Bioelectrical impedance phase angle as indicator and predictor of cachexia in head and neck cancer patients treated with (chemo)radiotherapy

Research progress on predictive models for malnutrition in cancer patients

Disease-related malnutrition is a prevalent issue among cancer patients, affecting approximately 40-80% of those undergoing treatment. This condition is associated with numerous adverse outcomes, including extended hospitalization, increased morbidity and mortality, delayed wound healing, compromised muscle function and reduced overall quality of life. Moreover, malnutrition significantly impedes patients' tolerance of various cancer therapies, such as surgery, chemotherapy, and radiotherapy, resulting in increased adverse effects, treatment delays, postoperative complications, and higher referral rates. At present, numerous countries and regions have developed objective assessment models to predict the risk of malnutrition in cancer patients. As advanced technologies like artificial intelligence emerge, new modeling techniques offer potential advantages in accuracy over traditional methods. This article aims to provide an exhaustive overview of recently developed models for predicting malnutrition risk in cancer patients, offering valuable guidance for healthcare professionals during clinical decision-making and serving as a reference for the development of more efficient risk prediction models in the future.

Phase angle - A screening tool for malnutrition, sarcopenia, and complications in gastric cancer

BACKGROUND

Patients with gastric cancer (GC) are more likely to experience malnutrition and muscle wasting. This study aims to investigate the potential of phase angle (PhA) as a screening tool for identifying malnutrition and sarcopenia in GC patients, as well as its association with short-term outcomes after radical gastrectomy.

METHODS

This cross-sectional study enrolled patients diagnosed with GC at The Affiliated People's Hospital of Jiangsu University from October 2021 to September 2022. PhA was measured using bioelectrical impedance analysis. Computed tomography scan images were analyzed for body composition at the level of the third lumbar vertebra. Malnutrition was diagnosed using Global Leadership Initiative on Malnutrition (GLIM) criteria. Sarcopenia diagnosis was based on the Asian Working Group for Sarcopenia (AWGS) 2019 criteria.

RESULTS

A total of 248 patients with GC were analyzed, including 188 patients who underwent radical gastrectomy. Of these, 71.4 % (n = 177) were male and 28.6 % (n = 71) were female and the median overall age was 68 years (IQR: 61-72 years). According to GLIM criteria, 49.2 % (n = 122) of patients were malnourished and 19.8 % (n = 49) had sarcopenia based on AWGS criteria. A one-degree decrease in PhA was significantly associated with GLIM malnutrition (Odds Ratio [OR] = 8.108, 95 % CI:3.181-20.665) and sarcopenia (OR = 2.903, 95 % CI:1.170-7.206). PhA exhibited fair to good diagnostic accuracy in identifying GLIM malnutrition (male: AUC = 0.797; female: AUC = 0.816) and sarcopenia (male: AUC = 0.814; female: AUC = 0.710). Low PhA (OR = 3.632, 95 % CI: 1.686-7.824) and operation time (OR = 2.434, 95 % CI:1.120-5.293) were independently associated with the risk of postoperative complications.

CONCLUSIONS

PhA can serve as a reliable screening tool for identifying patients at risk of malnutrition, sarcopenia, and postoperative complications in GC.

Phase Angle, Handgrip Strength, and Other Indicators of Nutritional Status in Cancer Patients Undergoing Different Nutritional Strategies: A Systematic Review and Meta-Analysis

Malnutrition in cancer patients is one of the most influential factors in the evolution and mortality of such patients. To reduce the incidence of malnutrition, it is necessary to establish a correct nutritional intervention. For this purpose, precise tools and indicators must be developed to determine the patient’s condition. The main objective of this systematic review and meta-analysis was to analyze the relationship between different nutritional strategies, phase angle (PA), and handgrip strength in patients with cancer, with the secondary objectives being the modification of other indicators of nutritional status, such as weight and body mass index (BMI). A systematic review of randomized clinical trials was carried out in March 2023 in the databases PubMed, Web of Science, Cochrane, and Scopus. As a risk-of-bias tool, RoB 2.0 was utilized. A total of 8 studies with a total of 606 participants were included in the analysis. A significant increase in PA was observed after the different nutritional strategies (SMD: 0.43; 95% CI: 0.10 to 0.77; p = 0.01; I2 = 65.63%), also detecting a significant increase in handgrip strength (SMD: 0.27, 95% CI: 0.08 to 0.47; p = 0.01; I2 = 30.70%). A significant increase in PA and handgrip were observed in cancer patients subjected to different nutritional strategies. These results suggest that these indicators could be used in the nutritional and functional assessment of the patients.

Oropharyngeal dysphagia and cachexia: Intertwined in head and neck cancer

BACKGROUND

This study aims to investigate the relationship between cancer cachexia and oropharyngeal dysphagia (OD) in patients with head and neck cancer (HNC) prior to chemoradiotherapy or bioradiotherapy (CRT/BRT).

METHODS

A prospective cohort study with patients with HNC undergoing CRT/BRT (2018-2021) was conducted. Body composition and skeletal muscle function were evaluated using bioelectrical impedance analysis, handgrip strength, and the short physical performance battery (SPPB). The M. D. Anderson Dysphagia Inventory (MDADI), Eating Assessment Tool (EAT)-10 questionnaire, and patient characteristics were collected. A standardized videofluoroscopic swallowing study was offered to patients.

RESULTS

Sixty-six patients were included. Twenty-six patients scored EAT-10 ≥ 3 and seventeen were cachectic. ACE-27 score >1, cachexia, abnormal SPPB-derived repeated chair-stand test, lower MDADI scores, and higher overall stage grouping showed potential predictive value (p ≤ 0.10) for EAT-10 ≥ 3. Using multivariable regression analysis, only cachexia remained a significant predictor of EAT-10 ≥ 3 (HR 9.000 [95%CI 2.483-32.619], p = 0.001).

CONCLUSION

Cachexia independently predicted the presence of patient-reported OD.

Influence of fat-free mass index on the survival of patients with head and neck cancer

PURPOSE

To determine whether muscle mass, defined by fat-free mass index (FFMI) measured with bioelectrical impedance analysis (BIA), is predictive of survival of head and neck squamous cell carcinoma (HNSCC) patients.

METHODS

HNSCC patients treated between 2014 and 2018 at the Department for Nutrition of the Institute of Oncology Ljubljana were reviewed. The FFMI values from the pretreatment BIA measurements and pretreatment body mass index (BMI) were used to categorize patients into groups with low and normal muscle mass and BMI using the Global Leadership Initiative on malnutrition (GLIM) recommended cutoff values. The impact of FFMI on disease-free survival (DFS) and overall survival (OS) was determined.

RESULTS

Of the 71 included patients, 31 (43.7%) had normal FFMI, and 40 (56.3%) had low FFMI, whereas 44 (62%) and 27 (38%) of the patients had normal and low BMI, respectively. Between FFMI and BMI values, a significant correlation was found (R_P = 0.75, p < 0.001). Univariate regression analysis showed that FFMI (as a continuous variable) was of prognostic significance for OS (p = 0.039), which was confirmed by multivariate regression analysis (p = 0.029). The model where BMI replaced FFMI negated the prognostic value of BMI (as a continuous variable). Neither FFMI nor BMI was found to be a predictor of DFS on univariate or multivariate analysis.

CONCLUSIONS

In the present group of HNSCC patients, low FFMI adversely influenced OS, emphasizing the importance of using body composition measurement over BMI alone for pretreatment nutritional evaluation of these patients.

Development and validation of the modified index of fragility in head and neck cancer surgery

BACKGROUND

This study aims to develop and validate, a clinically useful modified index of fragility (mIFG) to identify patients at risk of fragility and to predict postoperative adverse events.

METHOD

An observational study was performed using the American College of Surgeons National Surgical Quality Improvement Program database, from 2006 to 2018. All patients undergoing nonemergency head and neck cancer surgery were included. A seven-item index (mIFG) was developed using variables associated with frailty, cachexia, and sarcopenia, drawn from the literature (weight loss, low body mass index, dyspnea, diabetes, serum albumin, hematocrit, and creatinine). Multivariable logistic regression was used to model the association between mIFG, postoperative adverse events and death. A validation cohort was then used to ascertain the diagnostic accuracy of the mIFG.

RESULTS

A total of 23,438 cases were included (16,407 in the derivation group and 7031 in the validation group). There was a total of 4273 postoperative major adverse events (AE) and deaths, 1023 postoperative pulmonary complications and 1721 wound complications. Using the derivation cohort, the 7-item mIFG was independently associated with death, major AEs, pulmonary and wound complications, when controlling for significant covariates. The mIFG predicted death and major adverse events using the validation cohort with an accuracy of 0.70 (95% CI: 0.63-0.76) and 0.64 (95% CI: 0.63-0.66), respectively. The mIFG outperformed the modified Frailty index.

CONCLUSION

The modified index of fragility is a reliable and easily accessible tool to predict risk of postoperative adverse events and death in patients undergoing head and neck cancer surgery.

Association between PhA and Physical Performance Variables in Cancer Patients

Maintaining the physical performance of cancer patients is increasingly considered due to the growing number of cancer patients and the aggressiveness of the treatments. For this reason, bioimpedance is now being used to record patients' body composition by obtaining the phase angle (PhA). Although there is a direct relationship between PhA, age, sex and disease prognosis, it has not been measured as an analysis of physical performance in oncology patients and is a valid tool in the follow-up of cancer patients. For this purpose, 311 patients were evaluated, and both bioelectrical impedance analysis (BIA) and physical performance measurements were performed. The modification of the results concerning PhA was found to be highly relational, as a variation in one of the variables affected the other. It was concluded that each degree increase in PhA modified -22.57 s [-27.58; -17.53] in 400-m walking test (400 mWT); 13.25 kg [10.13; 16.35] in upper-body strength (UBS); 6.3 [4.95; 7.65] in lower-body strength (LBS); 1.55 mL/kg/min [0.98; 2.12] in VO2peak; 6.53 Watts [3.83; 9.20] in ventilatory threshold 1 (VT1); 10.36 Watts [7.02; 13.64] in ventilatory threshold 2 (VT2). It was also noted that age was a factor that affected the relationship between PhA and 400 mWT; the older the age, the higher the relationship. PhA data has been shown to be highly correlated with physical performance. This is of great importance in clinical practice because a cancer patient's physical performance levels can be assessed during treatment.

Bioelectrical Phase Angle in Patients with Breast Cancer: A Systematic Review

Simple Summary

Breast cancer (BC) patients suffer from loss of muscle tissue and fluid alterations during the whole trajectory of the disease. Such alterations might be reflected by phase angle (PhA) measures, but its use in the oncologic setting is still limited. Therefore, the aim of this systematic review was to assess PhA in BC patients, since it has been proven to be a reliable index for predicting nutritional status and survival. Findings reveal that PhA decreases after chemotherapy in BC patients, with high results in women with a better nutritional status, and these changes may persist even after five years. However, PhA remains stable, or can increase in some cases, when patients are supported by targeted lifestyle interventions. Thus, PhA can be useful to identify and monitor changes in body compartments and the nutritional status of BC patients over time.

Abstract

Breast cancer (BC) is the most common cancer diagnosed among women worldwide. Phase angle (PhA), a proxy measure of membrane integrity and function, has gained relevance in clinical practice and it has been suggested to be a prognostic and nutritional indicator. This systematic review aimed to explore PhA and its relationship with nutritional status and survival in BC patients. Four databases (PubMed, EMBASE, Web of Science, and CINAHL) were systematically searched until September 2021 for studies evaluating PhA in BC patients. A total of 16 studies met the inclusion criteria, where 11 were observational studies and 5 were interventional studies. Baseline PhA-value varied from 4.9 to 6.30 degrees, showing a great variability and heterogeneity across the selected studies. Available data suggested that PhA decreased by 5–15% after completing chemotherapy, and those effects might persist in the long term. However, the use of tailored nutritional and/or exercise programs during and after therapy could prevent PhA reduction and body derangement. High PhA values were found in women displaying a better nutritional status, while inconsistent data were found on survival. Therefore, further studies are needed to focus on the clinical relevance of PhA in BC patients, evaluating its association with disease outcomes and survival.

Understanding Cachexia in Head and Neck Cancer

One of the major comorbidities of cancer and cancer therapy is posing a global health problem in cancer cachexia. Cancer cachexia is now considered a multifactorial syndrome that presents with drastic loss of body weight, anorexia, asthenia, and anemia. Head and neck cancer (HNC) patients are at a greater risk for development and severity of cachexia syndrome as there is direct involvement of structures associated with nutritional intake. Yet, the scientific evidence, approach, and management of cachexia in HNCs are yet to be largely explored. The article aims to succinctly review the concepts of cancer cachexia with relevance to HNCs and summarizes the current findings from recent research.

Association of handgrip strength and endurance with body composition in head and neck cancer patients

Introduction:

Assessment of skeletal muscle function (SMF) is of clinical relevance in the prediction of treatment outcome and to decide on optimal management of head & neck cancer (HNC) patients. Handgrip strength (HGS) & handgrip endurance (HGE) are considered as surrogate marker for whole-body skeletal muscle function. Further, SMF depends substantially on the body composition (BC). Hence in this study, we compared BC, HGS and HGE between HNC patients and healthy controls and also analysed the association of HGS, HGE with body composition in HNC patients.

Methods:

A cross-sectional study, conducted in 44 subjects in the age between 18 to 60 years. Twenty-two were histologically proven HNC patients prior to cancer-specific treatment and twenty-two age and gender-matched healthy volunteers. The parameters recorded were Height, weight, waist circumference, hip circumference, HGS, HGE and BC. Hand-held dynamometer was used to measure HGS and HGE measured using a stopwatch. BC was estimated by whole-body bioelectrical Impedance analysis method using Bodystat Quad scan 4000 device.

Result:

Comparison of data between HNC patient & healthy control was done by Student's t test. HGS, HGE, lean body mass (LBM), fat-free mass index (FFMI), Phase angle (PA), body cell mass (BCM) and body cell mass index (BCMI) were found to be reduced significantly in HNC patients when compared to healthy subjects. Further, Pearson correlation analysis revealed a significant positive correlation of HGS & HGE with LBM, FFMI, PA, BCM & BCMI, whereas body fat mass index showed a negative correlation with HGS & HGE in HNC patients.

Conclusion:

Our findings revealed, a significant reduction in HGS, HGE in patient with HNC which denotes decreased skeletal muscle function and it is linearly associated with low muscle mass, body cell mass and phase angle.

Nutritional Deficiencies in Radiotherapy-Treated Head and Neck Cancer Patients

Nutritional deficiencies (malnutrition, cachexia, sarcopenia, and unfavorable changes in the body composition) developing as a side effect of radiotherapy (RT) currently represents a significant but still inaccurately studied clinical problem in cancer patients. The incidence of malnutrition observed in head and neck cancer (HNC) patients in oncological radiology departments can reach 80%. The presence of malnutrition, sarcopenia, and cachexia is associated with an unfavorable prognosis of the disease, higher mortality, and deterioration of the quality of life. Therefore, it is necessary to identify patients with a high risk of both metabolic syndromes. However, the number of studies investigating potential predictive markers for the mentioned purposes is still significantly limited. This literature review summarizes the incidence of nutritional deficiencies in HNC patients prior to therapy and after the commencement of RT, and presents recent perspectives for the prediction of unfavorable nutritional changes developing as a result of applied RT.

Local tissue electrical parameters predict oral mucositis in HNSCC patients: A diagnostic accuracy double-blind, randomized controlled trial

Oral Mucositis (OM) is a common adverse effect of head and neck squamous cell carcinoma (HNSCC) treatment. The purpose of this study was to investigate the significance of early changes in tissue electrical parameters (TEPs) in predicting the development of OM in HNSCC patients receiving radiation therapy (RT). The current study combined two study designs. The first was a case-control study. The control group comprised of RT patients who did not receive head and neck RT, and patients with HNSCC who received RT comprised the case group. In the second part of the study, the case group was included in a parallel cohort. A total of 320 patients were assessed for eligibility, and 135 patients were enrolled. Double blinding was performed, and neither the patients nor the care providers knew the measured parameters. The primary outcome was the detection of between-group changes in local TEPs over the follow-up period. The secondary outcome was the appearance of OM grades II, III, or IV and the predictive value of local TEPs in determining the incidence of OM after RT. The variables, impedance module, resistance, reactance, phase angle, and capacitance, were analyzed by the receiver operator curves (ROC). The case and control groups did not differ in demographic and clinical characteristics. Radiation therapy increased the local impedance module, resistance, reactance, and phase angle and reduced the local tissue capacitance in both groups. Evaluation of TEPs in the first week of RT correlated with the development of OM lesions during cancer therapy. ROC analysis showed that local impedance module and resistance presented higher specificity than did other parameters in predicting OM. In conclusion, local tissue electrical parameters measured at the first RT week can be useful tools to predict oral mucositis.

Can Bioelectrical Impedance Analysis and BMI be a Prognostic Tool in Head and Neck Cancer Patients? A Review of the Evidence

Background: Malnutrition can significantly affect disease progression and patient survival. The efficiency of weight loss and bioimpedance analysis (BIA)-derived measures in the evaluation of malnutrition, and disease progression and prognosis in patients with head and neck cancer (HNC) are an important area of research. Method: The PubMed database was thoroughly searched, using relative keywords in order to identify clinical trials that investigated the role of BIA-derived measures and weight loss on the disease progression and prognosis of patients with HNC. Twenty-seven studies met the criteria. More specifically, six studies examined the prognostic role of the tissue electrical properties in HNC patients; five examined the role of the tissue electrical properties on identifying malnutrition; four studies looked at the changes in the tissue electrical properties of HNC patients; and 12 examined the prognostic role of weight loss on survival and/or treatment outcomes. Results: Several studies have investigated the role of nutritional status tools on prognosis in HNC patients. Current studies investigating the potential of BIA-derived raw data have shown that phase angle (PA) and capacitance of the cell membrane may be considered prognostic factors of survival. Weight loss may be a prognostic factor for treatment toxicity and survival, despite some conflicting evidence. Conclusions: Further studies are recommended to clarify the role of BIA-derived measures on patients’ nutritional status and the impact of PA on clinical outcomes as well as the prognostic role of weight loss.

Refeeding syndrome in hematological cancer patients - current approach

Introduction: According to estimates based on the GLOBOCAN database of the International Agency for Research on Cancer, in 2018 alone, 18 100 000 cancers were globally diagnosed. Importantly, the majority of cancer patients experience unintended weight loss that leads to many adverse clinical consequences, including malnutrition and cancer cachexia. At the same time, each nutritional intervention must be carried out individually, as it can lead to critical complications, resulting in a threat to the health and life of the cachectic patient. An example of this type of risk is refeeding syndrome.Areas covered: Three factors seem to be crucial in this case: early identification of patients at risk of malnutrition, the introduction of an individualized diet regimen and constant monitoring of nutritional intervention. It seems equally important to spread awareness about the possibility of refeeding syndrome and knowledge about its patomechanisms and consequences among medical staff. This should lead to minimizing the risk of refeeding syndrome.Expert opinion: It should be noted that current guidelines on the pathogenesis, risk factors and methods of prevention and treatment of refeeding syndrome require further modifications, that would harmonize the management regimen in both prevention and therapy of refeeding syndrome.

Psychological distress and nutritional status in head and neck cancer patients: a pilot study

Purpose

To determine whether the psychological state of patients with head and neck cancer (HCN) is associated with their nutritional status.

Methods

In 40 patients with locally advanced HNC treated with definitive or adjuvant (chemo)radiotherapy, psychological and nutritional status were assessed before treatment, at its completion and 3 months’ post-therapy. Psychosocial distress was measured using the Hospital Anxiety and Depression Scale questionnaire (HADS-A, HADS-D), whereas the nutritional status was evaluated using standard methods (Nutritional Risk Screening Tool 2002, anthropometric data, dynamometry and laboratory tests) and with a bioelectrical impedance analysis parameter phase angle (PA).

Results

Before treatment, more patients were screened positive for anxiety than at treatment completion (p = 0.037) or 3 months’ post-therapy (p = 0.083). Depression prevalence was non-significantly higher at the end and after therapy. Compared to the baseline, more cachectic patients and a reduction of PA values were found at successive assessments. Anxiety was more often recorded among malnourished/cachectic patients (assessment 1, p = 0.017; assessment 2, p = 0.020) who were also found more frequently depressed (assessment 2, p = 0.045; assessment 3, p = 0.023). Significantly higher PA values were measured in patients without distress determined at 3 months’ post-therapy by the HADS-A (p = 0.027).

Conclusion

The association between the psychological and nutritional status found in this pilot study and the options for intervention warrants further clarification in a larger prospective trial.

Phase Angle as an Objective and Predictive Factor of Radiotherapy-induced Changes in Body Composition of Male Patients With Head and Neck Cancer

BACKGROUND

Unfavorable changes in body composition are frequent among patients with head and neck cancer (HNC). Unfortunately, in daily clinical practice, there is a lack of reliable diagnostic tools for predicting changes in body composition in individuals following radiotherapy (RT). Among non-invasive tools, bioelectrical impedance analysis (BIA) seems to be most promising. One BIA parameter, the phase angle (PA), reflects condition of various body cells and their mass in detail.

MATERIALS AND METHODS

Using BIA, the body composition was measured prior to and after RT in 52 male patients with HNC. PA derived from BIA prior to RT was tested as a predictor of body composition changes developing during RT.

RESULTS

Patients with low PA had a greater than 9.3-fold higher chance of body mass index (BMI) reduction below 18.5 kg/m² and over 5.9-fold and 4.2-fold higher chance of lean mass and fat mass reduction after therapy end compared with patients with a high PA value. PA values demonstrated significant diagnostic accuracy for detection of fat-free mass, lean mass and BMI reduction in the study group [area under the curve (AUC)=0.781, 0.774 and 0.786, respectively].

CONCLUSION

PA prior to RT is a useful marker for selection of individuals with HNC who are at a high risk of unfavorable changes in body composition.

Muscle alterations in the development and progression of cancer-induced muscle atrophy: a review

Cancer cachexia-cancer-associated body weight and muscle loss-is a significant predictor of mortality and morbidity in cancer patients across a variety of cancer types. However, despite the negative prognosis associated with cachexia onset, there are no clinical therapies approved to treat or prevent cachexia. This lack of treatment may be partially due to the relative dearth of literature on mechanisms occurring within the muscle before the onset of muscle wasting. Therefore, the purpose of this review is to compile the current scientific literature on mechanisms contributing to the development and progression of cancer cachexia, including protein turnover, inflammatory signaling, and mitochondrial dysfunction. We define "development" as changes in cell function occurring before the onset of cachexia and "progression" as alterations to cell function that coincide with the exacerbation of muscle wasting. Overall, the current literature suggests that multiple aspects of cellular function, such as protein turnover, inflammatory signaling, and mitochondrial quality, are altered before the onset of muscle loss during cancer cachexia and clearly highlights the need to study more thoroughly the developmental stages of cachexia. The studying of these early aberrations will allow for the development of effective therapeutics to prevent the onset of cachexia and improve health outcomes in cancer patients.

Combined analysis of miRNA-181a with phase angle derived from bioelectrical impedance predicts radiotherapy-induced changes in body composition and survival of male patients with head and neck cancer

BACKGROUND

Nutritional deficits developing as an effect of applied radiotherapy (RTH) negatively affect patients' quality of life, survival, and therapy outcomes. We demonstrated novel approach to prediction of RTH-induced changes in body composition of patients with head and neck cancer using phase angle (PA) derived from bioelectrical impedance in combination with miRNA-181a expression.

RESULTS

Patients with simultaneous presence of low PA and high miRNA expression were at a significantly higher risk of decreasing the fat-free mass index (FFMI) <14.9 kg/m² (odds ratio [OR] = 5.14; P = .02), FFM < 44.7 kg (OR = 6.20; P = .04), and lean mass (OR = 10.0; P = .04) during the therapy period. Receiver operating curve analysis allowed to predict changes in FFMI, lean mass, and FFM with area under the curve calculation over 0.700. The simultaneous presence of high miRNA and low PA negatively affected patients' survival (OR = 5.12; P = .02).

CONCLUSION

Evaluation of PA in combination with miRNA demonstrates higher diagnostic accuracy and predictive value for detecting RTH-induced changes in body composition of patients with cancer.

Assessment of adult malnutrition and prognosis with bioelectrical impedance analysis: phase angle and impedance ratio

PURPOSE OF REVIEW

Malnutrition affects prognosis in many groups of patients. Although screening tools are available to identify adults at risk for poor nutritional status, a need exists to improve the assessment of malnutrition by identifying the loss of functional tissues that can lead to frailty, compromised physical function, and increased risk of morbidity and mortality, particularly among hospitalized and ill patients and older adults. Bioimpedance analysis (BIA) offers a practical approach to identify malnutrition and prognosis by assessing whole-body cell membrane quality and depicting fluid distribution for an individual.

RECENT FINDINGS

Two novel applications of BIA afford opportunities to safely, rapidly, and noninvasively assess nutritional status and prognosis. One method utilizes single-frequency phase-sensitive measurements to determine phase angle, evaluate nutritional status, and relate it to prognosis, mortality, and functional outcomes. Another approach uses the ratio of multifrequency impedance values to indicate altered fluid distribution and predict prognosis.

SUMMARY

Use of basic BIA measurements, independent of use of regression prediction models and assumptions of constant chemical composition of the fat-free body, enables new options for practical assessment and clinical evaluation of impaired nutritional status and prognosis among hospitalized patients and elders that potentially can contribute to improved patient care and clinical outcomes. However, these novel applications have some technical and physiological limitations that should be considered.

Bioelectrical impedance analysis of head and neck cancer patients at presentation

CONCLUSION

Finnish head and neck cancer (HNC) patients show signs of severe malnutrition already at presentation, measured by bioelectric impedance analysis (BIA). BIA may be a practical method to detect malnutrition, analyze body composition, and to identify high-risk patients in this population.

OBJECTIVES

BIA is a validated method for evaluating body composition and detecting malnutrition. Low phase angle (PA) is associated with increased mortality and morbidity. Vector analysis (BIVA) provides a qualitative measure for hydration and cell mass, independent of body size. This study describes BIA results in Finnish HNC patients at presentation.

METHODS

Forty-one newly-diagnosed HNC patients at the Helsinki University Hospital were included. BIA measures (resistance, reactance, PA, fat-free mass index [FFMI], and fat mass index [FMI]), body mass index (BMI), and Charlson Comorbidity Index (CCI) were determined.

RESULTS

The majority of patients were men (78%), with a normal average BMI of 25.2. Low FFMI was seen in 44% of women and 28% of men. The PA (median = 4.6; IQ range = 4-5) was lower than the reference values in 76% (n = 31) of cases. In BIVA, only 13 (32%) of the patients were within normal range and 15 (37%) were plotted in the quadrant indicating malnutrition.