital alive. CONCLUSIONS BIVA can be used in children with SAM to distinguish tissue-vs. hydration-related weight changes during treatment, and also identify children at high risk of death enabling early clinical interventions.
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Affiliation(s)
- Tsinuel Girma
- Department of Pediatrics and Child Health, Jimma University, Ethiopia.
| | - Pernille Kæstel
- International Atomic Energy Agency, Vienna, Austria; Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | | | | | - Gregers S Andersen
- Department of Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | | | - Henrik Friis
- International Atomic Energy Agency, Vienna, Austria
| | - Jonathan Ck Wells
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK
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22
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Association between phase angle and isolated and grouped physical fitness indicators in adolescents. Physiol Behav 2020; 217:112825. [PMID: 31991158 DOI: 10.1016/j.physbeh.2020.112825] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/23/2020] [Accepted: 01/25/2020] [Indexed: 11/20/2022]
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Langer RD, da Costa KG, Bortolotti H, Fernandes GA, de Jesus RS, Gonçalves EM. Phase angle is associated with cardiorespiratory fitness and body composition in children aged between 9 and 11 years. Physiol Behav 2020; 215:112772. [DOI: 10.1016/j.physbeh.2019.112772] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/21/2019] [Accepted: 12/10/2019] [Indexed: 12/14/2022]
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The importance of bioelectrical impedance in the critical pediatric patient. Clin Nutr 2019; 39:1188-1194. [PMID: 31153673 DOI: 10.1016/j.clnu.2019.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND & AIMS Sepsis is still a significant cause of death in the Intensive Care Unit and its early diagnosis is vital. Changes in cell permeability have been observed early in sepsis. Lower values of bioelectrical impedance (BIA) such as reactance adjusted by height (Xc/H) and phase angle (PA) have already been studied as a prognostic biomarker for many diseases and may indicate cell injury. BIA is a low cost, practical, noninvasive method that can be measured at bedside. This study investigated the utility of PA and Xc/H raw values in the pediatric critical care unit as predictors of progression to septic shock, as a clinical monitoring tool and to support the diagnosis of septic shock. METHODS We prospectively analyzed bioelectrical impedance in 145 children aged between one month and six years who were not in septic shock on admission to the intensive care unit Serial bioelectrical impedance analysis (BIA) measures were analyzed to determine the sensitivity and specificity of accurately identifying children who subsequently developed septic shock. Kaplan-Meier septic shock-free survival curves modeled by Xc/H and PA were done. RESULTS The free-septic shock survival curve analysis showed that patients with the lowest median values of Xc/H and PA were associated with the highest percentage of occurrence of septic shock (p = 0.0001 for Xc/H and <0.0006 for PA) and longest length of stay in the intensive care unit (p < 0.0011 for Xc/H and p < 0.004 for PA). Values of Xc/H below 48.63 Ohm/m at admission showed statistically significant odds ratio (OR) of 3.72 for developing septic shock any time during the hospitalization period, with a 87% sensitivity, 35% specificity and an area under the curve (AUC) of 0.62. The PA at admission did not show significant results. During hospitalization, patients with Xc/H below 35.72 Ohm/m were 3.38 times more likely to develop septic shock in the next day, with a sensitivity of 66.7%, a specificity of 62.3% and AUC of 0.65. PA values below 3.27 had an OR of 9.58 for a septic shock the next day with a sensitivity of 95.8%, specificity of 29.4% and AUC of 0.62. The presence of a value of Xc/H below 33 Ohm/m showed a strong association with the occurrence of septic shock on the same day of the measurement, with an OR of 11.7, as well as a value of PA below 2.64, showed an OR of 14.2. CONCLUSIONS The bioelectrical parameters Xc/H and phase angle have limitations in predicting septic shock as isolated biomarkers, but have a potential role as a monitoring tool in the pediatric intensive care unit. The comparative value with other biomarkers remains to be elucidated.
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Abstract
Malnutrition occurs when nutrient intake does not meet the needs for normal body functions and as a consequence leads to alterations of growth and development in children. Chronic illness puts children at risk for developing malnutrition. Because of children's rapid periods of growth and development, early diagnosis, prevention, and management of malnutrition are paramount. The reasons for malnutrition in children with chronic disease are multifactorial and are related to the underlying disease and non-illness-associated factors. This review addresses the causes, evaluation, and management of malnutrition in pediatric congenital heart disease, chronic kidney disease, liver disease, and cystic fibrosis.
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Affiliation(s)
- Catherine Larson-Nath
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - Praveen Goday
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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26
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Marino LV, Eveleens RD, Morton K, Verbruggen SCAT, Joosten KFM. Peptide nutrient-energy dense enteral feeding in critically ill infants: an observational study. J Hum Nutr Diet 2019; 32:400-408. [PMID: 30848864 DOI: 10.1111/jhn.12645] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Enteral feeding is challenging in critically ill infants. Target intakes are often not achieved as a result of fluid restriction, procedural interruptions and perceived enteral feeding intolerance. In those infants perceived to have poor feeding tolerance, the use of a peptide nutrient-energy dense enteral feed (PEF) may improve nutritional intake and minimise feeding interruptions as a result of gastrointestinal symptoms. The aim of this observational study was to characterise the use of a PEF amongst critically ill infants in two paediatric intensive care units (PICUs). METHODS Records from critically ill infants aged <12 months admitted to two PICUs were retrospectively reviewed with a PICU length of stay (LOS) ≥ 7 days. Achievement of nutritional targets for the duration of PEF was reviewed. Gastrointestinal symptoms, including gastric residual volume, constipation and vomiting, were evaluated as tolerance parameters. RESULTS In total, 53 infants were included, with a median age on admission of 2.6 months. Median admission weight was 3.9 kg in PICU-1 and 4.7 kg in PICU-2. Median (interquatile range) energy intake in PICU-1 and PICU-2 was 68 (47-92) and 90 (63-124) kcal kg-1 , respectively, and median (interquatile range) protein intake 1.7 (1.1-2.4) g kg-1 and 2.5 (1.6-3.2) g kg-1 , respectively. Feeding was withheld because of feeding intolerance in one infant (4%) on two occasions in PICU-1 for 2.5 h and in two infants (7%) on two occasions in PICU-2 for 19.5 h. Gastric residual mean (SD) volumes were 3.5 (5.4) mL kg-1 in PICU-1 and 16.9 (15.6) mL kg-1 in PICU-2. CONCLUSIONS Peptide nutrient-energy dense feeding in infants admitted to the PICU is feasible, well tolerated and nutritional targets are met. However, with this study design, it is not possible to draw any conclusions regarding the benefit of PEF over standard PE feed in critically ill children and future work is required to clarify this further.
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Affiliation(s)
- L V Marino
- Department of Dietetics and Speech & Language Therapy, University of Southampton, Southampton, UK.,NIHR Biomedical Research Centre Southampton, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK.,Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - R D Eveleens
- Intensive Care Unit, Department of Paediatrics and Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - K Morton
- Faculty of Health Sciences, University of Southampton, Southampton, UK.,Paediatric Intensive Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S C A T Verbruggen
- Intensive Care Unit, Department of Paediatrics and Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - K F M Joosten
- Intensive Care Unit, Department of Paediatrics and Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
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van Puffelen E, Hulst JM, Vanhorebeek I, Dulfer K, Van den Berghe G, Joosten KFM, Verbruggen SCAT. Effect of late versus early initiation of parenteral nutrition on weight deterioration during PICU stay: Secondary analysis of the PEPaNIC randomised controlled trial. Clin Nutr 2019; 39:104-109. [PMID: 30879734 DOI: 10.1016/j.clnu.2019.02.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/30/2019] [Accepted: 02/08/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND & AIMS Critically ill children are at increased risk of weight deterioration in the paediatric intensive care unit (PICU). Whether early initiation of parenteral nutrition (PN) prevents weight deterioration is unknown. The aims of this study were to assess the effect of withholding supplemental PN during the first week on weight Z-score change in PICU and to evaluate the association between weight Z-score change in the PICU and clinical outcomes. METHODS This is a secondary analysis of the Paediatric Early versus Late Parenteral Nutrition in Intensive Care Unit (PEPaNIC) randomised controlled trial (N = 1440), which focused on the subgroup of patients with longitudinal weight Z-scores available on admission and on the last day in PICU. Patients were randomly allocated to initiation of supplemental PN after one week (Late-PN) or within 24 h (Early-PN) when enteral nutrition was insufficient. The effect of Late-PN versus Early-PN on the change in weight Z-score was investigated, adjusted for risk factors. Moreover, the association between weight Z-score change and clinical outcomes was explored, adjusted for risk factors. RESULTS Longitudinal weight Z-scores were available for 470 patients. Enteral nutrition intake was equal in the Early-PN and Late-PN group. Less weight Z-score deterioration during PICU stay was associated with a lower risk of new infections (adjusted OR per Z-score increase 0.72 [0.55-0.96], p = 0.02), and with a higher likelihood of an earlier discharge from PICU alive (adjusted HR per Z-score increase 1.22 [1.10-1.37], p < 0.001). During PICU-stay, the change in weight Z-score did not differ among both groups (Late-PN median 0.00 [-0.34-0.12] vs Early-PN median -0.03 [-0.48-0.01], adjusted β = 0.10 [-0.05-0.25], p = 0.18). CONCLUSIONS Weight deterioration during the PICU stay was associated with worse clinical outcomes. Withholding supplemental PN during the first week did not aggravate weight Z-score deterioration during PICU stay. TRIAL REGISTRATION clinicaltrials.gov NCT01536275.
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Affiliation(s)
- E van Puffelen
- Department of Paediatrics and Paediatric Surgery, Intensive Care Unit, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J M Hulst
- Department of Paediatrics, Division of Paediatric Gastroenterology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - I Vanhorebeek
- Department of Cellular and Molecular Medicine, Clinical Division and Laboratory of Intensive Care Medicine, University Hospitals KU Leuven, Leuven, Belgium
| | - K Dulfer
- Department of Paediatrics and Paediatric Surgery, Intensive Care Unit, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - G Van den Berghe
- Department of Cellular and Molecular Medicine, Clinical Division and Laboratory of Intensive Care Medicine, University Hospitals KU Leuven, Leuven, Belgium
| | - K F M Joosten
- Department of Paediatrics and Paediatric Surgery, Intensive Care Unit, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - S C A T Verbruggen
- Department of Paediatrics and Paediatric Surgery, Intensive Care Unit, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands.
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Tume LN, Valla FV, Floh AA, Goday P, Jotterand Chaparro C, Larsen B, Lee JH, Moreno YMF, Pathan N, Verbruggen S, Mehta NM. Priorities for Nutrition Research in Pediatric Critical Care. JPEN J Parenter Enteral Nutr 2018; 43:853-862. [DOI: 10.1002/jpen.1498] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/03/2018] [Indexed: 01/14/2023]
Affiliation(s)
- Lyvonne N. Tume
- Faculty of Health & Applied SciencesUniversity of the West of England Bristol UK
| | - Frédéric V. Valla
- Pediatric Intensive Care UnitHôpital Femme Mère EnfantHospices Civils de Lyon Lyon‐Bron France
| | - Alejandro A. Floh
- Department of PediatricsUniversity of Toronto Toronto Canada
- Cardiac Critical Care UnitDepartment of Critical CareThe Hospital for Sick Children Toronto Canada
| | - Praveen Goday
- Pediatric GastroenterologyNutrition Medical College of Wisconsin Milwaukee Wisconsin USA
| | - Corinne Jotterand Chaparro
- Department of Nutrition and DieteticsUniversity of Applied Sciences Western Switzerland (HES‐SO) Geneva Switzerland
- Pediatric Intensive Care UnitMedico‐Surgical Department of PediatricsUniversity Hospital of Lausanne Lausanne Switzerland
| | - Bodil Larsen
- Department of ALES (Human Nutrition)University of Alberta Edmonton Canada
| | - Jan Hau Lee
- Children's Intensive Care UnitKK Women's and Children's Hospital Singapore Singapore
- Duke‐NUS Medical School Singapore Singapore
| | - Yara M. F. Moreno
- Department of Nutrition and Postgraduate Program in NutritionSanta Catarina Federal UniversityHealth Sciences Centre Florianópolis Santa Catarina Brazil
| | - Nazima Pathan
- Addenbrooke's HospitalUniversity of Cambridge Cambridge England
| | - Sascha Verbruggen
- Pediatric Intensive Care UnitErasmus MC ‐ Sophia Children's Hospital Rotterdam the Netherlands
| | - Nilesh M. Mehta
- Department of AnesthesiologyCritical Care and Pain MedicineBoston Children's HospitalHarvard Medical School Boston Massachusetts USA
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Marino LV, Harris A, Johnstone C, Friend A, Newell C, Miles EA, Lucas JS, Calder PC, Walker WT. Characterising the nutritional status of children with primary ciliary dyskinesia. Clin Nutr 2018; 38:2127-2135. [PMID: 30243504 DOI: 10.1016/j.clnu.2018.08.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/28/2018] [Accepted: 08/25/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Primary ciliary dyskinesia (PCD) is a rare, heterogeneous genetic disorder where impaired mucociliary clearance is caused by dysfunctional motile cilia leading to bronchiectasis. There is limited evidence characterising the nutritional status of children with PCD, although lower body mass index (BMI) z-score has been associated with worse lung function (FEV1). METHODS All children (n = 43) with PCD, aged <16 years, from a single tertiary centre were prospectively enrolled. Information on clinical phenotype and nutritional status including bioelectrical impedance spectroscopy (BIS) phase-angle was collected. RESULTS There was a weak positive association between height-for-age z-score (HAZ) and FEV1 z-score (n = 28, r = 0.4, p = 0.049). Those with a low fat free mass index (<-2 z scores) had a lower BMI z score (-1.3 ± 1.2 vs. 0.8 ± 0.7, p = 0.0002). BIS phase angle identified more patients at nutritional risk than using moderate malnutrition cut-offs of either HAZ or BMI ≤ -2 z scores alone (21% vs. 4.6% vs. 6.9% respectively). PCD patients had a higher incidence of vitamin D insufficiency (<50 nmoL/L) (54%) and deficiency (<30 nmoL/L) (26%) than healthy children. CONCLUSIONS We have characterised the nutritional phenotype of a cohort of children with PCD. Monitoring vitamin D levels is important in PCD patients. There is a weak association between lung function and nutritional status, and measures of BIS phase-angle. The use of BIS phase-angle may allow for early identification of at risk children and may therefore be of benefit for nutritional assessments in the clinical setting. These findings will help inform a future nutritional intervention strategy in children with PCD.
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Affiliation(s)
- L V Marino
- Department of Dietetics/Speech and Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK.
| | - A Harris
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - C Johnstone
- Department of Dietetics/Speech and Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - A Friend
- Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - C Newell
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - E A Miles
- Human Development & Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - J S Lucas
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK; Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Clinical and Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - P C Calder
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK; Human Development & Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - W T Walker
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK; Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Clinical and Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
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30
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The development of a consensus-based nutritional pathway for infants with CHD before surgery using a modified Delphi process. Cardiol Young 2018; 28:938-948. [PMID: 29704905 PMCID: PMC5977758 DOI: 10.1017/s1047951118000549] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
UNLABELLED IntroductionDespite improvements in the medical and surgical management of infants with CHD, growth failure before surgery in many infants continues to be a significant concern. A nutritional pathway was developed, the aim of which was to provide a structured approach to nutritional care for infants with CHD awaiting surgery.Materials and methodsThe modified Delphi process was development of a nutritional pathway; initial stakeholder meeting to finalise draft guidelines and develop questions; round 1 anonymous online survey; round 2 online survey; regional cardiac conference and pathway revision; and final expert meeting and pathway finalisation. RESULTS Paediatric Dietitians from all 11 of the paediatric cardiology surgical centres in the United Kingdom contributed to the guideline development. In all, 33% of participants had 9 or more years of experience working with infants with CHD. By the end of rounds 1 and 2, 76 and 96% of participants, respectively, were in agreement with the statements. Three statements where consensus was not achieved by the end of round 2 were discussed and agreed at the final expert group meeting. CONCLUSIONS Nutrition guidelines were developed for infants with CHD awaiting surgery, using a modified Delphi process, incorporating the best available evidence and expert opinion with regard to nutritional support in this group.
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Alshehri A, Afshar K, Bedford J, Hintz G, Skarsgard ED. The relationship between preoperative nutritional state and adverse outcome following abdominal and thoracic surgery in children: Results from the NSQIP database. J Pediatr Surg 2018; 53:1046-1051. [PMID: 29499844 DOI: 10.1016/j.jpedsurg.2018.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 02/01/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Anthropometric measurements can be used to define pediatric malnutrition. Our study aims to: (1) characterize the preoperative nutritional status of children undergoing abdominal or thoracic surgery, and (2) describe the associations between WHO-defined acute (stunting) and chronic (wasting) undernutrition (Z-scores <-2) and obesity (BMI Z-scores >+2) with 30-day postoperative outcomes. METHODS We queried the Pediatric NSQIP Participant Use File and extracted data on patients' age 29days to 18years who underwent abdominal or thoracic procedures. Normalized anthropometric measures were calculated, including weight-for-height for <2years, BMI for ages ≥2years, and height for age. Logistic regression models were developed to assess nutritional outlier status as an independent predictor of postoperative outcome. RESULTS 23,714 children (88% ≥2y) were evaluated. 4272 (18%) were obese, while 2640 (11.1%) and 904 (3.8%) were stunted and wasted, respectively, after controlling for gender, ASA/procedure/wound classification, preoperative steroid use, need for preoperative nutritional support, and obese children had higher odds of SSIs (OR 1.29, 95% CI 1.1-1.5, p=0.001), while stunted children were at increased risk of any 30-day postoperative complication (OR 1.16, 95% CI 1.0-1.3, p=0.036). CONCLUSION Children who are stunted or obese are at increased risk of adverse outcome after abdominal or thoracic surgery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Abdullah Alshehri
- Divisions of Pediatric Surgery, Urology, University of British Columbia, Vancouver, Canada
| | - Kourosh Afshar
- Divisions of Pediatric Surgery, Urology, University of British Columbia, Vancouver, Canada
| | - Julie Bedford
- Department of Quality and Safety, University of British Columbia, Vancouver, Canada; British Columbia Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Graeme Hintz
- Departments of Surgery and Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Erik D Skarsgard
- Divisions of Pediatric Surgery, Urology, University of British Columbia, Vancouver, Canada.
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