Phase Angle as an Indicator of Sarcopenia, Malnutrition, and Cachexia in Inpatients with Cardiovascular Diseases

Identifying determinants of physical activity in older patients with musculoskeletal disorders undergoing rehabilitation: Comparison of two distinct models using structural equation modeling

AIM

Mobility restrictions cause older adults with musculoskeletal disorders to have lower levels of physical activity. However, the determinants of their physical activity during hospitalization are unclear. We aimed to compare two conceptual frameworks using structural equation modeling to identify factors influencing physical activity in older patients with musculoskeletal disorders.

METHODS

This cross-sectional study included older patients with musculoskeletal disorders at a single convalescent rehabilitation hospital. Physical activity was objectively measured using a triaxial accelerometer. We utilized structural equation modeling to contrast two conceptual frameworks: (i) the sarcopenia/nutrition/activities of daily living model, and (ii) the age-related deconditioning/activities of daily living model. The models' goodness-of-fit was evaluated, including root mean square approximation error, goodness-of-fit index (GFI), adjusted GFI and Akaike information criterion.

RESULTS

We enrolled 274 older patients (age 78.0 years; 42 men, 232 women) with musculoskeletal disorders. Among them, 123 (44.9%) were diagnosed with sarcopenia and 69 (25.2%) with malnutrition. The goodness-of-fit of the (ii) model (root mean square approximation error = 0.068, GFI = 0.958, adjusted GFI = 0.909, Akaike information criterion = 5780.875) was superior to the (i) model (root mean square approximation error = 0.080, GFI = 0.953, adjusted GFI = 0.887, Akaike information criterion = 5791.429).

CONCLUSIONS

We discovered that the age-related deconditioning/activities of daily living model effectively explained physical activity in hospitalized older patients with musculoskeletal disorders. A comprehensive approach considering age-related changes, such as sarcopenia and malnutrition, might offer a simpler and more effective framework for understanding and promoting physical activity in this demographic. Geriatr Gerontol Int 2025; 25: 160-166.

Association between phase angle and all-cause mortality in adults aged 18-49 years: NHANES 1999-2004

Phase angle (PhA) is an indicator of nutritional status. The association between PhA and all-cause mortality has been confirmed in older adults, but no relevant studies have been conducted in adults aged 18-49 years. This study aimed to investigate the relationship between PhA and all-cause mortality in adults aged 18-49 years. Our study included 6338 adults aged 18-49 from the National Health and Nutrition Examination Survey (1999-2004). Kaplan-Meier (KM) curve, multiple Cox regression and stratified analyses were performed. These adults were divided into two groups based on the median PhA value (the low PhA group: PhA < 6.96°; the high PhA group: PhA ≥ 6.96°). During a median follow-up of 214 months, 307 all-cause deaths were recorded. The all-cause mortality rate was 5.07% in the low PhA group and 3.98% in the high PhA group. After full adjustment, a higher PhA value was significantly associated with reduced risk of all-cause mortality (HR = 0.73,95CI%:0.59-0.91, P = 0.005). Similarly, compared with those in the low PhA group, individuals in the high PhA group had a lower risk of all-cause mortality (HR = 0.67, 95% CI 0.46-0.98, P = 0.041). There was an interaction between smoking status and PhA (P for interaction = 0.029), with a statistically significant negative association between PhA and all-cause mortality in the non-smokers (HR:0.62, 95%CI:0.53-0.88, P = 0.003). In conclusion, there was a significant negative association between PhA and all-cause mortality in adults aged 18-49 years. The negative association was stronger in non-smokers.

Age-related changes in bioelectrical impedance analysis-derived phase angle (PhA) and the association between PhA and sarcopenic obesity in Chinese adults

There are limited studies on the phase angle (PhA) and sarcopenic obesity (SO) in the Chinese population. This study aimed to establish 50 kHz-PhA reference data for SO population, and to evaluate the correlation between 50 kHz-PhA and SO. A total of 10,312 participants including 5415 men and 4897 women were enrolled in this study, and their resistance and reactance at 50 kHz, and body composition parameters were measured a segmental multifrequency bioelectrical impedance analysis device (InBody 720). Participants were compared between the SO and non-SO groups. Then, age and fat parameters related changes in PhA were evaluated. Furthermore, Receiver Operating Characteristic (ROC) curves were used to identify the optimal PhA cutoff values for detecting SO in males and females. The results showed significant differences in PhA and body composition parameters between the SO group and the non-SO group in both sexes (P < .001), and the prevalence rates of SO increase with age in both sexes (P < .001). The PhA values decrease with age, with a significant decrease beginning at age 65 years for males and 66 years for females. The accumulation of excess adipose tissue was also found to be associated with decrease in 50 kHz-PhA value. Furthermore, PhA was negatively associated with SO, independent of age and sex. The area under the ROC curve (AUC) of PhA for SO was 0.790 (95% CI: 0.746-0.833, P < .001) in males and 0.763 (95% CI: 0.702-0.825, P < .001) in females. The optimal cutoff value was ≤ 5.55° (specificity 0.693, sensitivity 0.759) for males and ≤4.79° (specificity 0.687, sensitivity 0.738) for females. In conclusion, 50 kHz-PhA can be used as a predictor of SO, with cutoff values of ≤5.55° for males and ≤4.79° for females. This simple and practical method of using 50 kHz-PhA to predict SO could be valuable in clinical practice.

The diagnostic performance of phase angle for sarcopenia among older adults: A systematic review and diagnostic meta-analysis

OBJECTIVE

Phase angle is a promising tool for diagnosing sarcopenia. This study aimed to summarize its diagnostic performance by performing a systematic review and meta-analysis.

METHODS

We conducted a systematic search of PubMed, Web of Science, Embase, and Scopus. The Quality Assessment of Diagnostic Accuracy Studies, Version 2, was used to evaluate the quality of the studies. A bivariate random effects model was employed for data synthesis, and diagnostic performance was reported in terms of pooled sensitivity, specificity, and the area under the summary receiver operating characteristic curve (AUC). Additionally, meta-regression, subgroup analyses, and sensitivity analyses were performed.

RESULTS

A total of 15 studies were included in this meta-analysis, involving 4,063 participants. The overall risk of bias in the included studies was high. The meta-analysis revealed that the pooled sensitivity and specificity across all studies were 0.74 [95 % confidence interval (CI): 0.71-0.78] and 0.75 (95 % CI: 0.70-0.79), respectively, with an AUC of 0.79 (95 % CI: 0.76-0.83). Meta-regression indicated that study design, country, population, sex-specificity, and age may influence the diagnostic performance of phase angle. The optimal diagnostic performance was observed in the cut-off interval of 4.20 to 4.50°.

CONCLUSION

The phase angle demonstrated moderate diagnostic performance for sarcopenia, and the possible cut-off interval is 4.20 to 4.50 °. However, large-scale, multicenter prospective studies are necessary to assess its clinical applicability at specific cut-off values.

Nutritional assessment of patients with liver cirrhosis in the outpatient setting: A narrative review

Malnutrition is common in liver cirrhosis and is associated with increased rates of complications, hospitalization, and mortality. There are no consensus guidelines for malnutrition assessment in liver cirrhosis and a large number of clinicians do not routinely assess for malnutrition in patients with liver cirrhosis. This review explores the tools available for assessment of malnutrition in patients with liver cirrhosis, including nutritional screening protocols, anthropometric tools, biochemical tools, techniques analyzing body composition and functional assessments. We evaluate these tools and offer recommendations regarding their suitability for outpatient settings. In this review, we recommend the Royal Free Hospital-Nutritional Prioritising Tool for identifying patients at risk of malnutrition. Additionally, we recommend the use of the anthropometric tools Triceps Skinfold Thickness for females and Mid-Arm Muscle Circumference for males, due to differing patterns of muscle and fat malnutrition. Complementing this Bioelectrical Impedance Analysis can be utilized to assess body composition for the diagnosis of malnutrition. Biochemical markers have thus far failed to show a correlation with malnutrition. While hand grip strength is useful for detecting sarcopenia, a common complication of malnutrition, further evidence is required to validate its correlation with malnutrition.

Phase angle: Differences between disease-related malnutrition, obesity and healthy people

INTRODUCTION

Bioelectrical Impedance Analysis (BIA) is a tool used in clinical nutrition and pure electrical data such as phase angle (PA) has shown prognostic value. It relates resistance and reactance indicating cellular health.

OBJECTIVE

To determine differences in PA between patients with obesity and disease-related malnutrition (DRM) compared to the healthy population, and to establish associations between PA and other body composition (BC) parameters.

MATERIALS AND METHODS

Retrospective observational study with 1079 patients from the Obesity and Nutrition Department of the Complejo Asistencial Universitario de León between April/2014 and August/2022 as well as 86 healthy controls. Demographic and anthropometric variables were collected and BC was performed with BIA Tanita MC780®. Diagnosis of malnutrition according to GLIM criteria and obesity with body mass index (BMI).

RESULTS

PA50KHz in obesity group is 5.98º, DRM 4.79º and control group 6.08º. Statistically significant differences in PA between DRM and control groups, as well as DRM and obesity (p < 0.001). Weak positive correlation in total population (r = 0.452, p < 0.001) as well as control group (r = 0.463, p < 0.001) between BMI and PA. Weak negative correlation in the total population (r = -0.408, p < 0.001), DRM (r = -0.268, p < 0.001) and obesity (r = -0.342, p < 0.001) between age and PA.

CONCLUSIONS

In this study, significantly lower PA was observed in the DRM group than in the control and obesity groups. No statistically significant differences between PA in the obesity and control groups and no correlation between BMI and PA in the obesity group. More studies are needed to standardize cut-off points in different contexts and populations.

Phase angle is a useful predicting indicator for protein-energy wasting and cardiovascular risk among maintenance hemodialysis patients

Protein-energy wasting (PEW) is a major contributor to the high mortality among maintenance hemodialysis (MHD) patients. Cardiovascular disease (CVD) is the leading cause of death in dialysis patients, and PEW can significantly increase cardiovascular mortality in MHD patients. Previous studies have confirmed that PA may be a good objective indicator for determining the nutritional status and prognosis of MHD patients. Our study aimed to determine the predictive value of phase angle (PA) as detected by bioelectrical impedance analysis (BIA) on PEW and cardiovascular (CV) risk among MHD patients. Our retrospective observational study involved 161 adult patients with HD. The Cardiovascular risk score is a risk model based on the Japan Dialysis Outcome and Practice Patterns Study (J-DOPPS). We established LASSO logistic regression analysis model to identify key parameters related to body composition that can predict PEW in MHD patients. The area under the curve (AUC) values for PA, appendicular skeletal muscle mass index (ASMI), body cell mass (BCM), and mid-arm circumference (MAC) in predicting PEW in male MHD patients were relatively large, with 0.708, 0.674, 0.663, and 0.735, respectively. The predicted PEW values of these parameters were slightly lower in female patients than in men. We incorporated PA, ASMI, BCM, and MAC into a model that predicted the incidence of PEW in maintenance hemodialysis patients using LASSO technology. We discovered that the model predicted a greater AUC of PEW occurrence than any single factor, 0.877 for men and 0.76 for women. The results of the univariate logistic regression analysis showed that the low PA tertile array group had a greater incidence of PEW than the high PA group (P < 0.001). Additionally, we also found that lower PA was associated with higher CV risk scores. The PA detected by bioelectrical impedance analysis could predict the risk of PEW and cardiovascular events among patients with MHD. When used in conjunction, PA, ASMI, BCM, and MAC have a high diagnostic efficacy for PEW in patients on maintenance hemodialysis.

Bioelectrical impedance-derived phase angle (PhA) in people living with obesity: Role in sarcopenia and comorbidities

BACKGROUND AND AIM

Obesity is characterized by alterations in fat and muscle mass. Phase angle (PhA) is considered an index of muscle mass, and is related to comorbidities in SO. This work aimed to assess the relationship between PhA, muscle mass, inflammation, and comorbidities in obesity.

METHODS AND RESULTS

We included 198 outpatients with obesity (BMI≥30) divided into tertiles according to PhA distribution (<5°, 5°-6°, >7°). Body composition was analyzed using bioimpedance (Tanita MC-780P Multi-Frequency Segmental Body Composition Analyzer). Quantitative variables were compared using the Kruskal-Wallis test and qualitative variables using the chi-square test. A correspondence analysis was built to show the influence of qualitative variables on subjects in each tertile. Patients in the lowest tertile had the lowest skeletal muscle mass and appendicular skeletal muscle mass index (ASMI); the highest inflammatory index (albumin and derived neutrophil-to-lymphocyte ratio, Alb-dNLR); and the highest percentage of individuals with a history of type 2 diabetes mellitus (T2DM), chronic kidney disease (CKD), and heart failure (HF). The correspondence analysis showed an association between the lowest tertile and presence of HF with preserved ejection fraction (HFpEF) and CKD. On the logistic regression model, ASMI (OR 0.9, 95%CI 0.85-0.95, p = 0.0004), Alb-dNLR (OR 1.04, 95%CI 1.04-16.4, p = 0.04) and HFpEF and T2DM were significantly associated with the lowest PhA.

CONCLUSIONS

Identifying high-risk individuals living with obesity is a priority. These results show that lower PhA is related to inflammation, poorer skeletal muscle mass and consequently, their impact on obesity-related comorbidities and clinical outcomes.

Exploring the association between phase angle of bioimpedance at 50 kHz and cardiovascular risk

BACKGROUND

Cardiovascular diseases are characterized by chronic inflammation, leading to increased inflammatory markers that can cause cell damage and death. Phase angle has emerged as a marker of cellular health. It is considered a prognostic factor in various acute and chronic conditions. However, few studies have examined its association with cardiovascular disease risk measures. This study aims to investigate the relationship between phase angle, the general Framingham risk score, and the HEARTS cardiovascular risk score.

METHODS

This cross-sectional study included a convenience sample of adult patients of 2 primary health care services. Phase angle was measured using multifrequency bioimpedance analysis at 50 kHz. The risk of cardiovascular events was calculated using the Framingham and HEARTS risk scores. Statistical analysis included generalized linear regression models, unadjusted and adjusted according to sex and age, to determine the association between scores, risk factors, and phase angle.

RESULTS

The study included 164 individuals with a mean age 52.2 (SD 17.9). According to the HEARTS score, low-risk patients had higher phase angle values than those with high or very high risk [ß = -0.57 (95% CI -0.95; -0.19), P = 0.003]. Framingham scores showed a trend toward significance for higher mean phase angle values in low-risk than high-risk patients [ß = -0.43 (95% CI -0.88 to 0.02), P = 0.06].

CONCLUSION

Phase angle values were lower in high and very high-risk patients than in low-risk patients, which shows that phase angle is a promising risk predictor for patients with cardiovascular diseases.

Preoperative bioelectrical impedance, measured phase angle, and hand-grip strength as predictors of postoperative outcomes in patients undergoing cardiac surgery: a systematic review

BACKGROUND

Postoperative problems are a major danger for patients after heart surgery. Predicting postoperative outcomes for cardiac surgery is limited by current preoperative evaluations. Handgrip strength (HGS) testing and bioelectrical impedance analysis (BIA) may provide extra ways to identify individuals at risk of surgical problems, enhancing risk assessment and results.

OBJECTIVE

The purpose of this systematic review is to assess the utility of measured phase angle (PA), HGS, and bioelectrical impedance as perioperative risk markers in adult patients undergoing elective heart surgery.

METHOD

The PRISMA principles were followed in this review. We searched all available electronic databases, including the Science Direct search engine and PubMed, MEDLINE, EMBASE, Cochrane Library, Web of Science, PsycINFO, CINAHL, Google Scholar, Scopus, and the Science Direct search engine, from their creation to the present, as well as the medRxiv pre-print site. We considered studies with adult subjects undergoing elective heart surgery who were monitored for problems after surgery and had perioperative BIA and HGS testing.

RESULTS

As a result, out of the 1544 pieces of research that were discovered, eight studies were deemed suitable for inclusion in the review and supplied data from 2781 people. The findings demonstrated a substantial correlation between poor preoperative PA and a higher risk of serious postoperative morbidity, as well as prolonged hospital stays. Furthermore, poor HGS and low PA were linked to greater death rates. Additionally, there was a strong correlation found between low PA and HGS and longer stays in the ICU, as well as an increased chance of dying from all causes in a year. In conclusion these results imply that preoperative HGS and PA may be significant indicators of postoperative results and may assist in identifying patients who are more vulnerable to problems and death.

Identifying Malnutrition Risk in the Elderly: A Single- and Multi-Parameter Approach

Malnutrition is a significant concern affecting the elderly, necessitating a complex assessment. This study aims to deepen the understanding of factors associated with the assessment of malnutrition in the elderly by comparing single- and multi-parameter approaches. In this cross-sectional study, 154 individuals underwent a comprehensive geriatric assessment (CGA). Malnutrition risk was determined using the mini nutritional assessment (MNA). Additional factors assessed included sarcopenia, polypharmacy, depression, appetite, handgrip strength, and gait speed. Phase angle (PA) and body composition were measured using bioelectrical impedance analysis (BIA). The MNA identified a malnutrition risk in 36.8% of individuals. The geriatric depression scale (GDS) and PA demonstrated moderate effectiveness in assessing malnutrition risk, with AUC values of 0.69 (95% CI: 0.60-0.78) and 0.62 (95% CI: 0.54-0.72), respectively. A logistic regression model incorporating handgrip strength, skeletal muscle mass, sarcopenia, osteoporosis, depression, specific antidepressant use, mobility, appetite, and smoking achieved superior performance in predicting malnutrition risk, with an AUC of 0.84 (95% CI: 0.77-0.91). In conclusion, this study demonstrates that integrating multiple parameters into a composite model provides a more accurate and comprehensive assessment of malnutrition risk in elderly adults.

The 30-second chair stand test (CS30) as a predictor of exercise tolerance in elderly individuals (≥75 years) with stage A/B heart failure

Background

In Japan, the number of very elderly individuals with heart failure (HF) is on the rise. One indicator of HF stage progression is a decrease in exercise tolerance (ET). While peak oxygen uptake (peak VO₂) determined by cardiopulmonary exercise testing (CPX) is the gold standard for ET assessment, the wide-scale applicability of CPX is constrained owing to expensive equipment and challenges in this population. The 30-second chair stand test (CS30), a simple and quick alternative, is widely used among community-dwelling elderly individuals. The objective of this study was to investigate whether CS30 is a predictor of ET in elderly individuals with stage A/B HF.

Methods

Of 748 outpatients aged 75 years and over who visited our center between March 2021 and December 2022, 493 patients (296 males and 197 females) were included in this study. CS30 was measured using a seat height of 40 cm, and peak VO₂ was assessed using CPX.

Results

The findings showed a statistically significant positive association between CS30 and peak VO₂ for both males and females (males: β = 0.255, 95 % CI = 0.102-0.407; females: β = 0.282, 95 % CI = 0.043-0.521). Receiver operating characteristic (ROC) analyses showed moderate accuracy of CS30 in predicting low ET in both sexes (males AUC = 0.740, 95 % CI = 0.640-0.841, p < 0.001; females AUC = 0.725, 95 % CI = 0.644-0.807, p < 0.001). The cut-off values of CS30 were established as 18 times for males and 16 times for females.

Conclusions

CS30 is a potentially convenient method for estimating current ET in older adults, providing a feasible alternative to CPX.

Association between preoperative phase angle and all-cause mortality after cardiovascular surgery: A retrospective cohort study

BACKGROUND

The importance of preoperative physical function assessment for post-operative intervention has been reported in older patients undergoing cardiovascular surgery. Phase angle (PhA), measured using bioelectrical impedance analysis, is an indicator of cellular health and integrity and is reported as a prognostic factor in several chronic diseases; however, its association with the long-term prognosis of cardiovascular surgery remains unclear. This study aimed to investigate the prognostic value of PhA for long-term mortality in patients undergoing cardiovascular surgery.

METHODS

This retrospective cohort study included consecutive patients who underwent elective cardiovascular surgery between October 2016 and March 2021 at Nagoya Heart Center, Japan. PhA was assessed using bioelectrical impedance analysis before surgery, and physical function measures (gait speed, grip strength and short physical performance battery [SPPB]) were measured synchronously. The association between PhA and all-cause mortality after discharge was assessed using Kaplan-Meier and multivariate Cox regression analyses. The incremental prognostic value of PhA was compared with other physical function measures using net reclassification improvement (NRI) and integrated discrimination improvement (IDI).

RESULTS

A total of 858 patients were included in the present analysis (mean age = 68.4 ± 11.9 years, 67.6% male). PhA positively correlated with body mass index (ρ = 0.38, P < 0.001), skeletal muscle mass index (ρ = 0.58, P < 0.001), usual gait speed (ρ = 0.44, P < 0.001), grip strength (ρ = 0.73, P < 0.001) and SPPB (ρ = 0.51, P < 0.001). The mean follow-up period, within which 44 (4.7%) died, was 908.9 ± 499.9 days for the entire cohort. Kaplan-Meier survival curves based on the PhA tertiles showed that higher PhA was associated with better survival (log-rank test, P < 0.001). The Cox regression analysis showed the independent association of PhA with mortality risk (hazard ratio: 0.91 per 0.1° increment; 95% confidence interval [CI]: 0.87-0.95; P < 0.001). The NRI and IDI showed significant improvements in predicting mortality after adding PhA to the clinical model consisting of age, sex and cardiac and renal function (NRI: 0.426, 95% CI: 0.124-0.729, P = 0.006; IDI: 0.037, 95% CI: 0.012-0.062, P = 0.003). The predictive model consisting of the clinical model and PhA was superior to the model consisting of the clinical model and each of the other physical function indicators (P < 0.05).

CONCLUSIONS

PhA correlated with physical function and independently predicted long-term mortality after cardiovascular surgery. The additive prognostic value of PhA compared with the other physical function measures suggests the clinical usefulness of preoperative PhA for risk stratification in planning post-operative treatment and rehabilitation.

Evaluation of Change in Body Composition, including Phase Angle, in Post-Myocardial Infarction Patients Rehabilitated under the KOS-Zawał (MC-AMI) Programme

Background: Ischaemic heart disease, including myocardial infarction, is one of the main causes leading to heart failure as a consequence of ischaemic myocardial damage. In recent years, survival in the acute phase of myocardial infarction has improved significantly, but the high mortality rate within 12 months of hospital discharge (reaching up to 9.8% in Poland) remains a challenge. Therefore, the KOS-Zawał (MC-AMI) comprehensive 12-month post-MI care programme was introduced in Poland in 2017. Aim: This study aimed to assess body composition (including, but not limited to, the phase angle, visceral fat, total body fat, redistribution between intracellular and extracellular fluid in the body, and metabolic age) using a bioelectrical impedance analysis (BIA) in post-MI patients before and after early post-MI rehabilitation who were participating in the KOS-Zawał (MC-AMI) programme. Methods: This study involved an examination (before rehabilitation) of 94 post-myocardial infarction patients who were referred to a cardiology appointment within 7-10 days of hospital discharge, during which a clinical assessment, electrocardiogram, and biochemical blood tests (complete blood count, CRP, and serum creatinine) were performed. For various reasons (death, qualification for device implantation, non-completion of rehabilitation, failure to attend a follow-up BIA), data from 55 patients who were examined twice (before and after rehabilitation) were used for the final analysis. Measurements were taken using a high-grade Tanita MC-780 BIA body composition analyser, which measured the resistance of tissues to a low-intensity electrical impulse (not perceptible to the subject). Results: Participation in rehabilitation as part of the KOS-Zawał (MC-AMI) programme was associated with a decrease in metabolic age in patients, with a reduction in visceral fat levels and levels of adipose tissue in the lower and upper limbs. Moreover, a clinically beneficial reduction in the ratio of extracellular water to total body water was also observed. These changes were statistically significant (p < 0.005). In contrast, there were no statistically significant differences in the change in phase angle values in the subjects before and after the 5-week post-infarction rehabilitation. Conclusions: Participation in early post-myocardial infarction rehabilitation as part of the KOS-Zawał (MC-AMI) programme (25 training sessions) is associated with significant improvements in body composition parameters, such as visceral adipose tissue, limb fat, and water redistribution, and, consequently, a reduction in metabolic age, despite no significant increase in phase angle values. It was hypothesised that the good baseline condition of the subjects might explain the lack of significant change in the phase angle over the short observation period. For further analysis, it would be worthwhile to increase the number of patients with baseline reduced phase angle values and monitor changes in this parameter throughout rehabilitation and the entire MC-AMI programme, because changes in the phase angle may also be influenced by other programme components such as dietary or psychological education. It is worth considering implementing a regular BIA assessment in patients in the programme as a motivating stimulus for diligent exercise and extending rehabilitation to be followed by telerehabilitation or hybrid telerehabilitation.

Pathophysiological roles of the serum acylcarnitine level and acylcarnitine/free carnitine ratio in patients with cardiovascular diseases

Introduction

L-carnitine exerts protective effects, such as maintaining mitochondrial functions and decreasing reactive oxygen species, while acylcarnitine (AC) is linked to the development of heart failure and atherosclerosis.

Hypothesis

Serum carnitines play important pathophysiological roles in cardiovascular diseases.

Methods

Pre-operative biochemical data were obtained from 117 patients (71 men, average age 69.9 years) who underwent surgery for cardiovascular diseases. Measurements included pre-operative biochemical data including estimated glomerular filtration rate (eGFR), physical functions, skeletal muscle mass index (SMI) measured by bioelectrical impedance analysis, anterior thigh muscle thickness (MTh) measured by ultrasound, and routine echocardiography. Carnitine components were measured with the enzyme cycling method. Muscle wasting was diagnosed based on the Asian Working Group for Sarcopenia criteria.

Results

Plasma brain natriuretic peptide (BNP) level was correlated with serum free carnitine (FC) and AC level, and the acylcarnitine/free carnitine ratio (AC/FC). AC/FC was elevated with stage of chronic kidney disease. In multivariate analysis, log (eGFR) and log (BNP) were extracted as independent factors to define log (serum AC) (eGFR: β = 0.258, p = 0.008; BNP: β = 0.273, p = 0.011), even if corrected for age, sex and body mass index. AC/FC was negatively correlated with hand-grip strength (r = -0.387, p = 0.006), SMI (r = -0.314, p = 0.012), and anterior thigh MTh (r = -0.340, p = 0.014) in men.

Conclusions

A significant association between serum AC level and AC/FC, and chronic kidney disease and heart failure exists in patients with cardiovascular diseases who have undergone cardiovascular surgery. Skeletal muscle loss and muscle wasting are also linked to the elevation of serum AC level and AC/FC.

Conflicting Associations among Bioelectrical Impedance and Cardiometabolic Health Parameters in Young White and Black Adults

PURPOSE

The purpose of this cross-sectional evaluation was to determine the associations between raw bioelectrical impedance and cardiometabolic health parameters in a sample of young non-Hispanic White and African American adults.

METHODS

A total of 96 (female: 52, male: 44) non-Hispanic White ( n = 45) and African American adults ( n = 51) between the ages of 19 and 37 yr (22.7 ± 3.83 yr) completed several fasted assessments including resting systolic blood pressure (rSBP), blood glucose (FBG), blood lipids, and bioelectrical impedance spectroscopy. Bioelectrical impedance spectroscopy-derived measurements included phase angle, bioimpedance index (BI), impedance ratio (IR), reactance index (XCi), fat-free mass (FFM), FFM index (FFMi), and absolute (a) and relative (%) total body water (TBW) and extracellular (ECF) and intracellular fluid (ICF). All bioelectric variables were collected at 50 kHz other than IR (250 kHz/5 kHz). Multiple regressions were conducted and adjusted for sex, age, and body mass index.

RESULTS

rSBP was positively, and HDL was inversely, associated with all bioelectrical impedance and absolute hydration variables (all P ≤ 0.050) other than XCi for rSBP and XCi and FFMi for HDL. rSBP ( P < 0.001) was inversely, and HDL ( P = 0.034) was positively, associated with IR. FBG was positively associated with BI, XCi, FFM, TBWa, and ECFa (all P < 0.050). Metabolic syndrome severity was positively associated with BI, FFM, TBWa, and ECFa for women (all P ≤ 0.050) and with ICFa for African American women ( P = 0.016).

CONCLUSIONS

Given the rapid increase in the prevalence of cardiometabolic health risks among young adults and the broad use of bioelectrical impedance in practice, the conflicting associations we observed in this age group suggest that bioelectrical impedance parameters should be used with caution in the context of cardiometabolic health risks and age.

Prognostic value of bioelectrical impedance analysis in head and neck cancer patients undergoing radiotherapy: a VALOR® study

Introduction

Bioelectrical impedance analysis (BIA) serves as a method to estimate body composition. Parameters such as phase angle (PA), standardized phase angle (SPA), body mass cell (BCM), BCM index (BCMI), and fat-free mass (FFM) might significantly impact the prognosis of head and neck cancer (HNC) patients. The present study aimed to investigate whether bioelectrical parameters can be used to predict survival in the HNC population and establish the optimal cutoff points for predictive accuracy.

Methods

A multicenter observational study was performed across 12 tertiary hospitals in Andalusia (a region from the south of Spain). A total of 494 patients diagnosed with HNC between 2020 and 2022 at different stages were included in this study, with a minimum follow-up period of 12 months. The BIA assessment was carried out during the first 2 weeks of radical radiotherapy treatment with chemotherapy or other systemic treatments. A multivariate logistic regression analysis of overall survival, complications, hospital admission, and palliative care and its relationship with BIA nutritional assessment was performed.

Results

Significant prognostic factors identified in the multivariable analysis encompassed phase angle (PA), standardized phase angle (SPA), body cell mass (BCM), and BCM index (BCMI). Lower PA and BCM values were significantly associated with adverse clinical outcomes. A BCM threshold above 17 kg/m2 was the most significant predictor for predicting survival within the overall HNC population. The PA values of <5.1° in male and <4.8° in female patients showed the best predictive potential for mortality. Increased PA (as a continuous variable) demonstrated a significantly reduced risk for mortality (OR, 0.64; 95% CI, 0.43-0.94; p < 0.05) and a decreased likelihood of hospital admission (OR, 0.75; 95% CI, 0.52-1.07; p < 0.05). Higher BCM correlated with a lower risk of mortality (OR, 0.88; 95% CI, 0.80-0.96; p < 0.01) and a diminished probability of hospital admission (OR, 0.91; 95% CI, 0.83-0.99; p < 0.05).

Conclusion

BIA is a crucial tool in the nutritional assessment of HNC patients. BCM and PA are the main bioelectrical parameters used to predict clinical outcomes in this population. Future studies are needed to validate BIA variables in a large cohort to ensure whether early intensification of nutritional treatment would improve survival.

The ability of phase angle and body composition to predict risk of death in maintenance hemodialysis patients

OBJECTIVE

The objective of this study was to investigate the ability of phase angle and body composition to identify risk factors for mortality among patients receiving maintenance hemodialysis (MHD) treatment.

METHODS

In this retrospective study, we examined the causes of death in 43 MHD patients who were treated at our hemodialysis center between January 2016 and December 2021 and compared the patients to 71 patients who survived during the same period. Body composition was measured using direct segmental multi-frequency bioelectrical impedance to obtain phase angle, fat-free mass (FFM), extracellular water/total body water (ECW/TBW), and waist circumference (WC). Laboratory data were also collected. Phase angle cut-off value-associated variables were identified using ROC analysis. The ability of body composition variables to identify risk factors for death in MHD patients was evaluated.

RESULTS

We found that cardiovascular disease was the most common cause of death among MHD patients. ROC curve analysis revealed that the optimal cut-off value for phase angle as a predictor of death risk in MHD patients was 4.50°. Additionally, lower phase angle, increased age, longer dialysis vintage, lower KT/V, and hypoproteinemia were identified as significant risk factors for death in MHD patients.

CONCLUSION

In conclusion, our findings suggest that cardiovascular disease is the leading cause of death among MHD patients and that lower phase angle, increased age, longer dialysis duration, and hypoproteinemia can be used to predict the risk of mortality in this patient population. The underlying mechanism by which lower phase angle can be used to predict the prognosis of MHD patients warrants further investigation.

Skeletal Muscle Quality Assessment in Patients With Cardiac Disease Associated With Type 2 Diabetes Mellitus: A Pilot Study

Background Type 2 diabetes mellitus (T2DM) is associated with changes in skeletal muscle quantity and quality, such as increased ectopic fat. Cardiac rehabilitation (CR) aims to improve the exercise capacity and muscle strength. This study aimed to determine the relationship between qualitative changes in the skeletal muscles and exercise function in patients with and without diabetes mellitus. Methods The study included patients with cardiovascular diseases who entered CR. Of 72 CR patients (68.1±9.0 years) who underwent a cardiopulmonary exercise test and skeletal muscle assessment at discharge, 15 patients with T2DM and 15 without DM were selected using propensity score matching by age and gender. Results No significant differences in the skeletal muscle echo intensity (EI) (T2DM: 58.4, Non-DM: 53.4, p=0.32), skeletal muscle index (T2DM: 7.5 kg/m2, Non-DM: 7.2 kg/m2, p=0.36), or the weight-bearing index (WBI)(T2DM: 0.44, Non-DM: 0.50, p=0.35) existed between the two groups. The phase angle (PhA) (T2DM: 3.67°, Non-DM: 4.49°, p<0.05) and peak oxygen uptake (T2DM: 12.3 mL/kg/min, Non-DM: 14.8 mL/kg/min, p<0.05) were significantly lower in the T2DM group. PhA values showed a significant correlation with the WBI, a parameter of lower limb muscle strength (r=0.50, p<0.05). Conclusion The coexistence of cardiovascular disease and T2DM resulted in a decrease in the PhA, indicating a qualitative decrease in skeletal muscle mass. The PhA is also associated with lower limb muscle strength.

Phase Angle as a Reliable Biomarker of Frailty to Predict Postoperative Outcomes in Patients Undergoing Off-Pump Coronary Artery Grafting: A Prospective Observational Study

OBJECTIVE

To elucidate the association between phase angle (PA) and a composite adverse outcome in patients requiring off-pump coronary artery bypass grafting (OPCAB).

DESIGN

A prospective observational study.

SETTING

High-volume single center.

PARTICIPANTS

A total of 229 adult patients who underwent OPCAB from May 2019 to October 2020.

INTERVENTIONS

Each patient underwent bioelectrical impedance analysis, including PA assessment before surgery (PApre), immediately postoperatively (PApost), and 1 day postoperatively (PAPOD1), using an Inbody S10. Frailty index and nutritional assessments also were obtained before surgery.

MEASUREMENTS AND MAIN RESULTS

Patient outcomes were assessed using a composite adverse outcome comprising death, myocardial infarction, revascularization, new-onset atrial fibrillation, acute kidney injury, stroke, postoperative pulmonary complications, wound complications, sepsis, reoperation, and/or delirium occurring during hospitalization and over the following year. Patients for whom composite adverse outcomes were reported had lower PApre than those without complications (5.4 ± 0.9 v 6.0 ± 0.9, p < 0.001). The PA was significantly associated with in-hospital and 1-year composite postoperative outcomes. The odds ratios (OR, [95% confidence interval]) for PApre by time were in-hospital complications (0.435 [0.314, 0.604], p < 0.001; 1-year complications: 0.459 [0.330, 0.638], p < 0.001) and PAPOD1 (OR, in-hospital complications: 0.400 [0.277, 0.576], 1-year complications: 0.429 [0.298, 0.619], p < 0.001). The PApre was significantly associated with days alive and out of hospital until 1 year. The cut-off value of PApre for optimal prediction of in-hospital complications was 6.0 (area under the curve: 0.691 [0.623-0.758], p < 0.001).

CONCLUSION

Low PA as an indicator of frailty is associated with adverse postoperative outcomes after OPCAB. Low PA may be employed as a noninvasive and practical tool for the prediction of prognosis in patients with coronary artery disease.

Is Phase Angle Useful in Screening for Sarcopenia in Patients with Hematologic Malignancies?

The purposes of this study were to investigate the relationship between sarcopenia and phase angle (PhA), and to examine whether PhA cutoff values can be used to identify sarcopenia in patients with hematologic malignancies. The study population comprised 108 patients with hematologic malignancies who were admitted for chemotherapy, and were undergoing rehabilitation for exercise therapy. The diagnostic criteria for sarcopenia were determined according to the Asian Working Group for Sarcopenia 2019. Muscle strength, endurance, and body composition (including PhA), were assessed. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to investigate associations between sarcopenia and PhA, and to determine cutoff values. Sarcopenia was found in 17.6% of the participants. PhA was significantly associated with sarcopenia (p < 0.01). The areas under the curve were 0.84 for the males and 0.87 for the females, and the cutoff values were 4.75° for the males (sensitivity 69%, specificity 83%) and 3.95° for the females (sensitivity 78%, specificity 85%). Our results suggest that PhA, which can be measured noninvasively, objectively, and rapidly, can be used as a screening tool for sarcopenia in patients with hematologic malignancies.

Skeletal muscle quality, measured via phase angle, and cardiorespiratory fitness in patients with obesity and heart failure with preserved ejection fraction

OBJECTIVES

Cardiorespiratory fitness (CRF) is influenced by body composition quantity and quality in heart failure with preserved ejection fraction (HFpEF) and obesity. Bioelectrical impedance analysis (BIA) provides a noninvasive quantitative and qualitative body composition assessment. The aim of this study was to determine the role of phase angle (PhA), a BIA-measure of skeletal muscle quality and body cell mass, on CRF in patients with obesity and HFpEF.

METHODS

Fifty-nine consecutive outpatients with HFpEF underwent cardiopulmonary exercise testing to measure CRF. Single-frequency segmental BIA was used to measure PhA and body composition quantity. Resting Doppler echocardiography and biomarkers were measured to assess cardiac function and systemic inflammation.

RESULTS

Compared with patients with lower PhA, patients with higher PhA (above mean 5.8°) presented a greater absolute peak oxygen consumption (VO2; 1.83 [1.3-2.1] versus 1.39 [1.1-1.6] L/min, P = 0.003), VO2 peak adjusted for body weight (17.5 [12.3-18.1] versus 13.3 [12.7-15.2] mL/kg/min, P = 0.040), and a lower edema index (48.7 [2.9] versus 51.4% [2.7], P < 0.001) and N-terminal pro-B-type natriuretic peptide (NT-proBNP; 64 [50-121] versus 183 [68-343.5] pg/dL, P < 0.001). In the overall sample, PhA was correlated with absolute VO2 peak (r = 0.468, P < 0.001), VO2 peak adjusted for body weight (r = 0.368, P = 0.004), VO2 peak adjusted for fat-free mass (r = 0.315, P = 0.015), edema index (r = -0.508, P < 0.001), and NT-proBNP (r = -0.579, P < 0.001). PhA remained a significant predictor for CRF even after adjustment for potential confounders and HFpEF severity.

CONCLUSION

In patients with obesity and HFpEF, a greater PhA is an independent predictor for favorable CRF.

Prognostic impact of pretreatment skeletal muscle index and CONUT score in diffuse large B-cell Lymphoma

BACKGROUND

Although the prognostic value of the Controlling Nutritional Status (CONUT) score in diffuse large B-cell lymphoma (DLBCL) has been reported in several previous studies, its clinical relevance for the presence of sarcopenia has not been assessed.

METHODS

In this study, 305 DLBCL patients were reviewed. They were categorized into normal/mild (n = 219) and moderate/severe (n = 86) CONUT groups. Sarcopenia was assessed using the L3-skeletal muscle index measured by baseline computed tomography imaging. Based on CONUT score and sarcopenia, patients were grouped: A (normal/mild CONUT and no sarcopenia), B (either moderate/severe CONUT or sarcopenia, but not both), and C (both moderate/severe CONUT and sarcopenia).

RESULTS

The moderate/severe CONUT group showed higher rates of ≥ grade 3 febrile neutropenia, thrombocytopenia, non-hematologic toxicities, and early treatment discontinuation not related to disease progression, compared to the normal/mild CONUT group. The moderate/severe CONUT group had a lower complete response rate (58.1% vs. 80.8%) and shorter median overall survival (18.5 vs. 162.6 months) than the normal/mild group. Group C had the poorest prognosis with a median survival of 8.6 months, while groups A and B showed better outcomes (not reached and 60.1 months, respectively). Combining CONUT score and sarcopenia improved the predictive accuracy of the Cox regression model (C-index: 0.763), compared to the performance of using either CONUT score (C-index: 0.754) or sarcopenia alone (C-index: 0.755).

CONCLUSIONS

In conclusion, the moderate/severe CONUT group exhibited treatment intolerance, lower response, and poor prognosis. Additionally, combining CONUT score and sarcopenia enhanced predictive accuracy for survival outcomes compared to individual variables.

A Novel Frailty Score Based on Laboratory Parameters (FIMS Score) for the Management of Older Patients with Severe Aortic Stenosis

This study aimed to develop a novel score based on common laboratory parameters able to identify frail and sarcopenic patients as well as predict mortality in elderly patients with severe aortic stenosis (AS) for tailored clinical decision-making. A total of 109 patients (83 ± 5 years; females, 68%) with AS underwent a multidisciplinary pre-operative assessment and finalized a "frailty-based management" for the AS interventional treatment. Laboratory parameters of statistically significant differences between sarcopenic and non-sarcopenic individuals were tested in the structural equation model (SEM) to build a Frailty Inflammation Malnutrition and Sarcopenia score (FIMS score). Mortality at 20 months of follow-up was considered an outcome. FIMS score, in particular, the cut-off value ≥ 1.28 was able to identify "frail" and "early frail" patients and predict mortality with a sensitivity of 83.3% and 82.6%, respectively (p = 0.001) and was an independent determinant associated with a higher risk of mortality (HR 5.382; p-value = 0.002). The FIMS score, easily achievable and usable in clinical practice, was able to identify frail and sarcopenic patients as well as predict their adverse clinical outcomes. This score could provide appropriate guidance during decision-making regarding elderly patients with severe AS.

Clinical usefulness of phase angle as an indicator of muscle wasting and malnutrition in inpatients with cardiovascular diseases

Background and Objectives: Extracellular water is increased in patients with edema, such as those with chronic heart failure, and it is difficult to assess skeletal muscle mass with the skeletal muscle mass index when extracellular water is high. We investigated the relationship between phase angle and physical function, nutritional indices, and sarcopenia in patients with cardiovascular diseases, including chronic heart failure. Methods and Study Design: In 590 patients with cardiovascular diseases (372 men), handgrip strength, gait speed, and anterior mid-thigh muscle thickness by ultrasound were measured, and the skeletal muscle mass index, phase angle, and the extracellular water: total body water ratio were measured with a bioelectrical impedance analyzer, and presence of sarcopenia was evaluated. Results: Phase angle, but not the skeletal muscle mass index, was correlated with serum albumin (r = 0.377, p < 0.001) and hemoglobin values in women. Multivariate regression analysis showed that at the extracellular water: total body water ratio below 0.4, both phase angle and skeletal muscle mass index were independent determinants of handgrip strength and log mid-thigh muscle thickness in men, after adjustment for age and presence of chronic heart failure. In contrast, for the ratio of 0.4 or greater, after adjustment for age and presence of chronic heart failure, phase angle was a stronger independent determinant of handgrip strength and log mid-thigh muscle thickness than the skeletal muscle mass index in men. Conclusions: Phase angle is a good marker of muscle wasting and malnutrition in patients with cardiovascular disease, including chronic heart failure.

Phase angle is related to physical function and quality of life in preoperative patients with lumbar spinal stenosis

Lumbar spinal stenosis (LSS) can interfere with daily life and quality of life (QOL). Evaluating physical function and QOL and helping patients to improve is the focus of rehabilitation. Phase angle (PhA) assessment is widely used to measure body composition and is considered an indicator of physical function and QOL. This study investigated the relationship between PhA and physical function, physical activity, and QOL in patients with LSS. PhA, handgrip strength, walking speed, Timed Up and Go test (TUG), Life Space Assessment (LSA), Prognostic Nutritional Index (PNI), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), and EQ-5D were assessed and statistically analyzed. The study included 133 patients with LSS. Multiple regression analysis of PhA adjusted for age, sex, and body mass index (Model 1) and for Model 1 + PNI (Model 2) showed significant correlations (P < 0.05) with handgrip strength, walking speed, TUG, and LSA. Regarding QOL, PhA was significantly correlated (P < 0.05) with lumbar function in JOABPEQ. PhA was associated with physical function and QOL in patients with LSS and might be a new clinical indicator in this population.

Reduced body cell mass and functions in lower extremities are associated with mild cognitive impairment and Alzheimer's dementia

This study examined the alterations of segmental body composition in individuals with Alzheimer's pathology (AD), including mild cognitive impairment (MCI) and dementia. A multifrequency bioimpedance analysis (BIA) was used to provide segmental water and impedance variables from 365 cognitively normal (CN), 123 MCI due to AD, and 30 AD dementia participants. We compared the BIA variables between the three groups, examined their correlations with neuropsychological screening test scores, and illustrate their 95% confidence RXc graphs. AD dementia participants were older, more depressive, and had worse cognitive abilities than MCI due to AD and CN participants. Although the BIA variables showed weak partial correlations with the cognitive test scores, we found patterns of an increasing water content in lean mass, increasing extra to intracellular water ratio, and decreasing reactance and phase angle in the lower extremities with effect sizes ranging from 0.26 to 0.51 in the groups of MCI and dementia due to AD compared with CN individuals. The RXc graphs upheld the findings with a significant displacement downward and toward the right, dominantly in the lower extremities. Individuals with AD pathology exhibit a reduced body cell mass or cell strength, an abnormal cellular water distribution, and an overhydration status in lean mass, especially in the lower extremities.

Phase angle of bioimpedance as a marker of inflammation in cardiovascular diseases: A systematic review

OBJECTIVE

The aim of this systematic review was to investigate whether phase angle (PhA) of bioelectrical impedance is associated with inflammatory markers in cardiovascular diseases (CVDs).

METHODS

A search was performed in the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Latin American Caribbean Health Sciences Literature (LILACS), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and Scopus; and in the gray literature up to January 2022. Studies with individuals with CVDs were included, to evaluate the association between PhA and the inflammatory markers interleukin (IL)-6, IL-10, IL-18, IL-1β, IL-33, tumor necrosis factor (TNF)-α, C-reactive protein (CRP), toll-like receptor (TLR) 2, TLR 4, nuclear factor κB, pathogen-associated molecular pattern molecules, lipopolysaccharides, interferon-γ-inducing factor, and JAK STAT.

RESULTS

We identified 755 articles and, after an eligibility analysis, 5 studies were included. The inflammatory markers investigated in the studies were CRP, TNF-α, and IL-33. In patients with CVDs, PhA was negatively associated with CRP and TNF-α in 80% and 100% of the studies, respectively.

CONCLUSIONS

The present results suggested that PhA is inversely associated with inflammatory markers in individuals with CVDs, and its clinical use is encouraged for better therapeutic planning.

Not only muscle mass but also muscle quality is associated with knee extension muscle strength in patients with hip fractures

Our results revealed that the decrease in isometric knee extension muscle strength on the operated and nonoperated sides in patients with hip fractures was associated with not only a decrease in skeletal muscle mass but also a decrease in muscle quality, characterized by a decreased PhA.

PURPOSE

This study aimed to assess the relationship between isometric knee extension muscle strength on the operated or nonoperated sides and PhA in patients with hip fractures at approximately 6 months postoperatively.

METHODS

This study was a cross-sectional study. Skeletal muscle index (SMI), PhA, knee extension muscle strength on the operated and nonoperated sides, and other physical function variables were assessed at approximately 6 months postoperatively. To identify predictors of knee extension muscle strength on the operated and nonoperated sides, hierarchical multiple regression analysis was performed.

RESULTS

A total of 90 patients with hip fractures were included (mean age, 80.1 ± 6.9 years). SMI (0.45) and PhA on the operated side (0.27) were the significant associated factors extracted for isometric knee extension muscle strength on the operated side (standardized partial regression coefficients), independent of age, sex, and body mass index (BMI). Movement control during one-leg standing on the nonoperated side (0.26), SMI (0.32), and PhA on the nonoperated side (0.40) were the significant associated factors extracted for isometric knee extension muscle strength on the nonoperated side, independent of age, sex and BMI.

CONCLUSIONS

Our results revealed that the decrease in isometric knee extension muscle strength on the operated and nonoperated sides in patients with hip fractures at approximately 6 months postoperatively was associated with not only a decrease in skeletal muscle mass but also a decrease in muscle quality, characterized by a decreased PhA.

A Current Review of the Uses of Bioelectrical Impedance Analysis and Bioelectrical Impedance Vector Analysis in Acute and Chronic Heart Failure Patients: An Under-valued Resource?

BACKGROUND

There is a need to detect and prevent fluid overload and malnutrition in heart failure. Bioelectrical impedance analysis and bioelectrical impedance vector analysis are medical instruments that can advance heart failure management by generating values of body composition and body water, assisting clinicians to detect fluid and nutritional status. However, there is a lack of evidence to summarise how they have been used among heart failure patients.

METHOD

A systematic search was conducted.

RESULT

Two hundred and four papers were screened. Forty-eight papers were reviewed, and 46 papers were included in this review. The literature shows that bioelectrical impedance analysis and bioelectrical impedance vector analysis were mostly used to assess fluid and nutritional status, together with diagnostic and prognostic values. Contraindication of using BIA and implications for practice are also demonstrated.

CONCLUSION

The findings suggest that bioelectrical impedance vector analysis is superior to bioelectrical impedance analysis when assessing hydration/nutritional status in heart failure. Assessing a patient using bioelectrical impedance analysis /bioelectrical impedance vector analysis, together with natriuretic peptide -heart failure biomarkers, increases the diagnostic accuracy of heart failure. Further studies are required to examine the cost effectiveness of using these instruments in clinical practice.

Association of phase angle values and sarcopenia in older patients with heart failure

BACKGROUND

Sarcopenia presents an accelerated and accentuated muscle loss in patients with heart failure (HF), leading to a worse prognosis for these patients. This study sought to assess the association of phase angle (PA) values with sarcopenia and its components, as well as to establish a PA cutoff point to predict outcomes such as hospitalization and mortality in older adult patients with HF.

METHODS

Sarcopenia diagnosis followed the European Working Group on Sarcopenia in Older People criteria. Anthropometric, bioelectrical impedance (PA and body composition), functional capacity and inflammatory markers were assessed.

RESULTS

Included patients were predominantly male (67%) and White, with a mean age of 69 ± 7 years, and a predominance of New York Heart Association I and II functional classes (82.1%) and reduced left ventricular ejection fraction (70.8%). Of the total sample, 23.6% were identified as sarcopenic. Mean PA values were lower in patients with sarcopenia (4.9 ± 0.9 and 6.0 ± 0.8°; P < 0.001). The cutoff point detected for sarcopenia in the receiver operating characteristic curve was 5.45°, which is an independent predictor for sarcopenia. PA values below this cutoff point were also associated with each of the sarcopenic components evaluated. PA proved to be an independent predictor for hospitalization (P = 0.042) in the entire sample studied.

CONCLUSION

PA is associated with diagnostic components of sarcopenia and the cutoff point 5.45° proved to be an independent predictor of sarcopenia and hospitalization >3 years in older adult patients with HF.

Effects of muscle mass and muscle quality estimated by phase angle on functional outcomes in older patients undergoing rehabilitation: A prospective cohort study

BACKGROUND

Both skeletal muscle mass and muscle quality are important predictors of poor prognosis in older patients. However, the effects of muscle mass and muscle quality estimated by the phase angle (PhA) on functional outcomes in older patients undergoing rehabilitation have yet to be reported. This study aimed to investigate whether appendicular skeletal muscle index (SMI) and muscle quality estimated by PhA were independently associated with activities of daily living (ADL) and physical function in older patients undergoing rehabilitation.

METHODS

This prospective cohort study included older patients in a subacute rehabilitation hospital (n = 443). Baseline SMI and PhA were measured using bioelectrical impedance analysis, and low SMI or low PhA were determined using each cutoff value. The primary outcomes were ADL abilities measured using the functional independence measure for motor function (FIM-M) score and physical function measured using the short physical performance battery (SPPB) score at hospital discharge. Association between low SMI and low PhA and FIM-M or SPPB scores at discharge were determined using multiple regression analysis adjusted for confounding factors.

RESULTS

There were significant differences between the normal- and low-PhA groups in the FIM-M and SPPB scores at discharge (P < 0.001). In multiple regression analysis, low PhA was independently associated with FIM-M (β = -0.109, P = 0.013) and SPPB scores (β = 0.535, P < 0.001) at discharge; however, low SMI was not independently associated with these functional outcomes.

CONCLUSION

Decreased muscle quality estimated by the PhA was independently associated with poor ADL abilities and poor physical function in older patients undergoing rehabilitation.

Screening efficacy of PhA and MNA-SF in different stages of sarcopenia in the older adults in community

OBJECTIVE

To compare the screening ability of the phase Angle (PhA) and the Short-Form Mini Nutritional Assessment (MNA-SF) alone and combined detection in the different stages of sarcopenia among the older adults in the community.

METHODS

The older adults aged 65 and above were enlisted during community outpatient service and their nutritional status was evaluated by MNA-SF scale. PhA was measured by bioelectrical impedance analysis (BIA). AWGS2019 and EWGSOP2010 were used to define the different stages of sarcopenia. We measured skeletal mass index (SMI) and grip strength with BIA and electronic grip apparatus and measured body function with 6-m pace, SPPB test, and standing test.

RESULTS

The AUC of PhA in the screening of possible sarcopenia was 0.640, the sensitivity was 58.49%, the specificity was 66.67%, and the cut-off value was 4.5. The AUC of the combined PhA and MNA-SF for possible sarcopenia was 0.642, the sensitivity was 57.55%, and the specificity was 70.00%. The AUC of MNA-SF for the screening of pre-sarcopenia was 0.805, the sensitivity was 66.67%, the specificity was 85.83%, and the cut-off value was 12. The AUC of the combined PhA and MNA-SF was 0.826, the sensitivity was 75.00%, and the specificity was 85.00%. The AUC of PhA in the screening of sarcopenia (common type) was 0.808, the sensitivity was 82.35%, the specificity was 73.33%, the cut-off value was 4.4. The AUC of the combined PhA and MNA-SF for sarcopenia (common type) was 0.835, the sensitivity was 76.47% and the specificity was 81.67%. The AUC of PhA and for the screening of severe sarcopenia was 0.935, the sensitivity was 93.33%, the specificity was 92.50%, and the cut-off value was 4.1. The AUC of the combined PhA and MNA-SF was 0.943, the sensitivity was 86.67%, and the specificity was 93.33%.

CONCLUSION

The screening ability of PhA alone or in combination was higher than that of MNA-SF in the screening of possible sarcopenia. The screening ability of the combined detection was higher than that of PhA alone in the screening of pre-sarcopenia. The combination of PhA and MNA-SF or PhA alone all performed better value in the screening of sarcopenia (common type). Compared to MNA-SF, the PhA performed better in the screening of severe sarcopenia, which provided references for identifying patients with different stages of sarcopenia in the community.

Association of Phase Angle with Overall Survival in Patients with Cancer: A Prospective Multicenter Cohort Study

Low phase angle (PhA) is related with poor clinical status of cancer patients. The objective of this study was to establish sex- and age-specific cutoff points and examine the association between PhA and overall survival (OS) in Chinese cancer patients. This cohort study included data on 1,814 patients with cancer from December 2013 to October 2020. The association between low PhA and overall survival was analyzed using the Kaplan-Meier method and Cox regression model. Among 1,814 participants, there were 993 (54.70%) male and 821 (45.30%) female patients. The optimal cutoff points of low PhA were 4.8°, 4.2°, 4.4°, and 3.8° for the young male, elderly male, young female, and elderly female, respectively. Low PhA was independently associated with poorer OS in young female, elderly female and male (HR: 1.59, 95% CI: 1.08-2.34; HR: 1.65, 95% CI: 1.03-2.67; HR: 2.00, 95% CI: 1.45-2.75). In addition, low PhA was demonstrated to be an adverse prognostic factor in patients with lung cancer, colorectal cancer, and esophagus cancer (HR: 1.85, 95% CI: 1.39-2.47; HR: 2.05, 95% CI: 1.13-3.70; HR: 2.92, 95% CI: 1.49-5.71). Based on cutoff points, low PhA was associated with worse prognosis in patients with cancer.

Evaluation of raw segmental bioelectrical impedance variables throughout anterior cruciate ligament reconstruction rehabilitation

Background.Raw bioelectrical impedance analysis (BIA) variables are related to physical function in healthy and diseased populations. Therefore, BIA may be an insightful, noninvasive method of assessment to track following anterior cruciate ligament reconstruction (ACLR).Objectives.Evaluate phase angle, reactance and impedance at 50 kHz (PhA₅₀, Xc₅₀, andZ₅₀, respectively) in the operative (OP) and non-operative (NOP) limbs during ACLR rehabilitation.Approach.Seventeen patient (12 M, 5 F; 18.8 ± 4.8 years) clinic reports were evaluated prior to ACLR (PRE), two- (2 W), six- (6 W), and twelve-weeks (12 W) post-ACLR and at return to sport testing (RTS).Setting.All observations occurred during the participant's physical therapy visits.Measurements.A multi-frequency BIA device measured segmental PhA, Xc, andZ. Linear mixed effects models were used to assess any leg and time interaction and changes over leg and time, independently. Any interactions or main effects were considered significant atp< 0.05.Main results.Significant legxtime interactions were observed for each variable. PhA₅₀and Xc₅₀of NOP were higher (p< 0.001) than OP at each time point by an average of by 0.9° and 4.9 Ω, respectively. In OP, PhA₅₀and Xc₅₀decreased from PRE to 2 W and increased from 6 to 12 W and 12 W to RTS (p< 0.01, for all). At RTS, PhA₅₀and Xc₅₀were similar to PRE in OP (p> 0.05). ForZ₅₀, the OP leg did not change over time (p> 0.05).Z₅₀was greater in NOP at 2 and 6 W (p< 0.01, for both). There were differences in PhA₅₀in NOP between PRE and 6 W and from 6 W to RTS (p< 0.05 for both). Xc₅₀did not change (p> 0.05), andZ₅₀PRE was lower than at 2 W (p< 0.05).Significance.A multi-frequency BIA device can detect changes in segmental BIA variables following ACLR.

Phase angle derived from bioelectrical impedance analysis as a marker for predicting sarcopenia

Sarcopenia is commonly defined as the age-related loss of muscle mass and function and may be caused by several factors, such as genetics, environmental conditions, lifestyle, drug use, and, in particular, comorbidities. People with pre-existing conditions are more likely to develop sarcopenia and subsequently have a less favorable prognosis. Recently, phase angle (PhA), which is derived from bioelectrical impedance analysis (BIA), has received a great deal of attention, and numerous studies have been carried out to examine the relationship between PhA and sarcopenia in different conditions. Based on these studies, we expect that PhA could be used as a potential marker for sarcopenia in the future.

Phase angle and cellular health: inflammation and oxidative damage

Phase angle is a composite measure that combines two raw bioelectrical impedance analysis measures: resistance and reactance. Phase angle has been considered an indicator of cellular health, integrity, and hydration. As inflammation and oxidative stress can damage cellular structures, phase angle has potential utility in early detecting inflammatory and oxidative status. Herein, we aimed to critically review the current understanding on the determinants of phase angle and its relationship with markers of inflammation and oxidative stress. We also discussed the potential role of phase angle in detecting chronic inflammation and related adverse outcomes. Several factors have been identified as predictors of phase angle, including age, sex, extracellular to intracellular water ratio, and fat-free mass. In addition to these factors, body mass index (BMI) also seems to influence phase angle. Available data also show that lower phase angle values are correlated (negligible to high correlation coefficients) with higher c-reactive protein, tumour necrosis factor-α, interleukin-6, and interleukin-10 in studies involving the general and aging populations, as well as patients with chronic conditions. Although fewer studies have evaluated the relationship between phase angle and markers of oxidative stress, available data also suggest that phase angle has potential to be used as an indicator (for screening) of oxidative damage. Future studies including diverse populations and bioelectrical impedance devices are required to confirm the validity and accuracy of phase angle as a marker of inflammation and oxidative stress for clinical use.

Phase angle of bioimpedance at 50 kHz is associated with cardiovascular diseases: systematic review and meta-analysis

The phase angle of bioimpedance is an important prognostic tool in clinical practice. The aim of this study was to investigate the association between phase angle and cardiovascular diseases. Electronic searches were carried out on MEDLINE, EMBASE, Cochrane, SCIELO, LILACS, CINAHL, Scopus, and the Web of Science. The PECO was "P" adults over 18 years of age, "E" the presence of cardiovascular disease, "C" absence of cardiovascular disease, and "O" phase angle values. The phase-angle means difference (MD) was analyzed separately by sex. Subgroup metanalysis with age, body mass index, and heart failure disease and meta-regressions were analyzed with random-effects models. Sensitivity analysis was performed considering only studies with high quality. The heterogeneity among studies was assessed using the Q-Cochran test and I² statistics. Four-hundred-thirty-nine articles were identified, and 22 studies were included in this systematic review, totaling 10.010 participants. Eight studies met the criteria for the meta-analysis, involving 2164 participants. The phase angle (PA) was measured at 50 kHz frequency in all studies. Individuals with cardiovascular disease had a smaller PA compared to the control group, for both males (MD -0.70; 95% CI -1.01 to -0.39) and females (MD -0.76; 95% CI -1.39 to -0.13). In the sensitivity analysis, in men, the quality of studies (P < 0.01), and in women, heart failure (P < 0.01) was significantly different between groups.The values of the phase angle were lower in individuals with cardiovascular disease than in control subjects. This result reinforces the importance of this tool in clinical practice, highlighting its potential to assess health status. Registration: The systematic review protocol was registered in the PROSPERO database as CRD42020164178.

Study of pulsed electrostatic field (PESF) in the perfusion of peripheral tissues: Microangiopathy, nutrition and quality of perceiver life

Microangiopathy compromises the structural and functional integrity of organs and tissues in patients with type II diabetes mellitus (T2DM) negatively affecting the perceived quality of life. Nitric oxide (NO) is a multifunctional signalling molecule, acting as a vasodilator, neurotransmitter, and modulator of inflammatory processes. Patients with type II diabetes mellitus and chronic kidney disease, controlled from glycaemic status, were treated or not with pulsed electrostatic field (PESF) cycles to evaluate effect on the perfusion of peripheral tissues. Everyone was monitored for the metabolic profile, and we tested circulating NO with a commercial enzyme immunoassay kit. In addition, we tested the perceived quality of life of patients before/after a PESF cycle using a questionnaire. Patients treated with PESF were improved circulating NO levels, significant changes in systolic and diastolic blood pressure, heart rate and were more homogeneous for their metabolic profile. The questionnaire showed also a marked improvement in the perceived quality of life. The use of pulsed electrostatic fields has allowed us to observe an improvement in the metabolic, psychological, and clinical profile in patients with T2DM and chronic kidney disease whose pathological profile is strongly compromised.

Combined resistance training with aerobic training improves physical performance in patients with coronary artery disease: A secondary analysis of a randomized controlled clinical trial

Background

The efficacy of combined resistance training (RT) and aerobic training (AT) compared with AT alone is well established in cardiac rehabilitation (CR); however, it remains to be elucidated whether RT load (high load [HL] vs. low load [LL]) modifies the outcomes. The aim of our study was to investigate the effects of HL-RT and LL-RT combined with AT in comparison to AT alone on body composition and physical performance in patients with coronary artery disease (CAD) enrolled in phase II CR.

Methods

We randomized 79 patients with a stable CAD to 12 weeks of lower limb LL-RT + AT (35-40% of one repetition maximum [1-RM]; n = 28), HL-RT + AT (70-80% of 1-RM; n = 26), or AT (n = 25). Fifty-nine patients (75% men) with mean (standard deviation) age 61 (8) years and left ventricular ejection fraction 53 (9)% completed LL-RT (n = 19), HL-RT (n = 21) and AT (n = 19). Body composition and physical performance (upper and lower submaximal muscle strength, flexibility, balance, and mobility) were measured at baseline and post-training.

Results

Training intervention had no significant impact on time × group interaction in the body composition measures. There was a significant time × group interaction for the gait speed test, chair sit-and-reach test, arm curl test, Stork balance test, up and go test, STS-5, and 6-min walk distance (p-values ≤ 0.001-0.04) following the training intervention. After the training intervention, HL-RT improved gait speed (+12%, p = 0.044), arm curl (+13%, p = 0.037), and time of Up and Go test (+9%, p < 0.001) to a greater extent compared with AT group, while there was a greater improvement in time of Up and Go test (+18%, p < 0.001) and time of five sit-to-stand tests (+14%, p = 0.016) following LL-RT when compared with AT. There were no differences between HL-RT and LL-RT in post-training improvement in any of the physical performance measures.

Conclusion

The combination of AT with HL-RT or LL-RT promoted similar improvements in physical performance, which were superior to AT. Therefore, both types of combined AT and RT can be applied to patients with CAD.

Clinical trial registration

[https://clinicaltrials.gov/ct2/show/NCT04638764] Identifier [NCT04638764].

Bioimpedance phase angle and sarcopenia in older patients with prostate cancer

AIM

The purpose of this study was to evaluate the factors associated with the bioimpedance phase angle (PhA) in older patients with prostate cancer, and to determine the optimal cutoff for the PhA in patients with sarcopenia and prostate cancer.

METHODS

This retrospective cross-sectional analysis enrolled patients with prostate cancer aged ≥60 years. Appendicular skeletal muscle mass and PhA estimated by bioimpedance analysis, grip strength, the five-time chair stand test, gait speed, the Short Physical Performance Battery, the 2-min walk test and the International Physical Activity Questionnaire Short Form were obtained at enrollment. The diagnosis of sarcopenia was based on the 2019 consensus of the Asian Working Group for Sarcopenia.

RESULTS

In total, 119 male participants (mean age = 70.7 ± 6.1 years) were available for analysis. A multivariable linear regression model revealed that age, body mass index and the maximal grip strength value were associated with the PhA. The area under the receiver operating characteristic curve value of the PhA for sarcopenia diagnosis was 0.77 (95% confidence interval 0.64-0.90, P < 0.001), with a PhA cutoff value of 4.87°.

CONCLUSIONS

PhA estimated by bioimpedance analysis may be utilized as useful clinical biomarker for reflecting muscle strength and sarcopenia in older patients with prostate cancer. Geriatr Gerontol Int 2022; ••: ••-••.

Preoperative Phase Angle as a Risk Indicator in Cardiac Surgery-A Prospective Observational Study

Background: The phase angle (PhA) can be used for prognostic assessments in critically ill patients. This study describes the perioperative course of PhA and associated risk indicators in a cohort of elective cardiac surgical patients. Methods: The PhA was measured in 168 patients once daily until postoperative day (POD) seven. Patients were split into two groups depending on their median preoperative PhA and analyzed for several clinical outcomes; logistic regression models were used. Results: The PhA decreased from preoperative (6.1° ± 1.9°) to a nadir on POD 2 (3.5° ± 2.5°, mean difference −2.6° (95% CI, −3.0°; −2.1°; p < 0.0001)). Patients with lower preoperative PhA were older (71.0 ± 9.1 vs. 60.9 ± 12.0 years; p < 0.0001) and frailer (3.1 ± 1.3 vs. 2.3 ± 1.1; p < 0.0001), needed more fluids (8388 ± 3168 vs. 7417 ± 2459 mL, p = 0.0287), and stayed longer in the ICU (3.7 ± 4.5 vs. 2.6 ± 3.8 days, p = 0.0182). Preoperative PhA was independently influenced by frailty (OR 0.77; 95% CI 0.61; 0.98; p = 0.0344) and cardiac function (OR 1.85; 95%CI 1.07; 3.19; p = 0.028), whereas the postoperative PhA decline was independently influenced by higher fluid balances (OR 0.86; 95% CI 0.75; 0.99; p = 0.0371) and longer cardiopulmonary bypass times (OR 0.99; 95% CI 0.98; 0.99; p = 0.0344). Conclusion: Perioperative PhA measurement is an easy-to-use bedside method that may critically influence risk evaluation for the outcome of cardiac surgery patients.

Phase Angle as a Comprehensive Tool for Nutritional Monitoring and Management in Patients with Crohn's Disease

Background and Aims: Crohn’s disease (CD) is usually accompanied by malnutrition. CD-related malnutrition can increase morbidity, disability, mortality, and hospitalization costs. The purpose of this study was to find a reliable indicator for evaluating CD patients’ nutritional status. Methods: All data were retrospectively collected from Xiangya Hospital, Central South University between May 2021 and February 2022. All patients were evaluated for nutritional status using the Global Leadership Initiative on Malnutrition (GLIM) criteria. Body composition, resistance, and reactance were recorded by a body analyser, and the phase angle (PhA) was calculated simultaneously. The Mann−Whitney U test, chi-square test, Fisher’s exact test, and univariate and multivariate logistic regression analyses were used. A receiver operating characteristic (ROC) curve was built to evaluate the predictive value of differential variables for diagnosing malnutrition based on the GLIM criteria. Results: A total of 169 CD patients were enrolled, of which 74 (58.3%) males and 32 (76.2%) females were diagnosed with malnutrition; 34 (45.9%) males and 22 (68.8%) females were severely malnourished. Univariate analysis identified that as nutritional status deteriorated, body mass index, PhA, and levels of haemoglobin and albumin decreased, while platelet count, erythrocyte sedimentation rate, and levels of C-reactive protein and fibrinogen increased (p < 0.05). Logistic regression analysis revealed that the PhA was significantly independently associated with malnutrition (p < 0.05). The ROC curve analysis indicated that the optimal PhA cut-off levels of 6.11° and 5.55° could be used to predict malnutrition according to the GLIM criteria in males and females, respectively, with a PhA < 5.53° and < 5.12° indicating severe malnutrition in males and females, respectively. Conclusion: The PhA is a sensitive, noninvasive, portable, inexpensive tool that can be used to monitor and manage the nutritional status of CD patients.

Cancer, Phase Angle and Sarcopenia: The Role of Diet in Connection with Lung Cancer Prognosis

Lung cancer is the most common cause of cancer death and is associated with malnutrition and sarcopenia. The detection of sarcopenia and conduction of simple body composition measurements, such as the phase angle (PhA) deriving from bioelectrical impedance analysis (BIA), can help to early identify, monitor, prevent and treat malnutrition. The present review aims to clarify the relationship between PhA and sarcopenia with the pathophysiology, clinical outcomes, and therapeutic aspects of lung cancer. PhA and sarcopenia are connected to lung cancer prognosis through various mechanisms including inflammation and oxidative stress, although more research is needed to identify the critical thresholds for increased mortality risk. Moreover, emphasis is given on the role of dietary interventions (oral nutritional supplementation, and dietary counseling) to manage sarcopenia and related variables in patients with lung cancer. Oral nutritional supplements and/or those containing n - 3 polyunsaturated fatty acids may have a positive effect on physical strength measures and muscle mass if administered at the beginning of chemotherapy. Data on sole dietary counseling or multimodal interventions are less promising so far. In the future, sophisticated body composition phenotypes deriving from the described methods along with artificial intelligence techniques could be used to design personalized nutrition interventions and timely treat these patients.

Prevalence of Sarcopenia in Women with Breast Cancer

Sarcopenia is a common finding in patients with cancer and potentially influences the patient’s outcome. The aim of this study was to evaluate the prevalence of sarcopenia, according to the European Working Group on Sarcopenia in Older People, in a sample of women with breast cancer (BC) and a BMI lower than 30 kg/m2. This cross-sectional study was conducted in patients with BC, stage 0-III, and receiving therapy for BC; the women were recruited at the Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy. A control group with similar age and BMI was selected from the internal database. Anthropometry, bioimpedance analysis (BIA) and hand grip strength (HGS) were measured to detect sarcopenia. A total of 122 patients (mean age 49.3 ± 11.0 years, BMI 24.6 ± 3.0 kg/m2) and 80 healthy controls were analyzed. Sarcopenia was found in 13.9% patients with BC, while none of the subjects in the control group was sarcopenic. By comparing BC patients with and without sarcopenia and the control group, the fat-free mass of sarcopenic BC patients were significantly lower than those of both non-sarcopenic BC patients and the control (p < 0.05). The phase angle was also significantly lower in sarcopenic patients (−0.5 degrees, p = 0.048) than in the control group. Considering the prevalence of sarcopenia in patients with BC, our findings suggest the usefulness of body composition and HGS evaluation for early screening of sarcopenia to reduce the risk of associated complications.

Neuromuscular Impairment of Knee Stabilizer Muscles in a COVID-19 Cluster of Female Volleyball Players: Which Role for Rehabilitation in the Post-COVID-19 Return-to-Play?

COVID-19 athletes reported persistent and residual symptoms many weeks after initial infection, including cough, fatigue, and neuromuscular disorders. Poor neuromuscular control may cause inefficient movement strategies increasing anterior cruciate ligament load. This is particularly relevant in female athletes, who show a 3-time higher risk than male counterparts. Aim is to evaluate the impairment in thigh muscles activation, body composition, and physical performance after COVID-19 in volleyball athletes. We recruited a cohort of female professional players from the same team. We assessed the pre-activation time of Rectus Femoris (RF), Vastus Medialis (VM), Medial Hamstring (MH), and Lateral Hamstring (LH) before (T0) and after (T1) COVID-19 infection, bioelectrical impedance analysis (BIA), and jump tests. We included 12 athletes with COVID-19 infection diagnosis in January 2021. At T1 we found a significant (p < 0.05) delay (ms) of the activation time of RF (426 ± 188 vs. 152 ± 106); VM (363 ± 192 vs. 140 ± 96); BF (229 ± 60 vs. 150 ± 63); MH (231 ± 88 vs. 203 ± 89), and a significant reduction of body composition at BIA. The neuromotor imbalance of the knee stabilizer muscle in female athletes after COVID-19 infection determines a deficit of knee stabilization. Physicians should consider neuromuscular and metabolic sequelae to identify athletes at higher risk of injury and set up specific neuromuscular rehabilitation protocols.

Worth the Wait? Time Course of Supine Shifts in Body Water Compartments on Variables of Bioelectrical Impedance Analysis

Bioelectrical impedance analysis (BIA) reference values are based on supine assessments. Little is known regarding the effects of time course shifts in body water compartments after assuming a supine position. The aim of this study was to characterize these effects and provide recommendations regarding the optimal waiting time to perform BIA. Thirty-eight healthy adults underwent BIA via the RJL Quantum Legacy analyzer immediately upon lying down and every 5 minutes for 15 minutes. Differences in resistance (R), reactance (Xc), intracellular (ICW), extracellular (ECW), total body water (TBW), body fat percentage (%BF), and phase angle (PhA) were assessed. There were small but significant increases in R, Xc, and %BF (all p<0.001), as well as small but significant decreases in ICW, ECW, and TBW (all p<0.001) over 15 minutes. No difference was observed for PhA (p=0.065). Average values changed over 15 minutes by +7.14Ω, +1.36Ω, -0.2L, -0.2L, -0.4L, +0.05° and +0.1% for R, Xc, ICW, ECW, TBW, PhA and %BF, respectively. BIA measurements are affected by shifts in body water compartments after assuming a supine position, but these differences lack clinical significance in healthy adults. Technicians working with healthy adults can perform BIA within 15 minutes after participants assume a supine position.

Phase Angle as an Indicator of Baseline Nutritional Status and Sarcopenia in Acute Stroke

OBJECTIVES

This study aimed to investigate whether phase angle is an indicator of malnutrition and sarcopenia in acute-phase stroke patients.

MATERIALS AND METHODS

We conducted a retrospective observational study of stroke patients in a single acute-care hospital. The phase angle was measured within 5 days after admission, and the correlation between nutritional status and sarcopenia index was investigated. The cut-off point that distinguishes malnutrition and sarcopenia was evaluated using the receiver operating characteristic curve. The effects of the geriatric nutritional risk index (GNRI) and sarcopenia on the phase angle were examined using multivariate linear regression analysis.

RESULTS

A total of 211 stroke patients (140 men) with a median age of 74 (65-83) were included in the analysis. Malnutrition was present in 38 (18.0%) patients, and 65 (30.8%) had sarcopenia. The phase angle significantly correlated with GNRI, grip strength, skeletal muscle musss index, and calf circumference in both men and women. The cut-off points for discriminating malnutrition were 5.05 for men and 3.96 for women, while the cut-off points for discriminating sarcopenia were 5.28 for men and 4.62 for women. Multivariate linear regression analysis showed that the GNRI and sarcopenia were independently related to the phase angle.

CONCLUSIONS

Phase angle is a useful indicator for distinguishing malnutrition and sarcopenia in patients with acute stroke.