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Härter J, Orlandi SP, Bielemann RM, Dos Santos LP, Gonzalez MC. Standardized phase angle: relationship with functionality, muscle mass and postoperative outcomes in surgical cancer patients. Med Oncol 2024; 41:139. [PMID: 38709365 DOI: 10.1007/s12032-024-02367-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/20/2024] [Indexed: 05/07/2024]
Abstract
To evaluate the association of standardized phase angle (SPA) with nutritional status, functional parameters, and postoperative outcomes in surgical cancer patients. This prospective study includes 59 cancer patients from Pelotas (Brazil) admitted for elective cancer surgery. We obtained the phase angle through Bioelectrical Impedance Analysis (BIA) and standardized it according to the population's reference values. We estimated the muscle mass using BIA for later calculation of the Skeletal Muscle Index (SMI) and performed handgrip strength (HGS) and gait speed (GS) tests. We used the Patient-Generated Subjective Global Assessment (PG-SGA) to assess the nutritional status. Postoperative complications and duration of hospital stay were evaluated as the outcomes. The prevalence of malnutrition in the sample was 28.8%, according to ASG-PPP. SPA was statistically lower in patients with malnutrition, with lower HGS and reduced GS. For postoperative outcomes, patients with severe complications and those with prolonged hospitalization also had lower SPA values. The greater the number of functional alterations in patients, the lower the SPA value, mainly when associated with reduced muscle mass assessed by BIA, suggesting that muscle mass reduction plays an important role in the association between functional alterations and phase angle in patients with cancer. According to the parameters used in this study, low SPA value was associated with impaired nutritional and functional status and negative outcomes in the analyzed sample.
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Affiliation(s)
- Jéssica Härter
- Programa de Pós-Graduação em Medicina: Ciências Médicas, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 2º andar, Porto Alegre, RS, 90035003, Brazil.
| | - Silvana Paiva Orlandi
- Departamento de Nutrição, Universidade Federal de Pelotas, Rua Gomes Carneiro, 01, Pelotas, RS, 96010-610, Brazil
| | - Renata Moraes Bielemann
- Programa de Pós-Graduação em Nutrição e Alimentos, Universidade Federal de Pelotas, Rua Gomes Carneiro, 01, Pelotas, RS, 96010-610, Brazil
| | - Leonardo Pozza Dos Santos
- Departamento de Nutrição, Universidade Federal de Pelotas, Rua Gomes Carneiro, 01, Pelotas, RS, 96010-610, Brazil
| | - Maria Cristina Gonzalez
- Programa de Pós-Graduação em Nutrição e Alimentos, Universidade Federal de Pelotas, Rua Gomes Carneiro, 01, Pelotas, RS, 96010-610, Brazil
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Prior-Sánchez I, Herrera-Martínez AD, Zarco-Martín MT, Fernández-Jiménez R, Gonzalo-Marín M, Muñoz-Garach A, Vilchez-López FJ, Cayón-Blanco M, Villarrubia-Pozo A, Muñoz-Jiménez C, Zarco-Rodríguez FP, Rabat-Restrepo JM, Luengo-Pérez LM, Boughanem H, Martínez-Ramírez MJ, García-Almeida JM. Prognostic value of bioelectrical impedance analysis in head and neck cancer patients undergoing radiotherapy: a VALOR® study. Front Nutr 2024; 11:1335052. [PMID: 38463940 PMCID: PMC10921554 DOI: 10.3389/fnut.2024.1335052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/23/2024] [Indexed: 03/12/2024] Open
Abstract
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.
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Affiliation(s)
| | - Aura Dulcinea Herrera-Martínez
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Cordoba, Spain
- Endocrinology and Nutrition Service, Reina Sofia University Hospital, Cordoba, Spain
| | - María Teresa Zarco-Martín
- Department of Endocrinology and Nutrition, San Cecilio University Hospital, Granada, Spain
- Granada Biosanitary Research Institute (Ibs. Granada), Granada, Spain
| | - Rocío Fernández-Jiménez
- Malaga Biomedical Research Institute and BIONAND Platform, Endocrinology and Nutrition Department, Hospital Virgen de la Victoria de Malaga, Malaga, Spain
- Department of Endocrinology and Nutrition, Quironsalud Malaga Hospital, Malaga, Spain
- Department of Medicine and Dermatology, Malaga University, Malaga, Spain
| | - Montserrat Gonzalo-Marín
- Endocrinology and Nutrition Department, Malaga Regional University Hospital, Malaga, Spain
- Malaga Biomedical Research Institute and BIONAND Platform, Malaga, Spain
| | - Araceli Muñoz-Garach
- Granada Biosanitary Research Institute (Ibs. Granada), Granada, Spain
- Department of Endocrinology and Nutrition, Virgen de las Nieves University Hospital, Granada, Spain
- Network Biomedical Research Center Physiopathology of Obesity and Nutrition (CiberOBN), Carlos III Health Institute, Madrid, Spain
| | - Francisco Javier Vilchez-López
- Endocrinology and Nutrition Department, Hospital Universitario Puerta del Mar, Cadiz, Spain
- Biomedical Research and Innovation Institute of Cadiz, Cadiz, Spain
| | - Manuel Cayón-Blanco
- Biomedical Research and Innovation Institute of Cadiz, Cadiz, Spain
- Endocrinology and Nutrition Department, Hospital Universitario de Jerez de la Frontera, Cadiz, Spain
| | - Ana Villarrubia-Pozo
- Department of Endocrinology and Nutrition, Seville Institute of Biomedicine (IBIS), Virgen del Rocio University Hospital, Seville, Spain
| | - Concepción Muñoz-Jiménez
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Cordoba, Spain
- Endocrinology and Nutrition Service, Reina Sofia University Hospital, Cordoba, Spain
| | | | | | - Luis Miguel Luengo-Pérez
- Department of Endocrinology and Nutrition, Badajoz University Hospital, Seville, Spain
- Department of Biomedical Sciences, Universidad de Extremadura, Badajoz, Spain
| | - Hatim Boughanem
- Malaga Biomedical Research Institute and BIONAND Platform, Endocrinology and Nutrition Department, Hospital Virgen de la Victoria de Malaga, Malaga, Spain
- Spanish Biomedical Research Center in Physiopathology of Obesity and Nutrition (CIBERObn), Carlos III Health Institute, Madrid, Spain
- Unidad de Gestión Clinica Medicina Interna, Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Cordoba, Spain
| | | | - Jose Manuel García-Almeida
- Malaga Biomedical Research Institute and BIONAND Platform, Endocrinology and Nutrition Department, Hospital Virgen de la Victoria de Malaga, Malaga, Spain
- Department of Endocrinology and Nutrition, Quironsalud Malaga Hospital, Malaga, Spain
- Department of Medicine and Dermatology, Malaga University, Malaga, Spain
- Spanish Biomedical Research Center in Physiopathology of Obesity and Nutrition (CIBERObn), Carlos III Health Institute, Madrid, Spain
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Arman S, Tilley RD, Gooding JJ. A review of electrochemical impedance as a tool for examining cell biology and subcellular mechanisms: merits, limits, and future prospects. Analyst 2024; 149:269-289. [PMID: 38015145 DOI: 10.1039/d3an01423a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Herein the development of cellular impedance biosensors, electrochemical impedance spectroscopy, and the general principles and terms associated with the cell-electrode interface is reviewed. This family of techniques provides quantitative and sensitive information into cell responses to stimuli in real-time with high temporal resolution. The applications of cell-based impedance biosensors as a readout in cell biology is illustrated with a diverse range of examples. The current state of the field, its limitations, the possible available solutions, and the potential benefits of developing biosensors are discussed.
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Affiliation(s)
- Seyedyousef Arman
- School of Chemistry, The University of New South Wales, Sydney, New South Wales 2052, Australia.
- Australia Centre for Nanomedicine, The University of New South Wales, Sydney, New South Wales 2052, Australia
| | - Richard D Tilley
- School of Chemistry, The University of New South Wales, Sydney, New South Wales 2052, Australia.
- Electron Microscope Unit, Mark Wainwright Analytical Centre, The University of New South Wales, Sydney, New South Wales 2052, Australia
| | - J Justin Gooding
- School of Chemistry, The University of New South Wales, Sydney, New South Wales 2052, Australia.
- Australia Centre for Nanomedicine, The University of New South Wales, Sydney, New South Wales 2052, Australia
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Crowell LL, Yakisich JS, Aufderheide B, Adams TNG. Phenotypic Characterization of 2D and 3D Prostate Cancer Cell Systems Using Electrical Impedance Spectroscopy. BIOSENSORS 2023; 13:1036. [PMID: 38131796 PMCID: PMC10742279 DOI: 10.3390/bios13121036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
Prostate cancer is the second leading cause of death in men. A challenge in treating prostate cancer is overcoming cell plasticity, which links cell phenotype changes and chemoresistance. In this work, a microfluidic device coupled with electrical impedance spectroscopy (EIS), an electrode-based cell characterization technique, was used to study the electrical characteristics of phenotype changes for (1) prostate cancer cell lines (PC3, DU145, and LNCaP cells), (2) cells grown in 2D monolayer and 3D suspension cell culture conditions, and (3) cells in the presence (or absence) of the anti-cancer drug nigericin. To validate observations of phenotypic change, we measured the gene expression of two epithelial markers, E-cadherin (CDH1) and Tight Junction Protein 1 (ZO-1). Our results showed that PC3, DU145, and LNCaP cells were discernible with EIS. Secondly, moderate phenotype changes based on differences in cell culture conditions were detected with EIS and supported by the gene expression of CDH1. Lastly, we showed that EIS can detect chemoresistant-related cell phenotypes with nigericin drug treatment. EIS is a promising label-free tool for detecting cell phenotype changes associated with chemoresistance. Further development will enable the detection and characterization of many other types of cancer cells.
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Affiliation(s)
- Lexi L. Crowell
- Department of Chemical and Biomolecular Engineering, University of California Irvine, Irvine, CA 92697, USA;
- Sue and Bill Gross Stem Cell Research Center, University of California Irvine, Irvine, CA 92697, USA
| | - Juan Sebastian Yakisich
- Department of Pharmaceutical Sciences, School of Pharmacy, Hampton University, Hampton, VA 23668, USA;
| | - Brian Aufderheide
- Department of Chemical Engineering, Hampton University, Hampton, VA 23668, USA;
| | - Tayloria N. G. Adams
- Department of Chemical and Biomolecular Engineering, University of California Irvine, Irvine, CA 92697, USA;
- Sue and Bill Gross Stem Cell Research Center, University of California Irvine, Irvine, CA 92697, USA
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA 92697, USA
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Amiri Khosroshahi R, Barkhordar M, Talebi S, Imani H, Sadeghi E, Mousavi SA, Mohammadi H. The impact of malnutrition on mortality and complications of hematopoietic stem cell transplantation in patients with acute leukemia. Clin Nutr 2023; 42:2520-2527. [PMID: 37925779 DOI: 10.1016/j.clnu.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND & AIMS Malnutrition is common in hematopoietic stem cell transplantation (HSCT) patients. However, there are few studies on the association between malnutrition and post-transplant outcomes, with inconsistent results. No standard screening tool has been established for malnutrition in these patients. Previous research suggests the Global Leadership Initiative on Malnutrition (GLIM) criteria is effective in predicting outcomes in other cancers. This study investigates the link between malnutrition based on the GLIM criteria with mortality and complications following allogeneic HSCT. METHODS This single-center, observational, longitudinal, and prospective study of 98 adult leukemia patients at the Hematology Center of Shariati Hospital in Tehran, Iran, monitored patients before transplantation until 100 days after the procedure, focusing on overall survival and mortality as a primary outcome, and secondary endpoints including oral mucositis, acute GVHD, infection during hospitalization, and readmission rates. RESULTS This study involved 98 allogeneic HSCT patients with a median age of 38 years old, 64.3 % with acute myeloid leukemia (AML), and 35.7 % with acute lymphoblastic leukemia (ALL). Among them, 26.5 % were categorized as malnourished based on GLIM criteria. During 100 days of follow-up, 13 patients died, but there was no significant difference in overall survival and mortality between malnourished and well-nourished patients. Malnourished patients demonstrated a noticeable upward trend in the incidence of oral mucositis, hospital readmission, and infection during their hospitalization. It is important to highlight that although this observed trend is discernible, it did not attain statistical significance in statistical analyses (P > 0.05). CONCLUSION The current study determined that, when assessed using the GLIM criteria, malnutrition did not exert a statistically significant influence on survival, mortality, or complications within the specified age range of 18-55 years, underscoring its limited impact on this cohort of younger patients.
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Affiliation(s)
- Reza Amiri Khosroshahi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Barkhordar
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran; Cell Therapy and Hematopoietic Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepide Talebi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran; Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Imani
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Sadeghi
- Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Asadollah Mousavi
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran; Cell Therapy and Hematopoietic Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Mohammadi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
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López-Plaza B, Gil Á, Menéndez-Rey A, Bensadon-Naeder L, Hummel T, Feliú-Batlle J, Palma-Milla S. Effect of Regular Consumption of a Miraculin-Based Food Supplement on Taste Perception and Nutritional Status in Malnourished Cancer Patients: A Triple-Blind, Randomized, Placebo-Controlled Clinical Trial-CLINMIR Pilot Protocol. Nutrients 2023; 15:4639. [PMID: 37960292 PMCID: PMC10648678 DOI: 10.3390/nu15214639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/20/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Taste disorders are common among cancer patients undergoing chemotherapy, with a prevalence ranging from 20% to 86%, persisting throughout treatment. This condition leads to reduced food consumption, increasing the risk of malnutrition. Malnutrition is associated not only with worse treatment efficacy and poor disease prognosis but also with reduced functional status and quality of life. The fruit of Synsepalum dulcificum (Daniell), commonly known as miracle berry or miracle fruit, contains miraculin, a taste-modifying protein with profound effects on taste perception. The CLINMIR Protocol is a triple-blind, randomized, placebo-controlled clinical trial designed to evaluate the regular consumption of a food supplement containing a miraculin-based novel food, dried miracle berry (DMB), on the taste perception (measured through electrogustometry) and nutritional status (evaluated through the GLIM Criteria) of malnourished cancer patients under active antineoplastic treatment. To this end, a pilot study was designed with 30 randomized patients divided into three study arms (150 mg DMB + 150 mg freeze-dried strawberries, 300 mg DMB, or placebo) for three months. Throughout the five main visits, an exhaustive assessment of different parameters susceptible to improvement through regular consumption of the miraculin-based food supplement will be conducted, including electrical and chemical taste perception, smell perception, nutritional and morphofunctional assessment, diet, quality of life, the fatty acid profile of erythrocytes, levels of inflammatory and cancer-associated cytokines, oxidative stress, antioxidant defense system, plasma metabolomics, and saliva and stool microbiota. The primary anticipated result is that malnourished cancer patients with taste distortion who consume the miraculin-based food supplement will report an improvement in food taste perception. This improvement translates into increased food intake, thereby ameliorating their nutritional status and mitigating associated risks. Additionally, the study aims to pinpoint the optimal dosage that provides maximal benefits. The protocol adheres to the SPIRIT 2013 Statement, which provides evidence-based recommendations and is widely endorsed as an international standard for trial protocols. The clinical trial protocol has been registered at the platform for Clinical Trials (NCT05486260).
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Affiliation(s)
- Bricia López-Plaza
- Nutrition Research Group, La Paz University Hospital Institute for Health Research (IdiPAZ), 28046 Madrid, Spain;
- Medicine Department, Faculty of Medicine, Complutense University of Madrid, Plaza de Ramón y Cajal s/n, 28040 Madrid, Spain
| | - Ángel Gil
- Department of Biochemistry and Molecular Biology II, University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria IBS.GRANADA, Complejo Hospitalario Universitario de Granada, 18014 Granada, Spain
- Institute of Nutrition and Food Technology “José Mataix”, Centre of Biomedical Research, University of Granada, Avda. del Conocimiento s/n, Armilla, 18016 Granada, Spain
- CIBEROBN (CIBER Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | | | | | - Thomas Hummel
- Smell & Taste Clinic, Department of Otorhinolaryngology, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany;
| | - Jaime Feliú-Batlle
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain;
- CIBERONC (CIBER Cancer), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Medicine Department, Faculty of Medicine, Autonomous University of Madrid, Arzobispo Morcillo 4, 28029 Madrid, Spain;
| | - Samara Palma-Milla
- Medicine Department, Faculty of Medicine, Autonomous University of Madrid, Arzobispo Morcillo 4, 28029 Madrid, Spain;
- Nutrition Department, Hospital University La Paz, 28046 Madrid, Spain
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Fernández-Jiménez R, Martín-Masot R, Cornejo-Pareja I, Vegas-Aguilar IM, Herrador-López M, Tinahones FJ, Navas-López VM, Bellido-Guerrero D, García-Almeida JM. Phase angle as a marker of outcome in hospitalized pediatric patients. A systematic review of the evidence (GRADE) with meta-analysis. Rev Endocr Metab Disord 2023; 24:751-765. [PMID: 37486555 PMCID: PMC10404571 DOI: 10.1007/s11154-023-09817-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 07/25/2023]
Abstract
Phase angle (PhA) is a valuable tool for evaluating the nutritional and inflammatory status, which can accompany acute and severe disorders. PhA is a cellular health biomarker, whose value is particularly substantial due to the negative consequences of these situations in the pediatric population. Relevant literature was collected with the aim of comprehensively analysing the evidence on the association between an altered PhA can serve as a predictive-marker for mortality and poor-outcomes in at-risk-pediatric patients. Understanding this relationship could have significant implications for identifying high-risk individuals and implementing timely interventions. A systematic review with meta-analysis was conducted in the primary electronic databases from inception until January 2023. Overall, four studies with a total of 740 patients were eligible for our analysis. Evidence demonstrates that PhA is associated with nutritional status, reflecting undernutrition and changes in body composition related to illness. This review suggests that PhA can indeed be used as an indicator of nutritional status and a tool for predicting prognosis, including mortality and poor-outcomes, in hospitalized pediatric patients. A low PhA was associated with a significant mortality risk [RR:1.51;95%CI (1.22-1.88),p = 0.0002;I2 = 0%,(p = 0.99)] and an increased complications risk [OR:8.17;95%CI (2.44-27.4),p = 0.0007;I2 = 44%,(p = 0.18)]. These findings highlight the importance of taking a comprehensive approach to clinical nutrition, integrating multiple evaluation aspects to establish an accurate diagnosis and personalized therapeutic plans. While PhA emerges as a valuable tool for assessing the risk of malnutrition and as a prognostic-indicator for poor-outcomes in pediatric patients. Further future studies are needed to focus on investigating this relationship in larger and diverse population to strengthen the evidence base.
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Affiliation(s)
- Rocío Fernández-Jiménez
- Department of Endocrinology and Nutrition, Virgen de la Victoria Hospital (IBIMA), Malaga University, Campus Teatinos S/N 29010, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga-Plataforma BIONAND (IBIMA), Virgen de la Victoria University Hospital, 29010 Málaga, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 29010 Málaga, Spain
| | - Rafael Martín-Masot
- Instituto de Investigación Biomédica de Málaga-Plataforma BIONAND (IBIMA), Virgen de la Victoria University Hospital, 29010 Málaga, Spain
- Pediatric Gastroenterology and Nutrition Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Isabel Cornejo-Pareja
- Department of Endocrinology and Nutrition, Virgen de la Victoria Hospital (IBIMA), Malaga University, Campus Teatinos S/N 29010, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga-Plataforma BIONAND (IBIMA), Virgen de la Victoria University Hospital, 29010 Málaga, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 29010 Málaga, Spain
| | - Isabel M. Vegas-Aguilar
- Department of Endocrinology and Nutrition, Virgen de la Victoria Hospital (IBIMA), Malaga University, Campus Teatinos S/N 29010, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga-Plataforma BIONAND (IBIMA), Virgen de la Victoria University Hospital, 29010 Málaga, Spain
| | - Marta Herrador-López
- Instituto de Investigación Biomédica de Málaga-Plataforma BIONAND (IBIMA), Virgen de la Victoria University Hospital, 29010 Málaga, Spain
- Pediatric Gastroenterology and Nutrition Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Francisco J. Tinahones
- Department of Endocrinology and Nutrition, Virgen de la Victoria Hospital (IBIMA), Malaga University, Campus Teatinos S/N 29010, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga-Plataforma BIONAND (IBIMA), Virgen de la Victoria University Hospital, 29010 Málaga, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 29010 Málaga, Spain
| | - Víctor Manuel Navas-López
- Instituto de Investigación Biomédica de Málaga-Plataforma BIONAND (IBIMA), Virgen de la Victoria University Hospital, 29010 Málaga, Spain
- Pediatric Gastroenterology and Nutrition Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Diego Bellido-Guerrero
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Ferrol, La Coruña, Ferrol, Spain
| | - José Manuel García-Almeida
- Department of Endocrinology and Nutrition, Virgen de la Victoria Hospital (IBIMA), Malaga University, Campus Teatinos S/N 29010, Malaga, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 29010 Málaga, Spain
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Baş D, Atahan C, Tezcanli E. An analysis of phase angle and standard phase angle cut-off values and their association with survival in head and neck cancer patients undergoing radiotherapy. Clin Nutr 2023; 42:1445-1453. [PMID: 37451156 DOI: 10.1016/j.clnu.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/18/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE The objective of this study is to identify the cutoff values for phase angle (PA) and standard phase angle (SPA) parameters, as determined by bioelectrical impedance analysis (BIA), for predicting malnutrition and investigating their association with overall survival in head and neck cancer (HNC) patients undergoing radiotherapy. METHODS In this study, nutritional assessment and follow-up of HNC patients undergoing radiotherapy (RT) between November 2017 and September 2022 were assessed. Nutritional assessment, body composition (BC), and PA results obtained from BIA (Tanita MC-980) were retrospectively evaluated. Statistical Package for Social Sciences (SPSS) version 25.0 (IBM Corp., Armonk, NY, USA) was used for statistical analysis. The results were evaluated at a confidence interval of 95% and a significance level of p ≤ 0.05. RESULTS A total of 53 patients, including 37 (70%) men and 16 (30%) women, with a median age of 60 (23-87 years) were included. The median follow-up time was 51 (range 24-59) months. The mean PA of the patients was calculated as 4.99° (±0.92, 95% CI: 4.74-5.25). The PA of patients with malnutrition (4.66° ± 0.87) was lower than that of well-nourished patients (5.71° ± 0.56) (p < 0.001). As a result of the ROC analysis based on this finding, the ideal PA cut-off point for determining the presence of malnutrition was found to be 5.65, with a sensitivity of 85%, specificity of 79%, accuracy of 83%, and a model discrimination power of excellent level (AUC: 85%, p < 0.001). The median overall survival time of the patients was calculated as 51 months (24-59 months). The mortality rate during the follow-up period was 13%, while the 1-, 3-, and 5-year overall survival rates of the patients were 96.1%, 89.3%, and 86.8%, respectively. Patients with SPA values less than -1.65 had a 5-year overall survival rate of 77.4%, while those with SPA values greater than or equal to -1.65 had a 5-year overall survival rate of 100% (p = 0.030) CONCLUSION: Our study recommends using PA and SPA as standard criteria for detecting malnutrition in HNC patients undergoing RT, with cut-off points of 5.65 and -1.65 respectively, to prevent treatment interruptions and improve outcomes. Further research is needed to validate the SPA cut-off value and its relationship with clinical outcomes, as SPA may be a more effective predictor of malnutrition and overall survival than PA alone.
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Affiliation(s)
- Dilşat Baş
- Acıbadem Altunizade Hospital, Department of Nutrition and Dietetics, Istanbul, Turkiye; Istanbul Galata University, Department of Nutrition and Dietetics, School of Health Sciences, Istanbul, Turkiye.
| | - Ceren Atahan
- Acibadem Mehmet Ali Aydınlar University, Medical School, Radiation Oncology Department, Istanbul, Turkiye.
| | - Evrim Tezcanli
- Acibadem Altunizade Hospital, Radiation Oncology Department, Istanbul, Turkiye.
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Gutiérrez-Santamaría B, Martinez Aguirre-Betolaza A, García-Álvarez A, Arietaleanizbeaskoa MS, Mendizabal-Gallastegui N, Grandes G, Coca A, Castañeda-Babarro A. Association between Phase Angle and Subjective Perceptions of Health Variables in Cancer Patients. Healthcare (Basel) 2023; 11:1852. [PMID: 37444686 DOI: 10.3390/healthcare11131852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/20/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
The phase angle, an increasingly studied healthcare tool, was studied to explore its relationship with psychological factors in cancer patients. The aim of this study was to investigate the relationship between the phase angle (PhA), obtained by the bioimpedance analysis of body composition, and psychological factors measured by questionnaire in cancer patients. The study included 311 patients who underwent bioimpedance testing to determine their PhA value; their psychological profiles were assessed using SF-36, FACIT, QLQ-C30, and GHQ-12 questionnaires. Mixed linear regression models were used to analyze the relationship between PhA and the psychological tests. The results showed a statistical correlation between PhA and the GHQ-12, FACIT, and SF-36 questionnaires, with higher PhA values associated with better results on the questionnaires. In the QLQ-C30 questionnaire, a correlation was observed between PhA and the functioning scales (p < 0.001), except for emotional and cognitive functioning (p = 0.148 and p = 0.544, respectively), but not in most of the symptom scales. The PhA is a useful tool for assessing the subjective health perception of cancer patients, especially with regard to psychological factors. While there is a statistically significant correlation, further research is required before confidently applying it in clinical practice. The current predictive value of this predictor for certain psychological aspects is limited, underscoring the need for additional research.
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Affiliation(s)
- Borja Gutiérrez-Santamaría
- Department of Physical Activity and Sport Sciences, Faculty of Education and Sport, University of Deusto, 48007 Bilbo, Bizkaia, Spain
| | - Aitor Martinez Aguirre-Betolaza
- Department of Physical Activity and Sport Sciences, Faculty of Education and Sport, University of Deusto, 48007 Bilbo, Bizkaia, Spain
| | - Arturo García-Álvarez
- Primary Care Research Unit of Bizkaia, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, 48903 Barakaldo, Biscay, Spain
| | - María Soledad Arietaleanizbeaskoa
- Primary Care Research Unit of Bizkaia, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, 48903 Barakaldo, Biscay, Spain
| | - Nere Mendizabal-Gallastegui
- Primary Care Research Unit of Bizkaia, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, 48903 Barakaldo, Biscay, Spain
| | - Gonzalo Grandes
- Primary Care Research Unit of Bizkaia, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, 48903 Barakaldo, Biscay, Spain
| | - Aitor Coca
- Department of Physical Activity and Sports Sciences, Faculty of Health Sciences, Euneiz University, Vitoria-Gasteiz, Alava, La Biosfera Ibilbidea, 6, 01013 Gasteiz, Araba, Spain
| | - Arkaitz Castañeda-Babarro
- Department of Physical Activity and Sport Sciences, Faculty of Education and Sport, University of Deusto, 48007 Bilbo, Bizkaia, Spain
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10
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Cornejo-Pareja I, Vegas-Aguilar IM, Fernández-Jiménez R, García-García C, Bellido-Guerrero D, Tinahones F, García-Almeida JM. Phase angle and COVID-19: A systematic review with meta-analysis. Rev Endocr Metab Disord 2023; 24:525-542. [PMID: 36959397 PMCID: PMC10036242 DOI: 10.1007/s11154-023-09793-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 03/25/2023]
Abstract
Phase angle (PhA) has been identified as a poor prognostic factor in patients with COVID-19. This study aimed to achieve a systematic review, where we discussed the potential role of PhA value as a prognostic marker of adverse clinical outcomes such as mortality and complication in hospitalized with SARS-CoV2 infection and established the strength of recommendations for use. A systematic literature review with meta-analysis was done in the main electronic databases from 2020 to January 2023. The selected articles had to investigate adverse consequences of the COVID-19 population and raw bioimpedance parameters such as PhA and published in peer-reviewed journals. GRADE tools regarded the quality of the methodology. The review protocol was registered in PROSPERO. Only eight studies, 483 studies, were eligible for the analysis. In general, differences in PhA were seen between the comparative study groups. Patients with a low PhA experienced poor outcomes. A low PhA was associated with a significantly increased mortality risk [RR: 2.44; 95% CI (1.20-4.99), p = 0.01; I2 = 79% (p = 0.0008)] and higher complications risk [OR: 3.47, 95% CI (1.16 - 10.37), p = 0.03; I2 = 82% (p = 0.004)] in COVID-19 patients. Our analysis showed four evidence-based recommendations on the prognostic value of PhA with two strong recommendations, one of moderate and another of low-moderate quality, for predicting mortality and complications, respectively. We recommend using PhA as a prognostic marker for mortality and complications in this population. Although the results are promising, future studies must identify the PhA cut-off to guide therapeutic decisions more precisely.Registration code in PROSPERO: CRD42023391044.
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Affiliation(s)
- Isabel Cornejo-Pareja
- Department of Endocrinology and Nutrition, Virgen de la Victoria Hospital, Malaga University, 29010 Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria University Hospital, 29010 Málaga, Spain
- Centro de Investigacion Biomedica en Red de la Fisiopatología de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 29010 Malaga, Spain
- Málaga University, 29010 Málaga, Spain
| | - Isabel M. Vegas-Aguilar
- Department of Endocrinology and Nutrition, Virgen de la Victoria Hospital, Malaga University, 29010 Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria University Hospital, 29010 Málaga, Spain
| | - Rocío Fernández-Jiménez
- Department of Endocrinology and Nutrition, Virgen de la Victoria Hospital, Malaga University, 29010 Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria University Hospital, 29010 Málaga, Spain
| | | | - Diego Bellido-Guerrero
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Ferrol, Ferrol, La Coruña Spain
| | - Francisco Tinahones
- Department of Endocrinology and Nutrition, Virgen de la Victoria Hospital, Malaga University, 29010 Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria University Hospital, 29010 Málaga, Spain
- Centro de Investigacion Biomedica en Red de la Fisiopatología de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 29010 Malaga, Spain
- Málaga University, 29010 Málaga, Spain
| | - Jose Manuel García-Almeida
- Department of Endocrinology and Nutrition, Virgen de la Victoria Hospital, Malaga University, 29010 Malaga, Spain
- Centro de Investigacion Biomedica en Red de la Fisiopatología de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 29010 Malaga, Spain
- Málaga University, 29010 Málaga, Spain
- Department of Endocrinology and Nutrition, Quironsalud Málaga Hospital, 29004 Málaga, Spain
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Association of indirect measurement of cell function by bioimpedance analysis with complications in oncologic hepatic surgery. HPB (Oxford) 2023; 25:283-292. [PMID: 36702662 DOI: 10.1016/j.hpb.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/21/2022] [Accepted: 09/28/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Bioelectric impedance vector analysis (BIVA) is a reliable tool to assess body composition. The aim was to study the association of BIVA-derived phase angle (PA) and standardized PA (SPA) values and the occurrence of surgery-related morbidity. METHODS Patients undergoing hepatectomy for cancer in two Italian centers were prospectively enrolled. BIVA was performed the morning of surgery. Patients were then stratified for the occurrence or not of postoperative morbidity. RESULTS Out of 190 enrolled patients, 76 (40%) experienced postoperative complications. Patients with morbidity had a significant lower PA, SPA, body cell mass, and skeletal muscle mass, and higher extracellular water and fat mass. At the multivariate analysis, presence of cirrhosis (OR 7.145, 95% CI:2.712-18.822, p < 0.001), the Charlson comorbidity index (OR 1.236, 95% CI: 1.009-1.515, p = 0.041), the duration of surgery (OR 1.004, 95% CI:1.001-1.008, p = 0.018), blood loss (OR 1.002. 95% CI: 1.001-1.004, p = 0.004), dehydration (OR 10.182, 95% CI: 1.244-83.314, p = 0.030) and SPA < -1.65 (OR 3.954, 95% CI: 1.699-9.202, p = 0.001) were significantly and independently associated with the risk of complications. CONCLUSION Introducing BIVA before hepatic resections may add valuable and independent information on the risk of morbidity.
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12
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Rectus Femoris Muscle and Phase Angle as Prognostic Factor for 12-Month Mortality in a Longitudinal Cohort of Patients with Cancer (AnyVida Trial). Nutrients 2023; 15:nu15030522. [PMID: 36771229 PMCID: PMC9919732 DOI: 10.3390/nu15030522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Cancer-related malnutrition is still unrecognized and undertreated in clinical practice. The morphofunctional assessment of disease-related malnutrition (DRM) is a new approach that focuses on evaluating changes in body composition and function. The aim of this study is to evaluate the prognostic value of classic and emerging assessment of malnutrition at 12-months survival in cancer patients. METHODS We conducted a prospective study on cancer outpatients. Bioelectrical impedance with phase angle (PhA), nutritional ultrasound by rectus femoris cross-sectional area (RFCSA), hand grip strength, and "Timed Up and Go Test" (TUG) were evaluated as predictors of mortality. RESULTS Fifty-seven patients were included. The non-survivors had lower PhA values than the survivors (4.7° vs. 5.4°; p < 0.001), and we had the same results with RFCSA 2.98 cm2/m2 vs. 4.27 cm2/m2 (p = 0.03). Cut-off points were identified using the ROC (receiver operating characteristic) curves for PhA (≤5.6° cancer patients, ≤5.9° men, ≤5.3° women), RFCSA (≤4.47 cm2/m2 cancer patients, ≤4.47° men, ≤2.73° women) and rectus femoris-Y-axis (RF-Y-axis; ≤1.3 cm cancer patients, ≤1.06 men, ≤1 women). In multivariate logistic regression analysis, we found that high PhA was significantly associated with a lower mortality hazard ratio (HR: 0.42 95% CI: 0.21-0.84, p = 0.014). Likewise, high RFCSA was associated with a decrease in mortality risk in the crude model (HR: 0.61 95% CI: 0.39-0.96, p = 0.031). This trend was also maintained in the adjusted models by the confounding variables. CONCLUSIONS Low PhA and RFCSA values are significant independent predictors of mortality in cancer patients. These cut-off points are clinical data that can be used for nutritional assessment and the prediction of clinical outcomes.
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13
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Gutiérrez-Santamaría B, Martinez Aguirre-Betolaza A, García-Álvarez A, Arietaleanizbeaskoa MS, Mendizabal-Gallastegui N, Grandes G, Castañeda-Babarro A, Coca A. Association between PhA and Physical Performance Variables in Cancer Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1145. [PMID: 36673900 PMCID: PMC9859119 DOI: 10.3390/ijerph20021145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/31/2022] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
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.
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Affiliation(s)
- Borja Gutiérrez-Santamaría
- Department of Physical Activity and Sport Sciences, Faculty of Education and Sport, University of Deusto, 48007 Bilbao, Biscay, Spain
| | - Aitor Martinez Aguirre-Betolaza
- Department of Physical Activity and Sport Sciences, Faculty of Education and Sport, University of Deusto, 48007 Bilbao, Biscay, Spain
| | - Arturo García-Álvarez
- Primary Care Research Unit of Bizkaia, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, 48903 Barakaldo, Biscay, Spain
| | - Maria Soledad Arietaleanizbeaskoa
- Primary Care Research Unit of Bizkaia, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, 48903 Barakaldo, Biscay, Spain
| | - Nere Mendizabal-Gallastegui
- Primary Care Research Unit of Bizkaia, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, 48903 Barakaldo, Biscay, Spain
| | - Gonzalo Grandes
- Primary Care Research Unit of Bizkaia, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, 48903 Barakaldo, Biscay, Spain
| | - Arkaitz Castañeda-Babarro
- Department of Physical Activity and Sport Sciences, Faculty of Education and Sport, University of Deusto, 48007 Bilbao, Biscay, Spain
| | - Aitor Coca
- Department of Physical Activity and Sports Sciences, Faculty of Health Sciences, Euneiz University, 01013 Vitoria-Gasteiz, Araba, Spain
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14
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Jiang N, Zhang J, Cheng S, Liang B. The Role of Standardized Phase Angle in the Assessment of Nutritional Status and Clinical Outcomes in Cancer Patients: A Systematic Review of the Literature. Nutrients 2022; 15:nu15010050. [PMID: 36615707 PMCID: PMC9824322 DOI: 10.3390/nu15010050] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/10/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Compared with the phase angle (PA), the predictive ability of the standardized phase angle (SPA) in assessing nutritional status and clinical outcomes in cancer patients remains uncertain. This review aimed to assess (1) the relationship between SPA and nutritional status and clinical outcomes (including complications and survival) in cancer patients; (2) the predictive ability of SPA alone and in comparison with the predictive ability of PA; and (3) the cut-off value of SPA in cancer patients. Studies that addressed the relationship of SPA use to nutritional status, complications, and survival in cancer patients were searched and identified from six electronic databases (PubMed, Medline, CINAHL, Embase, Web of Science, and the Cochrane Library). The included studies were considered to meet the following criteria: English studies with original data that reflected the effects of SPA on nutritional status and clinical outcomes (including complications and survival) and reported a cut-off value of SPA in cancer patients aged ≥18. Thirteen studies that included a total of 2787 participants were evaluated. Five studies assessed the relationship between SPA and nutritional status, and four of them reported a positive relationship between SPA and nutritional status in cancer patients, even considering SPA as a predictor. Twelve studies assessed the relationship between SPA and clinical outcomes in cancer patients. Two-thirds of the studies that evaluated complications reported the predictive ability of SPA; 30% of survival studies reported a positive relationship, 40% reported SPA as a predictor, and 30% reported no relationship. The standard cut-off value for SPA has not yet been determined. Data from the selected studies suggest that SPA might be a predictor of nutritional status. Further studies are needed to determine the value of SPA in predicting nutritional status and clinical outcomes in cancer patients.
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Affiliation(s)
| | | | | | - Bing Liang
- Correspondence: ; Tel.: +86-138-4311-4648
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15
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Lima J, Eckert I, Gonzalez MC, Silva FM. Prognostic value of phase angle and bioelectrical impedance vector in critically ill patients: A systematic review and meta-analysis of observational studies. Clin Nutr 2022; 41:2801-2816. [PMID: 36395589 DOI: 10.1016/j.clnu.2022.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/21/2022] [Accepted: 10/14/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND AIMS Assessment of the raw parameters derived from bioelectrical impedance analysis (BIA) has gained emphasis in critically ill patients. The phase angle (PhA) reflects the integrity of the cell membrane, and bioelectrical impedance vector analysis (BIVA) is indicative of patients' hydration status. The aim of this study was to investigate whether these parameters are associated with clinical outcomes in the intensive care unit (ICU) setting. METHODS We conducted a systematic review with meta-analysis. We searched PubMed, Embase, Scopus and Web of Science for all published observational studies without language restrictions up to April 2022. Two reviewers independently performed study selection and data extraction. We judged the risk of bias by the Newcastle-Ottawa Scale and the certainty of evidence by the GRADE approach. Mortality was the primary outcome. Secondary outcomes included ICU length of stay, hospital length of stay, duration of mechanical ventilation, nutritional risk, and malnutrition. A meta-analysis with a random-effect model was performed to combine data on R version 3.6.2. RESULTS Twenty-seven studies were included in the systematic review (4872 participants). Pooled analysis revealed that patients with low PhA had a higher risk of death (14 studies; RR = 1.82, 95% CI 1.46 to 2.26; I2 = 42%) and spent more days in ICU (6 studies; MD = 1.79, 95% CI 0.33 to 3.24, I2 = 69%) in comparison to patients with normal PhA. The pooled analysis also showed higher PhA values in survivors compared to non-survivor patients (12 studies; MD = 0.75°, 95% CI 0.60° to 0.91°, I2 = 31%). Overhydration defined by BIVA was not a predictor of mortality (4 studies; RR = 1.01, 95% CI 0.70 to 1.46; I2 = 0%). More than 40% of primary studies were classified with a high risk of bias, and the quality of evidence ranged from low to very low. CONCLUSIONS This meta-analysis revealed, with limited evidence, that low PhA was associated with higher mortality and ICU length of stay, while overhydration identified by BIVA was not a predictor of death in critically ill patients.
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Affiliation(s)
- Júlia Lima
- Master Student at Nutrition Science Graduate Program Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Maria Cristina Gonzalez
- Professor at Graduate Program in Health and Behavior, Catholic University of Pelotas, Rio Grande do Sul, Brazil
| | - Flávia Moraes Silva
- Professor at Nutrition Department and Nutrition Science Graduate Program of Federal University of Health Science of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
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Cornejo-Pareja I, Vegas-Aguilar IM, García-Almeida JM, Bellido-Guerrero D, Talluri A, Lukaski H, Tinahones FJ. Phase angle and standardized phase angle from bioelectrical impedance measurements as a prognostic factor for mortality at 90 days in patients with COVID-19: A longitudinal cohort study. Clin Nutr 2022; 41:3106-3114. [PMID: 33642143 PMCID: PMC7886631 DOI: 10.1016/j.clnu.2021.02.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/24/2021] [Accepted: 02/06/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS Severe acute COVID-19 has taken on pandemic proportions with growing interest in identification of prognostic factors for mortality. Standardized bioelectrical impedance (BI) phase angle (SPhA), which is PhA adjusted by age and sex, has been related to mortality in patients with several diseases but never investigated in COVID-19. Inflammation, a consequence of COVID-19 infection, affects fluid status (hydration) and can be identified with PhA. The aim of this study was to determine the predictive role of PhA on 90 days survival of adults with COVID-19. METHODS We studied 127 consecutive patients diagnosed with COVID-19. BI measurements determined with a 50 kHz phase-sensitive BI device, body composition parameters and laboratory markers were evaluated as predictors of mortality. RESULTS Non-surviving COVID-19 patients had significantly lower PhA and SPhA values (p < 0.001) and increased hydration (p < 0.001) compared to surviving patients. Patients in the lowest SPhA quartile had increased (p < 0.001) mortality and hospital stay, hyperhydration (p < 0.001), increased inflammation biomarkers [CRP (p < 0.001)], decreased nutritional parameters: body mass cell index [BCMI (p < 0.001) albumin (p < 0.001)], and reduced other biomarkers [D-dimer (p = 0.002)]. Multivariate analysis (Cox regression) revealed that PhA and hydration status, adjusted for age, sex, BMI, diabetes, hypertension, dyslipidaemia or heart disease, were associated (p < 0.001) with increased mortality. The hazard ratio was 2.48 (95% CI, 1.60-3.84, p < 0.001) for PhA and 1.12 (95% CI, 1.04-1.20, p = 0.003) for hydration percentage. PhA <3.95° was the cut-off for predicting mortality in acute COVID-19 with 93.8% sensitivity and 66.7% specificity. PhA offers greater sensitivity as a predictive prognostic test at admission, compared to the established analytical parameters of poor prognosis (CRP, lymphocytes, prealbumin). CONCLUSIONS Low PhA (<3.95°), independent of age, sex, BMI, and comorbidities, is a significant predictor of mortality risk in COVID-19. These findings suggest that the evaluation of body composition with single-frequency phase-sensitive BI measurements should be included in the routine clinical assessment of COVID-19 patients at hospital admission to identify patients at increased mortality risk.
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Affiliation(s)
- Isabel Cornejo-Pareja
- Department of Endocrinology and Nutrition, Virgen de la Victoria Hospital (IBIMA), Malaga University, Malaga, Spain,Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Málaga, Spain,Corresponding author. Virgen de la Victoria Hospital, Campus de Teatinos S/N, 29010, Málaga, Spain
| | - Isabel M. Vegas-Aguilar
- Department of Endocrinology and Nutrition, Virgen de la Victoria Hospital (IBIMA), Malaga University, Malaga, Spain,Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Málaga, Spain
| | - Jose Manuel García-Almeida
- Department of Endocrinology and Nutrition, Virgen de la Victoria Hospital (IBIMA), Malaga University, Malaga, Spain,Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Málaga, Spain,Corresponding author. Virgen de la Victoria Hospital, Campus de Teatinos S/N, 29010, Málaga, Spain
| | - Diego Bellido-Guerrero
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Ferrol, Ferrol, La Coruña, Spain
| | - Antonio Talluri
- Antonio Talluri BME, Fatbyte, Inc., 50012 Bagno a Ripoli, Florence, Italy
| | - Henry Lukaski
- Department of Kinesiology and Public Health Education, University of North Dakota, Grand Forks, ND 58202-7166, USA
| | - Francisco J. Tinahones
- Department of Endocrinology and Nutrition, Virgen de la Victoria Hospital (IBIMA), Malaga University, Malaga, Spain,Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Málaga, Spain
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Więch P, Wołoszyn F, Trojnar P, Skórka M, Bazaliński D. Does Body Position Influence Bioelectrical Impedance? An Observational Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9908. [PMID: 36011541 PMCID: PMC9408608 DOI: 10.3390/ijerph19169908] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
As the availability of various bioelectric impedance analysis (BIA) tools is increasing, the patient's position during the test may be of significant importance for the comparability of the results. An observational pilot study was undertaken between March and May 2021 at the Center for Innovative Research in Medical and Natural Sciences at the University of Rzeszow, Rzeszów, Poland. All participants (n = 49: M: 21.05 y ± 1.12 vs. F: 21.34 y ± 2.06) were subjected to measurements of selected nutritional status indicators and body components in three positions: lying, sitting and standing. The body composition indicators were obtained using a bioelectrical impedance device, AKERN BIA 101 Anniversary Sport Edition Analyzer (Akern SRL, Pontassieve, Florence, Italy). The results were analyzed using dedicated software (BodygramPlus 1.2.2.12 from AKERN 2016, Florence, Italy). Our observations indicate that there is a significant difference between lying and standing as well as sitting and standing with respect to anthropometric and nutritional indicators (resistance, reactance, phase angle, standardized phase angle, body cell mass index and fat-free mass index) and body composition components, with particular reference to intracellular and extracellular water. The described differences are significant for both sexes. This study showed that this significantly influenced the scores of components directly related to resistance, reactance and hydrated cell mass, while not affecting the percentages or absolute values of fat and fat-free mass.
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Affiliation(s)
- Paweł Więch
- Department of Nursing and Public Health, Institute of Health Sciences, College of Medical Sciences, University of Rzeszow, 35-959 Rzeszow, Poland
- Department of Nursing, Institute of Social Sciences and Health Protection, East European State Higher School in Przemysl, 37-700 Przemysl, Poland
| | - Filip Wołoszyn
- Department of Human Physiology, Institute of Medical Sciences, College of Medical Sciences, University of Rzeszow, 35-959 Rzeszow, Poland
| | - Patrycja Trojnar
- Medical College, University of Information Technology and Management, 35-225 Rzeszow, Poland
| | - Mateusz Skórka
- Orthopedics Department, St. Hedvig Clinical Provincial Hospital, 35-301 Rzeszow, Poland
| | - Dariusz Bazaliński
- Department of Nursing and Public Health, Institute of Health Sciences, College of Medical Sciences, University of Rzeszow, 35-959 Rzeszow, Poland
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Fernández-Medina B, Vegas-Aguilar I, García-Almeida JM, Sevilla-García I, Hernández-García C, Tinahones-Madueño FJ. Morfo-functional nutritional status in patients with gastroenteropancreatic neuroendocrine tumors (GEPNET). ENDOCRINOL DIAB NUTR 2022; 69:466-475. [PMID: 35989228 DOI: 10.1016/j.endien.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/18/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Patients with gastroenteropancreatic neuroendocrine tumors (GEPNET) can suffer from malnutrition. This is the first descriptive study of morfo-functional evaluation in GEPNET. OBJETIVES To describe a morfo-functional evaluation, and to compare with reference population available, and to correlate different nutritional parameters. Moreover, to compare nutritional evaluation in our study with another same location non-neuroendocrine tumors. MATERIALS AND METHODS A retrospective observational study, 50 patients with GEPNET, medium age 61 years. It was collected clinico-pathological characteristics and nutritional status was assessed by anthropometric, laboratory test, bioelectrical impedance analysis, phase angle, hand grip strength, and rectus femoris ultrasound for the assessment of muscle mass. We used SPSS statistics to describe and to analyze correlations of different variables. RESULTS Most frequent location of tumor was pancreas and small bowel, tumor grade 1 and advance stage. In morfo-functional evaluation highlighted: a low fat mass percentage (23,5 vs 34,4%), low muscle mass percentage (36,5 vs 41,2%) and low body mass cell percentage (40,4 vs 48,8%) compared with reference population available by sex and age. Standarized phase angle by sex and age result as positive (+0,851). There was no difference in hand grip strength compared with reference population. After a review of differents studies available, phase angle and hand grip strength of non neuroendocrine tumors in same location, could suggest a minor affection of nutritional state in our GEPNET sample. A positive correlation was observed between non classic methods of nutritional evaluation such as bioelectrical impedance analysis, hand grip strength and rectus femoris ultrasound. CONCLUSION Patients with gastroenteropancreatic neuroendocrine tumors (GEPNET) show a moderate affection of nutritional status in comparison to general population. Morphofunctional assessment provide us a precise knowledge about nutritional status.
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Affiliation(s)
- Beatriz Fernández-Medina
- Unidad de Gestión Clínica Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, Málaga, Spain.
| | - Isabel Vegas-Aguilar
- Unidad de Gestión Clínica Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - José Manuel García-Almeida
- Unidad de Gestión Clínica Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Isabel Sevilla-García
- Unidad de Gestión Clínica Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Carmen Hernández-García
- Unidad de Gestión Clínica Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, Málaga, Spain
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Fernández-Medina B, Vegas-Aguilar I, García-Almeida JM, Sevilla-García I, Hernández-García C, Tinahones-Madueño FJ. Valoración morfofuncional de la desnutrición en pacientes con tumores neuroendocrinos gastroenteropancreáticos (TNEGEP). ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2021.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Sat-Muñoz D, Martínez-Herrera BE, González-Rodríguez JA, Gutiérrez-Rodríguez LX, Trujillo-Hernández B, Quiroga-Morales LA, Alcaráz-Wong AA, Dávalos-Cobián C, Solórzano-Meléndez A, Flores-Carlos JD, Rubio-Jurado B, Salazar-Páramo M, Carrillo-Nuñez GG, Gómez-Sánchez E, Nava-Zavala AH, Balderas-Peña LMA. Phase Angle, a Cornerstone of Outcome in Head and Neck Cancer. Nutrients 2022; 14:nu14153030. [PMID: 35893884 PMCID: PMC9330539 DOI: 10.3390/nu14153030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/17/2022] [Accepted: 07/21/2022] [Indexed: 01/27/2023] Open
Abstract
In patients with head and neck cancer, malnutrition is common. Most cases are treated by chemo-radiotherapy and surgery, with adverse effects on the aerodigestive area. Clinical and biochemical characteristics, health-related quality of life, survival, and risk of death were studied. The selected subjects were divided into normal- and low-phase-angle (PA) groups and followed up for at least two years. Mean ages were 67.2 and 59.3 years for low and normal PA, respectively. Patients with PA < 4.42° had significant differences in age, anthropometric and biochemical indicators of malnutrition, and inflammatory status compared to patients with PA > 4.42°. Statistical differences were found in the functional and symptom scales, with lower functional scores and higher symptom scores in patients with low PA. Median survival was 19.8 months for those with PA < 4.42° versus 34.4 months for those with PA > 4.42° (p < 0.001).The relative risk of death was related to low PA (2.6; p < 0.001). The percentage of living patients (41.7%) is almost the same as the percentage of deceased subjects (43.1%; p = 0.002), with high death rates in patients with PA < 4.42°. Phase angle was the most crucial predictor of survival and a risk factor for death in the studied cases.
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Affiliation(s)
- Daniel Sat-Muñoz
- Departamento de Morfología, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara (UdG), 950 Sierra Mojada, Puerta 7, Edificio C, 1er Nivel, Guadalajara 44340, Jalisco, Mexico
- Cuerpo Académico UDG CA-874 “Ciencias Morfológicas en el Diagnóstico y Tratamiento de la Enfermedad”, 950 Sierra Mojada, Puerta 7, Edificio C, 1er Nivel, Guadalajara 44340, Jalisco, Mexico;
- Departamento Clínico de Oncología Quirúrgica, División de Oncología Hematología, Unidad Médica de Alta Especialidad (UMAE), Hospital de Especialidades (HE), Centro Médico Nacional de Occidente (CMNO), Instituto Mexicano del Seguro Social (IMSS), 1000 Belisario Domínguez, Guadalajara 44340, Jalisco, Mexico
- Comité de Cabeza y Cuello, UMAE, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, 1000 Belisario Domínguez, Guadalajara 44340, Jalisco, Mexico; (A.-A.A.-W.); (A.S.-M.)
- Correspondence: (D.S.-M.); (L.-M.-A.B.-P.); Tel.: +52-33-1349-6920 (D.S.-M.); +52-33-3115-7678 (L.M.-A.B.-P.)
| | - Brenda-Eugenia Martínez-Herrera
- Hospital General de Zona (HGZ), #02 c/MF “Dr. Francisco Padrón Puyou”, Órgano de Operación Administrativa Desconcentrada San Luis Potosi, IMSS, San Luis Potosi 78250, San Luis Potosi, Mexico;
- Unidad de Investigación Biomédica 02, UMAE Hospital de Especialidades (HE), Centro Médico Nacional de Occidente (CMNO), Instituto Mexicano del Seguro Social (IMSS), 1000 Belisario Domínguez, Guadalajara 44340, Jalisco, Mexico; (J.-A.G.-R.); (L.-X.G.-R.); (L.-A.Q.-M.); (A.-H.N.-Z.)
- Doctorado en Ciencias Médicas, Facultad de Medicina, Universidad de Colima, Colima 28040, Colima, Mexico;
| | - Javier-Andrés González-Rodríguez
- Unidad de Investigación Biomédica 02, UMAE Hospital de Especialidades (HE), Centro Médico Nacional de Occidente (CMNO), Instituto Mexicano del Seguro Social (IMSS), 1000 Belisario Domínguez, Guadalajara 44340, Jalisco, Mexico; (J.-A.G.-R.); (L.-X.G.-R.); (L.-A.Q.-M.); (A.-H.N.-Z.)
- Carrera de Médico Cirujano y Partero, Coordinación de Servicio Social, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara (UdG), Guadalajara 44340, Jalisco, Mexico
| | - Leonardo-Xicotencatl Gutiérrez-Rodríguez
- Unidad de Investigación Biomédica 02, UMAE Hospital de Especialidades (HE), Centro Médico Nacional de Occidente (CMNO), Instituto Mexicano del Seguro Social (IMSS), 1000 Belisario Domínguez, Guadalajara 44340, Jalisco, Mexico; (J.-A.G.-R.); (L.-X.G.-R.); (L.-A.Q.-M.); (A.-H.N.-Z.)
- Carrera de Médico Cirujano y Partero, Coordinación de Servicio Social, Centro Universitario del Sur, Universidad de Guadalajara (UdG), Ciudad Guzmán 49000, Jalisco, Mexico
- Comisión Interinstitucional de Formación de Recursos Humanos en Salud, Programa Nacional de Servicio Social en Investigación 2021, Demarcación Territorial Miguel Hidalgo 11410, Ciudad de México, Mexico Programa de Doctorado en Investigaciȯn Clínica, Coordinación de Posgrado, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara (UdG), Guadalajara 44340, Jalisco, Mexico
| | | | - Luis-Aarón Quiroga-Morales
- Unidad de Investigación Biomédica 02, UMAE Hospital de Especialidades (HE), Centro Médico Nacional de Occidente (CMNO), Instituto Mexicano del Seguro Social (IMSS), 1000 Belisario Domínguez, Guadalajara 44340, Jalisco, Mexico; (J.-A.G.-R.); (L.-X.G.-R.); (L.-A.Q.-M.); (A.-H.N.-Z.)
- Unidad Académica de Ciencias de la Salud, Consultor Nutricional en la Clínica de Rehabilitación y Alto Rendimiento ESPORTIVA, Universidad Autónoma de Guadalajara, Zapopan 45129, Jalisco, Mexico
| | - Aldo-Antonio Alcaráz-Wong
- Comité de Cabeza y Cuello, UMAE, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, 1000 Belisario Domínguez, Guadalajara 44340, Jalisco, Mexico; (A.-A.A.-W.); (A.S.-M.)
- Departamento Clínico de Anatomía Patológica, División de Diagnóstico, UMAE, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, 1000 Belisario Domínguez, Guadalajara 44340, Jalisco, Mexico
| | - Carlos Dávalos-Cobián
- Departamento Clínico de Gastroenterología, Servicio de Endoscopía, División de Medicina, UMAE, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, 1000 Belisario Domínguez, Guadalajara 44340, Jalisco, Mexico;
| | - Alejandro Solórzano-Meléndez
- Comité de Cabeza y Cuello, UMAE, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, 1000 Belisario Domínguez, Guadalajara 44340, Jalisco, Mexico; (A.-A.A.-W.); (A.S.-M.)
- Departamento Clínico de Oncología Radioterapia, Servicio Nacional de Radioneurocirugía, División de Oncología Hematología, UMAE, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, 1000 Belisario Domínguez, Guadalajara 44340, Jalisco, Mexico
| | - Juan-Daniel Flores-Carlos
- Departamento Clínico de Cirugía General, Servicio de Soporte Nutricio, División de Cirugía, UMAE, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, 1000 Belisario Domínguez, Guadalajara 44340, Jalisco, Mexico;
| | - Benjamín Rubio-Jurado
- Departamento Clínico de Hematología, División de Oncología Hematología, UMAE, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, 1000 Belisario Domínguez, Guadalajara 44340, Jalisco, Mexico;
| | - Mario Salazar-Páramo
- Academia de Inmunología, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara (UdG), 950 Sierra Mojada, Gate 7, Building O, 1st Level, Guadalajara 44340, Jalisco, Mexico;
| | - Gabriela-Guadalupe Carrillo-Nuñez
- Departamento de Microbiología y Patología, Cuerpo Académico CAC 365 Educación y Salud, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara (UdG), 950 Sierra Mojada, Gate 7, Building O, 1st Level, Guadalajara 44340, Jalisco, Mexico;
| | - Eduardo Gómez-Sánchez
- Cuerpo Académico UDG CA-874 “Ciencias Morfológicas en el Diagnóstico y Tratamiento de la Enfermedad”, 950 Sierra Mojada, Puerta 7, Edificio C, 1er Nivel, Guadalajara 44340, Jalisco, Mexico;
- División de Disciplinas Clínicas, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara (UdG), 950 Sierra Mojada, Edificio N, Puerta 1, Planta Baja, Guadalajara 44340, Jalisco, Mexico
| | - Arnulfo-Hernán Nava-Zavala
- Unidad de Investigación Biomédica 02, UMAE Hospital de Especialidades (HE), Centro Médico Nacional de Occidente (CMNO), Instituto Mexicano del Seguro Social (IMSS), 1000 Belisario Domínguez, Guadalajara 44340, Jalisco, Mexico; (J.-A.G.-R.); (L.-X.G.-R.); (L.-A.Q.-M.); (A.-H.N.-Z.)
- Unidad de Investigación Social Epidemiológica y en Servicios de Salud, Órgano de Operación Administrativa Desconcentrada, Guadalajara 44340, Jalisco, Mexico
- Programa Internacional Facultad de Medicina, Universidad Autónoma de Guadalajara, Av. Patria 1201, Lomas del Valle, Zapopan 45129, Jalisco, Mexico
- Servicio de Inmunología y Reumatología, División de Medicina Interna, Hospital General de Occidente, Secretaria de Salud Jalisco, Av. Zoquipan 1050, Zapopan 45170, Jalisco, Mexico
| | - Luz-Ma-Adriana Balderas-Peña
- Departamento de Morfología, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara (UdG), 950 Sierra Mojada, Puerta 7, Edificio C, 1er Nivel, Guadalajara 44340, Jalisco, Mexico
- Cuerpo Académico UDG CA-874 “Ciencias Morfológicas en el Diagnóstico y Tratamiento de la Enfermedad”, 950 Sierra Mojada, Puerta 7, Edificio C, 1er Nivel, Guadalajara 44340, Jalisco, Mexico;
- Unidad de Investigación Biomédica 02, UMAE Hospital de Especialidades (HE), Centro Médico Nacional de Occidente (CMNO), Instituto Mexicano del Seguro Social (IMSS), 1000 Belisario Domínguez, Guadalajara 44340, Jalisco, Mexico; (J.-A.G.-R.); (L.-X.G.-R.); (L.-A.Q.-M.); (A.-H.N.-Z.)
- Correspondence: (D.S.-M.); (L.-M.-A.B.-P.); Tel.: +52-33-1349-6920 (D.S.-M.); +52-33-3115-7678 (L.M.-A.B.-P.)
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Medeiros VGD, Pajecki D, Dias MCG, Dantas ACB, Cleva RD, Santo MA. FOOD TOLERANCE AND NUTRITIONAL RISK AFTER SLEEVE GASTRECTOMY AND ROUX-EN-Y GASTRIC BYPASS IN ELDERLY PATIENTS WITH SEVERE OBESITY: A PROSPECTIVE, RANDOMIZED CONTROLLED TRIAL. ARQUIVOS DE GASTROENTEROLOGIA 2022; 59:370-374. [PMID: 36102434 DOI: 10.1590/s0004-2803.202203000-67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Bariatric surgery is still controversial in elderly patients with severe obesity. Most publications focus on safety and early clinical outcomes. Food tolerance and nutritional postoperative risk is unknown for this population. METHODS Thirty-six elderly patients with severe obesity were recruited for an open-label randomized trial from September 2017 to May 2019 comparing laparoscopic sleeve gastrectomy (LSG) to Roux-en-Y Gastric Bypass (LRYGB). Food tolerance was accessed by Quality of Alimentation (QoA) questionnaire and data on weight loss, body composition, and nutritional risk were collected between 6 and 24 months after surgery. RESULTS Comparing LSG to LRYGB patients, the latter had higher total weight loss (22% vs 31%, P=0.01) and excess weight loss (53% vs 68%, P=0.01). Food tolerance to eight food groups was similar between groups (14 vs 15 points, P=0.270), as Suter score (23 vs 25, P=0.238). Daily protein intake was below recommendation in both groups (40 vs 51 g/d, P=0.105). Nutritional risk, evaluated through Standardized Phase Angle (-1.48 vs -1.99, P=0.027), was worse for LRYGB group. CONCLUSION Food tolerance and adequacy of food consumption were similar in both groups. LRYGB patients had higher nutritional risk.
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Affiliation(s)
- Veronica Garcia de Medeiros
- Divisão de Nutrição e Dietética, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Denis Pajecki
- Unidade de Cirurgia Bariátrica e Metabólica, Disciplina de Cirurgia do Aparelho Digestivo e Coloproctologia, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Maria Carolina Gonçalves Dias
- Divisão de Nutrição e Dietética, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Anna Carolina Batista Dantas
- Unidade de Cirurgia Bariátrica e Metabólica, Disciplina de Cirurgia do Aparelho Digestivo e Coloproctologia, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Roberto de Cleva
- Unidade de Cirurgia Bariátrica e Metabólica, Disciplina de Cirurgia do Aparelho Digestivo e Coloproctologia, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Marco Aurelio Santo
- Unidade de Cirurgia Bariátrica e Metabólica, Disciplina de Cirurgia do Aparelho Digestivo e Coloproctologia, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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22
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Yamanaka A, Yasui-Yamada S, Furumoto T, Kubo M, Hayashi H, Kitao M, Wada K, Ohmae N, Kamimura S, Shimada A, Sato N, Katoh S, Takeda N, Hamada Y. Association of phase angle with muscle function and prognosis in patients with head and neck cancer undergoing chemoradiotherapy. Nutrition 2022; 103-104:111798. [DOI: 10.1016/j.nut.2022.111798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/27/2022] [Accepted: 07/09/2022] [Indexed: 11/27/2022]
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23
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Queiroz SA, Gonzalez MC, da Silva AMB, Costa JKDA, de Oliveira CDR, de Sousa IM, Fayh APT. Is the standardized phase angle a predictor of short and long-term adverse cardiovascular events in acute myocardial infarction patients? A cohort study. Nutrition 2022; 103-104:111774. [DOI: 10.1016/j.nut.2022.111774] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 05/27/2022] [Accepted: 06/06/2022] [Indexed: 11/25/2022]
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24
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Correlation between phase angle and muscle mass, muscle function, and health perception in community-dwelling older women. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-022-00956-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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25
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Fernández-Jiménez R, Dalla-Rovere L, García-Olivares M, Abuín-Fernández J, Sánchez-Torralvo FJ, Doulatram-Gamgaram VK, Hernández-Sanchez AM, García-Almeida JM. Phase Angle and Handgrip Strength as a Predictor of Disease-Related Malnutrition in Admitted Patients: 12-Month Mortality. Nutrients 2022; 14:1851. [PMID: 35565818 PMCID: PMC9105999 DOI: 10.3390/nu14091851] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/17/2022] [Accepted: 04/26/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Phase Angle (PhA) value measured by bioelectrical impedance analysis (BIA) could be considered a good marker of the patient’s cell mass and cellular damage. Various studies have shown that the value of PhA is associated with an increased nutritional risk in several pathologies. However, not many studies have focused on the use of PhA as a screening tool in admitted patients. The aim of this study is to evaluate the prognostic value of PhA to determine disease-related malnutrition (DRM) and the risk that this entails for mortality and length of stay (LOS). Methods: 570 patients admitted to the hospital for different causes were included in this retrospective observational study. Patients’ nutritional risk was assessed by screening tests such as the Malnutrition Universal Screening tool (MUST) and Subjective Global Assessment (SGA), in addition to non-invasive functional techniques, such as BIA and handgrip strength (HGS), 24−48 h after admission. After performing an SGA as the gold standard to assess malnutrition, PhA and SPhA values were used to determine DRM. Furthermore, both samples: malnutrition status (MS) and non-malnutrition status (NMS) were compared, with SphA-Malnutrition corresponding to a diagnosis of malnutrition. Statistical analysis of the sample was conducted with JAMOVI version 2.2.2. Results: Patients with MS had lower PhA and SPhA than patients with NMS (p < 0.001). The ROC curve analysis (AUC = 0.81) showed a cut-off point for MS for PhA = 5.4° (sensitivity 77.51% and specificity 74.07%) and AUC = 0.776 with a cut-off point for SPhA = −0.3 (sensitivity 81.74% and specificity 63.53%). Handgrip strength (HGS) was also observed to be a good predictor in hospitalized patients. Carrying out a comparative analysis between MS and NMS, length of stay (LOS) was 9.0 days in MS vs. 5.0 days in NMS patients (OR 1.07 (1.04−1.09, p < 0.001)). A low SPhA-malnutrition value (SPhA < −0.3) was significantly associated with a higher mortality hazards ratio (HR 7.87, 95% CI 2.56−24.24, p < 0.001). Conclusion: PhA, SPhA and HGS are shown to be good prognostic markers of DRM, LOS and mortality and could therefore be useful screening tools to complement the nutritional assessment of admitted patients.
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Affiliation(s)
- Rocío Fernández-Jiménez
- Departmento de Endocrinologia y Nutrición, Quironsalud Málaga Hospital Av. Imperio Argentina, 29004 Málaga, Spain; (L.D.-R.); (M.G.-O.); (J.A.-F.); (J.M.G.-A.)
- Unidad de Gestion Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria de Málaga, 29010 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain; (F.J.S.-T.); (V.K.D.-G.)
| | - Lara Dalla-Rovere
- Departmento de Endocrinologia y Nutrición, Quironsalud Málaga Hospital Av. Imperio Argentina, 29004 Málaga, Spain; (L.D.-R.); (M.G.-O.); (J.A.-F.); (J.M.G.-A.)
| | - María García-Olivares
- Departmento de Endocrinologia y Nutrición, Quironsalud Málaga Hospital Av. Imperio Argentina, 29004 Málaga, Spain; (L.D.-R.); (M.G.-O.); (J.A.-F.); (J.M.G.-A.)
- Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain; (F.J.S.-T.); (V.K.D.-G.)
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
| | - José Abuín-Fernández
- Departmento de Endocrinologia y Nutrición, Quironsalud Málaga Hospital Av. Imperio Argentina, 29004 Málaga, Spain; (L.D.-R.); (M.G.-O.); (J.A.-F.); (J.M.G.-A.)
| | - Francisco José Sánchez-Torralvo
- Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain; (F.J.S.-T.); (V.K.D.-G.)
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
- Departamento de Medicina y Dermatología, Facultad de Medicina, University of Malaga, 29010 Málaga, Spain
| | - Viyey Kishore Doulatram-Gamgaram
- Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain; (F.J.S.-T.); (V.K.D.-G.)
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
- Departamento de Medicina y Dermatología, Facultad de Medicina, University of Malaga, 29010 Málaga, Spain
| | | | - José Manuel García-Almeida
- Departmento de Endocrinologia y Nutrición, Quironsalud Málaga Hospital Av. Imperio Argentina, 29004 Málaga, Spain; (L.D.-R.); (M.G.-O.); (J.A.-F.); (J.M.G.-A.)
- Unidad de Gestion Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria de Málaga, 29010 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain; (F.J.S.-T.); (V.K.D.-G.)
- Departamento de Medicina y Dermatología, Facultad de Medicina, University of Malaga, 29010 Málaga, Spain
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Morlino D, Cioffi I, Marra M, Di Vincenzo O, Scalfi L, Pasanisi F. Bioelectrical Phase Angle in Patients with Breast Cancer: A Systematic Review. Cancers (Basel) 2022; 14:cancers14082002. [PMID: 35454908 PMCID: PMC9025027 DOI: 10.3390/cancers14082002] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
- Delia Morlino
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Pansini 5, 80131 Naples, Italy; (D.M.); (M.M.); (F.P.)
| | - Iolanda Cioffi
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Pansini 5, 80131 Naples, Italy; (D.M.); (M.M.); (F.P.)
- Correspondence: ; Tel.: +39-0817462333
| | - Maurizio Marra
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Pansini 5, 80131 Naples, Italy; (D.M.); (M.M.); (F.P.)
| | - Olivia Di Vincenzo
- Department of Public Health, Federico II University Hospital, Pansini 5, 80131 Naples, Italy; (O.D.V.); (L.S.)
| | - Luca Scalfi
- Department of Public Health, Federico II University Hospital, Pansini 5, 80131 Naples, Italy; (O.D.V.); (L.S.)
| | - Fabrizio Pasanisi
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Pansini 5, 80131 Naples, Italy; (D.M.); (M.M.); (F.P.)
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Muscular Ultrasonography in Morphofunctional Assessment of Patients with Oncological Pathology at Risk of Malnutrition. Nutrients 2022; 14:nu14081573. [PMID: 35458134 PMCID: PMC9025957 DOI: 10.3390/nu14081573] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Muscular ultrasonography is a technique that allows assessing the amount and quality of muscle in a specific body region. The aim of the study was to compare the value of muscle ultrasonography in diagnosis of malnutrition with techniques such as anthropometry, handgrip strength and impedanciometry in patients with oncological pathology. Methods: Cross-sectional study in 43 patients with oncological pathology and high nutritional risk. Classical anthropometry (body mass index (BMI), arm circumference (AC), calf circumference (CC) and estimated appendicular muscle mass index (ASMI)) was performed. Body composition was measured with impedanciometry (BIA), phase angle (PA) and fat-free mass index (FFMI) and muscle ultrasonography of quadriceps rectus femoris (muscle area (MARA) and circumference (MCR) in section transverse). Malnutrition was diagnosed using the GLIM criteria and sarcopenia was assessed using EWGSOP2 criteria. Results: The mean age was 68.26 years (±11.88 years). In total, 23/20 of the patients were men/women. The BMI was 23.51 (4.75) kg/m2. The ASMI was 6.40 (1.86) kg/m2. The MARA was 3.31 cm2 in ultrasonography. In impedanciometry, phase angle was 4.91 (0.75)°; the FFMI was 17.01 kg/m2 (±2.65 kg/m2). A positive correlation was observed between the MARA with anthropometric measurements (AC: r = 0.39, p = 0.009; CC: r = 0.44, p < 0.01; ASMI: r = 0.47, p < 0.001); and with BIA (FFMI: r = 0.48, p < 0.01 and PA: r = 0.45, p < 0.001). Differences were observed when comparing the MARA based on the diagnosis of sarcopenia (Sarcopenia: 2.47 cm2 (±0.54 cm2); no sarcopenia: 3.65 cm2 (±1.34 cm2); p = 0.02). Conclusions: Muscle ultrasonography correlates with body composition measurement techniques such as BIA and anthropometry in patients with cancer.
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A Prospective Observational Pilot Study of Young Women Undergoing Initial Breast Cancer Treatment and Their Biopsychosocial Profile. REHABILITATION ONCOLOGY 2022. [DOI: 10.1097/01.reo.0000000000000298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Morphofunctional and Molecular Assessment of Nutritional Status in Head and Neck Cancer Patients Undergoing Systemic Treatment: Role of Inflammasome in Clinical Nutrition. Cancers (Basel) 2022; 14:cancers14030494. [PMID: 35158762 PMCID: PMC8833422 DOI: 10.3390/cancers14030494] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Malnutrition in patients with head and neck cancer is associated with worse clinical evolution and prognosis. Accurate nutritional assessments allow for early-identification of patients at risk of malnutrition. We aimed to perform a novel morphofunctional nutritional evaluation, including molecular analysis in patients with head and neck cancer who are undergoing systemic treatment. A morphofunctional nutritional assessment includes bioimpedance, anthropometric, ultrasound and biochemical measurements. We observed that malnutrition induces a profound alteration in the gene-expression pattern of inflammasome-machinery components, which are related with clinical nutritional parameters. This molecular analysis should be further studied as potential targets for nutrition-focused treatment strategies in cancer patients. Abstract Malnutrition in patients with head and neck cancer is frequent, multifactorial and widely associated with clinical evolution and prognosis. Accurate nutritional assessments allow for early identification of patients at risk of malnutrition in order to start nutritional support and prevent sarcopenia. We aimed to perform a novel morphofunctional nutritional evaluation and explore changes in inflammasome-machinery components in 45 patients with head and neck cancer who are undergoing systemic treatment. To this aim, an epidemiological/clinical/anthropometric/biochemical evaluation was performed. Serum RCP, IL6 and molecular expression of inflammasome-components and inflammatory-associated factors (NOD-like-receptors, inflammasome-activation-components, cytokines and inflammation/apoptosis-related components, cell-cycle and DNA-damage regulators) were evaluated in peripheral-blood mononuclear-cells (PBMCs). Clinical-molecular correlations/associations were analyzed. Coherent and complementary information was obtained in the morphofunctional nutritional assessment of the patients when bioimpedance, anthropometric and ultrasound data were analyzed. These factors were also correlated with different biochemical and molecular parameters, revealing the complementary aspect of the whole evaluation. Serum reactive C protein (RCP) and IL6 were the most reliable parameters for determining patients with decreased standardized phase angle, which is associated with increased mortality in patients with solid malignancies. Several inflammasome-components were dysregulated in patients with malnutrition, decreased phase angle and dependency grade or increased circulating inflammation markers. A molecular fingerprint based on gene-expression of certain inflammasome factors (p27/CCL2/ASC) in PBMCs accurately differentiated patients with and without malnutrition. In conclusion, malnutrition induces a profound alteration in the gene-expression pattern of inflammasome-machinery components in PBMCs. A comprehensive nutritional assessment including novel morphofunctional techniques and molecular markers allows a broad characterization of the nutritional status in cancer patients. Profile of certain inflammasome-components should be further studied as potential targets for nutrition-focused treatment strategies in cancer patients.
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MURGOCI N. The importance of body composition assessment in the rehabilitation process. BALNEO AND PRM RESEARCH JOURNAL 2021. [DOI: 10.12680/balneo.2021.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction. This personal study provides several aspects of the importance of body composition assessment in rehabilitation process in order to manage fat mass (FM), fat-free mas imbalances (FFM), pre-sarcopenia status, sarcopenia and risks association and to improve global functionality. Health outcomes and risk estimations regarding fat mass and skeletal muscle mass (SMM) plays a major role and should be integrated into the rehabilitation process routine in order to avoid functional impairment and physical disability by applying specific kinetic programs. Material and method. A number of 14 subjects classified as outpatients who have received physical therapy at home- kinesiotherapy for post-fracture / dislocation status of the lower limbs in accordance with the medical recommendations and legislation in force. At the end of the rehabilitation phase, the body composition was measured using bio impedance in order to adjust the next step of the active rehabilitation. The measurements were obtained with a completely bioelectrical impedance analyzer (BIA). Single frequency BIA (SF-BIA) was used. For each subject major body compartments determined as FFM (including bone mineral tissue, total body water-TBW and visceral protein), SMM and FM were measured as a tissue-system by means of linear empirical equations stored in the system memory together with personal physical data. IBM SPSS software version 25 was used for statistical analysis. Results and discussions. Four age groups determined as follows: 21.43% for 18-39 years, 50-69 years, >70 years each and 35.71% for 40-49 years, based on the rate of muscle loss, because its integrity is essential for rehabilitation program. From the 14 subjects there are 57.14 % men and 42.86% women, from urban environment 78.57% and rural 21.43%. Mean Age is 48.79 years ± 18.792 Std. Deviation. Fat mass from BIA recorded 21.43% cases low and normal each, and high/very high 57.14% of total cases. Consequently, of BMI (body mass index) association, 57.14% are at normal weight, 35.71% overweight and with obesity and 7.14% underweight. One Sample Chi-Square test applied to BMI Type Associate with FM reveals the statistical significance, < .05(.014). Fat-free mass index (FFMI), fat mass index (FMI), skeletal mass index (SMI) were computed by adjusted with height square. FMI somatotype components results are 64.3% adipose cases, 21.4% intermediate and 14.3% lean. One Sample Chi-Square test applied to FMI Types reveals the statistical significance < .05(.046). Regression equation of standard BMI and FMI with scatter plots for 77.8% of cases was computed in the present study. FFMI somatotype components recorded 57.1% intermediate cases, 21.4% slender and solid each. Regression equation of standard BMI and FFMI with scatter plots for 57.4% of cases was computed. Three patients exceeded 15 seconds at the chair stand test so probable sarcopenia was identified. From BIA were extracted the value for the skeletal mass and SMI was calculated by height adjusted: 13 (92.86%) cases have normal values and one (7.14%) case have optimal value. Regression equation of standard BMI and SMI with scatter plots for 66.4% of cases was computed. Pearson correlation (CI =99%) denotes strong statistical relationship between BMI and FMI (r=0.882), FFMI (r=0.815), Age (r=0.659), Water (r=-0.693). FMI also correlates strongly with Age (r= 0.707), Water (r=-0.925) and Proteins values (r=-0.819). FFMI also correlates strongly with SMI (r=0.984). Water correlates with Protein (r=0.848, CI = 99%). Beta regression analysis strongly correlates SMI prediction with FFMI (ß=0.731), Water (ß=0.138) and Protein (ß=-0.370) for p<0.05. Anova significance of .000 (CI=99%) with applicability of 99.8% of the cases (R2 =0.998) proved that constant predictors: Water (%), FFMI, Proteins (%), FMI, BMI interact to influence SMM variability. 64.25% of subjects recorded an insufficient water level and 71.43% of subjects recorded an insufficient proteins level. Body composition evaluation should be integrated into routine clinical practice for the initial assessment and sequential follow-up and the strongest point of BIA is the possibility to replace invasive laboratory analysis with a quick, noninvasive test that can be carried out in a medical office. Body composition evaluation should be performed at the different stages of the disease, during the course of treatments and the rehabilitation phase. Conclusions. For each patient specific kinetic program will be developed. FMI increase (64.3% adipose cases) denotes the risk of metabolic syndrome and insulin resistance. Consequently, resistive and concentric exercises will be applied. For FFMI loss (57.1% intermediate cases, 21.4% slender) and SMI increasing (92.86% cases have normal values but not optimal ones, 21.43% pre-sarcopenia detected by positive chair test) resistance, eccentric/concentric exercises should be applied. All kinetic programs will be preceded by warm-up and followed by stretching taking into account cardiac reserve for each patient. Maximal/sub-maximal force exercises will be used age-related. Additional water (64.25% of subjects recorded an insufficient water level) and proteins levels (71.43% of subjects recorded an insufficient proteins level) must be balanced by nutritional support in accordance with rehabilitation consult and current physician approval in the interdisciplinary team. BIA may be an important supporting tool for health professionals in order to customize the rehabilitation programs for each patient.
Keywords: body composition, rehabilitation, bioelectrical impedance, fat-free mass index, fat mass index, skeletal muscle index,
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Affiliation(s)
- Nicolae MURGOCI
- “Dunărea de Jos” University, Faculty of Physical Education and Sports, Galați, Romania
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Fernandes SA, Rossoni C, Koch VW, Imbrizi M, Evangelista-Poderoso R, Pinto LP, Magro DO. Phase angle through electrical bioimpedance as a predictor of cellularity in inflammatory bowel disease. Artif Intell Gastroenterol 2021; 2:111-123. [DOI: 10.35712/aig.v2.i4.111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/19/2021] [Accepted: 07/26/2021] [Indexed: 02/06/2023] Open
Abstract
It is estimated in Western industrialized countries that inflammatory bowel disease (IBD) has a prevalence of 1 for every 200 inhabitants. In the past, the fat mass disproportionate increase in relation to the fat-free mass was considered uncommon in patients with IBD, due to the observation of the disease being more common with weight loss and malnutrition. However, more in-depth investigations demonstrate that the fat/lean mass disproportion stands out both in prevalence in patients with new diagnoses of ulcerative colitis or Crohn's disease as well as a factor of poor prognosis to the natural evolution of the disease or to the therapeutic response. Another important aspect associated with obesity in IBD is the increased risk of drug clearance [including anti-tumor necrosis factor (TNF) and anti-integrin agents], resulting in short half-life and low trough drug concentrations, since the levels of TNF secreted by adipocytes sequester anti-TNF agents, which could result in suboptimal response to biologics. In view of these characteristic aspects of the inflammatory process of IBD, the identification of cellular functioning is necessary, which can be associated with the staging of the underlying disease, biochemical parameters, and body composition, helping as an indicator for a more accurate clinical and nutritional conduct.
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Affiliation(s)
- Sabrina A Fernandes
- Postgraduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
| | - Carina Rossoni
- Institute of Environmental Health (ISAMB), Faculty of Medicine, University of Lisbon, Lisbon 1649-028, Portugal
| | - Vivian W Koch
- Gastroenterology Department, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020-090, Brazil
- Gastroenterology Department, Grupo Hospitalar Conceição, Porto Alegre 91350-250, Brazil
| | - Marcello Imbrizi
- Coloproctology Department, State University of Campinas (UNICAMP-SP), São Paulo 13056-405, Brazil
| | | | - Letícia Pereira Pinto
- Postgraduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
| | - Daniéla Oliveira Magro
- Department of Surgery, State University of Campinas (UNICAMP-SP) and Faculty of Medical Sciences (FCM), São Paulo 13056-405, Brazil
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Osuna-Padilla IA, Rodríguez-Moguel NC, Rodríguez-Llamazares S, Aguilar-Vargas A, Casas-Aparicio GA, Ríos-Ayala MA, Hernández-Cardenas CM. Low phase angle is associated with 60-day mortality in critically ill patients with COVID-19. JPEN J Parenter Enteral Nutr 2021; 46:828-835. [PMID: 34291834 PMCID: PMC8420520 DOI: 10.1002/jpen.2236] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Malnutrition status, body composition indicators, and bioelectrical impedance analysis (BIA) parameters have been associated with increased risk of death in several pathologies. The aim of this study was to describe the associations between phase angle (PhA) indicators obtained by BIA with length of hospital stay, days on mechanical ventilation, and 60‐day mortality in critically ill patients infected with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Methods This is a prospective cohort of mechanically ventilated patients with coronavirus disease 2019 (COVID‐19). We assessed nutrition risk and body composition with BIA within 48 h from intensive care unit admission. Logistic and linear regression models were used to analyze the association between variables and clinical outcomes. Survival analysis by PhA value was performed using Kaplan‐Meier curves. Results Sixty‐seven patients were included. PhA (odds ratio [OR], 0.36; P = .002), standardized PhA (SPA) (OR, 0.45; P = .001), and extracellular water/total body water ratio (OR, 3.25; P = .002) were significant predictors of 60‐day mortality. PhA <3.85° in females and <5.25° in males showed good and fair discrimination, respectively, for mortality prediction. Using cutoff values, low PhA was associated with a significantly increased risk of 60‐day mortality (hazard ratio, 3.08; 95% CI, 1.12–8.41; P = .02). No association was detected for SPA. Conclusion Low PhA values could be a predictor of 60‐day mortality in critically ill patients with COVID‐19. This biological marker could be incorporated as part of nutrition and mortality risk assessment in this population.
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Affiliation(s)
- Iván Armando Osuna-Padilla
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.,Departamento de Áreas Críticas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Nadia Carolina Rodríguez-Moguel
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Sebastián Rodríguez-Llamazares
- Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Adriana Aguilar-Vargas
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Gustavo Alejandro Casas-Aparicio
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Martin Armando Ríos-Ayala
- Departamento de Áreas Críticas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
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Nutritional status and body composition assessment in patients with a new diagnosis of advanced solid tumour: Exploratory comparison of computed tomography and bioelectrical impedance analysis. Clin Nutr 2021; 40:1268-1273. [DOI: 10.1016/j.clnu.2020.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 05/20/2020] [Accepted: 08/08/2020] [Indexed: 01/01/2023]
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Roccamatisi L, Gianotti L, Paiella S, Casciani F, De Pastena M, Caccialanza R, Bassi C, Sandini M. Preoperative standardized phase angle at bioimpedance vector analysis predicts the outbreak of antimicrobial-resistant infections after major abdominal oncologic surgery: A prospective trial. Nutrition 2021; 86:111184. [PMID: 33676330 DOI: 10.1016/j.nut.2021.111184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/30/2020] [Accepted: 01/21/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Infectious morbidity is the most common and costly among all surgery-related complications, and infections by multidrug-resistant microorganisms (MDR) are associated with poor outcomes. Derangements of body composition is a recognized risk factor for infections. The aim of this study was to investigate the potential association between specific traits of body composition and the risk of having MDR-related infections. METHODS This was a prospective study with patients scheduled for major abdominal surgery for gastrointestinal cancer. Bioimpedance vector analysis (BIVA), a reliable tool for body composition assessment, was performed the day before the operation. Postoperative complications were collected focusing on resistance patterns and site of infection. Patterns of resistance were compared with BIVA parameters. RESULTS Data from 182 patients suffering from pancreatic (n = 76, 41.7%), rectal (n = 38, 20.9%), gastric (n = 31, 17%), or hepatic (n = 37, 20.3%) malignancy were collected. Overall complications occurred in 108 patients (59%), and in 45 patients (28%) bacterial infections were proven at culture. Of these, 15 (8%) were multidrug-sensitive (MDS), 38 MDR, and 2 extended drug-resistant (XDR) infections. The standardized phase angle measured (SPA) at BIVA was significantly lower in the MDR/XDR infections (-0.02 ± 1.20) than for no infection/MDS (0.56 ± 1.53; P = 0.029). A multivariate analysis showed that SPA was the only independent variable for MDR/XDR infections with an odds ratio of 3.057 (95% confidence interval, 1.354-6903; P = 0.007). The predictive ability of SPA revealed an area under the receiver operating characteristic curve of 0.662, with an optimal threshold of -0.3. CONCLUSIONS In surgical cancer patients, preoperative value of SPA lower than -0.3 is associated with the outbreak of MDR bacterial infections.
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Affiliation(s)
- Linda Roccamatisi
- School of Medicine and Surgery, University of Milano-Bicocca and Department of Surgery, San Gerardo Hospital, Monza, Italy Monza, Italy
| | - Luca Gianotti
- School of Medicine and Surgery, University of Milano-Bicocca and Department of Surgery, San Gerardo Hospital, Monza, Italy Monza, Italy.
| | - Salvatore Paiella
- Unit of General and Pancreatic Surgery, The Pancreas Institute, Policlinico GB Rossi, University of Verona Hospital Trust, Verona, Italy
| | - Fabio Casciani
- Unit of General and Pancreatic Surgery, The Pancreas Institute, Policlinico GB Rossi, University of Verona Hospital Trust, Verona, Italy
| | - Matteo De Pastena
- Unit of General and Pancreatic Surgery, The Pancreas Institute, Policlinico GB Rossi, University of Verona Hospital Trust, Verona, Italy
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Claudio Bassi
- Unit of General and Pancreatic Surgery, The Pancreas Institute, Policlinico GB Rossi, University of Verona Hospital Trust, Verona, Italy
| | - Marta Sandini
- School of Medicine and Surgery, University of Milano-Bicocca and Department of Surgery, San Gerardo Hospital, Monza, Italy Monza, Italy; Department of General Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
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Crowell LL, Yakisich JS, Aufderheide B, Adams TNG. Electrical Impedance Spectroscopy for Monitoring Chemoresistance of Cancer Cells. MICROMACHINES 2020; 11:E832. [PMID: 32878225 PMCID: PMC7570252 DOI: 10.3390/mi11090832] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/28/2020] [Accepted: 08/29/2020] [Indexed: 12/14/2022]
Abstract
Electrical impedance spectroscopy (EIS) is an electrokinetic method that allows for the characterization of intrinsic dielectric properties of cells. EIS has emerged in the last decade as a promising method for the characterization of cancerous cells, providing information on inductance, capacitance, and impedance of cells. The individual cell behavior can be quantified using its characteristic phase angle, amplitude, and frequency measurements obtained by fitting the input frequency-dependent cellular response to a resistor-capacitor circuit model. These electrical properties will provide important information about unique biomarkers related to the behavior of these cancerous cells, especially monitoring their chemoresistivity and sensitivity to chemotherapeutics. There are currently few methods to assess drug resistant cancer cells, and therefore it is difficult to identify and eliminate drug-resistant cancer cells found in static and metastatic tumors. Establishing techniques for the real-time monitoring of changes in cancer cell phenotypes is, therefore, important for understanding cancer cell dynamics and their plastic properties. EIS can be used to monitor these changes. In this review, we will cover the theory behind EIS, other impedance techniques, and how EIS can be used to monitor cell behavior and phenotype changes within cancerous cells.
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Affiliation(s)
- Lexi L. Crowell
- Department of Chemical and Biomolecular Engineering, University of California-Irvine, Irvine, CA 92697, USA;
- Sue & Bill Gross Stem Cell Research Center, University of California Irvine, Irvine, CA 92697, USA
| | - Juan S. Yakisich
- Department of Pharmaceutical Sciences, Hampton University, Hampton, VA 23668, USA;
| | - Brian Aufderheide
- Department of Chemical Engineering, Hampton University, Hampton, VA 23668, USA;
| | - Tayloria N. G. Adams
- Department of Chemical and Biomolecular Engineering, University of California-Irvine, Irvine, CA 92697, USA;
- Sue & Bill Gross Stem Cell Research Center, University of California Irvine, Irvine, CA 92697, USA
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Choi HN, Kim KA, Kim YS, Yim JE. Independent Association of Phase Angle with Fasting Blood Glucose and Hemoglobin A1c in Korean Type 2 Diabetes Patients. Clin Nutr Res 2020; 9:205-212. [PMID: 32789150 PMCID: PMC7402973 DOI: 10.7762/cnr.2020.9.3.205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 12/28/2022] Open
Abstract
The relationship between phase angle (PhA) of bioelectrical impedance analysis (BIA) and glycemic parameters in diabetes mellitus (DM) patients has not been well studied. To evaluate the prognostic value of the PhA from BIA as a glycemic marker, we investigated the relationship of PhA with various variables such as age, body mass index (BMI), and glycemic parameters in Korean patients with type 2 DM (T2DM). We evaluated the anthropometric data, body composition, glycemic parameters, and PhA of 321 T2DM patients aged 30–83 years. The patients were classified by sex into men (n = 133) and women (n = 188). General linear models identified the independent effects of PhA after covarying for age, sex and BMI. The PhA, body cell mass (BCM), extracellular mass (ECM), lean body mass, intracellular water (ICW), extracellular water (ECW), total body water (TBW), fasting blood glucose, and hemoglobin A1c (HbA1c) of T2DM Korean patients were significantly higher in men than in women. However, fat mass, ECM/BCM, ECW/ICW, ECW/TBW, and serum insulin were significantly higher in women than in men. Statistically significant independent associations were observed between PhA and age, BCM, ECM, ECM/BCM, ICW, ECW, ECW/ICW, and ECW/TBW for both sexes. There was no significant association between PhA and BMI the patients. Glycemic parameters, such as HbA1c and fasting blood glucose were independently associated with PhA. These results suggest that PhA could be an indicator for assessing ability to control fasting blood glucose in T2DM patients in Korea.
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Affiliation(s)
- Ha-Neul Choi
- Department of Food and Nutrition, Changwon National University, Changwon 51140, Korea
| | - Kyung-Ah Kim
- Department of Food and Nutrition, Chungnam National University, Daejeon 34134, Korea
| | - Young-Seol Kim
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul 02447, Korea
| | - Jung-Eun Yim
- Department of Food and Nutrition, Changwon National University, Changwon 51140, Korea
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Hirose S, Nakajima T, Nozawa N, Katayanagi S, Ishizaka H, Mizushima Y, Matsumoto K, Nishikawa K, Toyama Y, Takahashi R, Arakawa T, Yasuda T, Haruyama A, Yazawa H, Yamaguchi S, Toyoda S, Shibasaki I, Mizushima T, Fukuda H, Inoue T. Phase Angle as an Indicator of Sarcopenia, Malnutrition, and Cachexia in Inpatients with Cardiovascular Diseases. J Clin Med 2020; 9:jcm9082554. [PMID: 32781732 PMCID: PMC7463846 DOI: 10.3390/jcm9082554] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/25/2020] [Accepted: 08/04/2020] [Indexed: 12/13/2022] Open
Abstract
Malnutrition is associated with sarcopenia, cachexia, and prognosis. We investigated the usefulness of phase angle (PhA) as a marker of sarcopenia, cachexia, and malnutrition in 412 hospitalized patients with cardiovascular disease. We analyzed body composition with bioelectrical impedance analysis, and nutritional status such as controlling nutritional status (CONUT) score. Both skeletal muscle mass index (SMI) and PhA correlated with age, grip strength and knee extension strength (p < 0.0001) in both sexes. The SMI value correlated with CONUT score, Hb, and Alb in males. Phase angle also correlated with CONUT score, Hb, and Alb in males, and more strongly associated with these nutritional aspects. In females, PhA was correlated with Hb and Alb (p < 0.001). In both sexes, sarcopenia incidence was 31.6% and 32.4%; PhA cut-off in patients with sarcopenia was 4.55° and 4.25°; and cachexia incidence was 11.5% and 14.1%, respectively. The PhA cut-off in males with cachexia was 4.15°. Multivariate regression analysis showed that grip strength and brain natriuretic peptide (BNP) were independent determinants of SMI, whereas grip strength, BNP, and Hb were independent determinants of PhA. Thus, PhA appears to be a useful marker for sarcopenia, malnutrition, and cachexia in hospitalized patients with cardiovascular disease.
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Affiliation(s)
- Suguru Hirose
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (S.H.); (A.H.); (H.Y.); (S.Y.); (S.T.); (T.I.)
| | - Toshiaki Nakajima
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (S.H.); (A.H.); (H.Y.); (S.Y.); (S.T.); (T.I.)
- Correspondence:
| | - Naohiro Nozawa
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.N.); (S.K.); (H.I.); (Y.M.); (K.M.); (K.N.); (Y.T.); (R.T.); (T.A.); (T.M.)
| | - Satoshi Katayanagi
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.N.); (S.K.); (H.I.); (Y.M.); (K.M.); (K.N.); (Y.T.); (R.T.); (T.A.); (T.M.)
| | - Hayato Ishizaka
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.N.); (S.K.); (H.I.); (Y.M.); (K.M.); (K.N.); (Y.T.); (R.T.); (T.A.); (T.M.)
| | - Yuta Mizushima
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.N.); (S.K.); (H.I.); (Y.M.); (K.M.); (K.N.); (Y.T.); (R.T.); (T.A.); (T.M.)
| | - Kazuhisa Matsumoto
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.N.); (S.K.); (H.I.); (Y.M.); (K.M.); (K.N.); (Y.T.); (R.T.); (T.A.); (T.M.)
| | - Kaori Nishikawa
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.N.); (S.K.); (H.I.); (Y.M.); (K.M.); (K.N.); (Y.T.); (R.T.); (T.A.); (T.M.)
| | - Yohei Toyama
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.N.); (S.K.); (H.I.); (Y.M.); (K.M.); (K.N.); (Y.T.); (R.T.); (T.A.); (T.M.)
| | - Reiko Takahashi
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.N.); (S.K.); (H.I.); (Y.M.); (K.M.); (K.N.); (Y.T.); (R.T.); (T.A.); (T.M.)
| | - Tomoe Arakawa
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.N.); (S.K.); (H.I.); (Y.M.); (K.M.); (K.N.); (Y.T.); (R.T.); (T.A.); (T.M.)
| | - Tomohiro Yasuda
- School of Nursing, Seirei Christopher University, Hamamatsu, Shizuoka 433-8558, Japan;
| | - Akiko Haruyama
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (S.H.); (A.H.); (H.Y.); (S.Y.); (S.T.); (T.I.)
| | - Hiroko Yazawa
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (S.H.); (A.H.); (H.Y.); (S.Y.); (S.T.); (T.I.)
| | - Suomi Yamaguchi
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (S.H.); (A.H.); (H.Y.); (S.Y.); (S.T.); (T.I.)
| | - Shigeru Toyoda
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (S.H.); (A.H.); (H.Y.); (S.Y.); (S.T.); (T.I.)
| | - Ikuko Shibasaki
- Department of Cardiovascular Surgery, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (I.S.); (H.F.)
| | - Takashi Mizushima
- Department of Rehabilitation, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293, Japan; (N.N.); (S.K.); (H.I.); (Y.M.); (K.M.); (K.N.); (Y.T.); (R.T.); (T.A.); (T.M.)
| | - Hirotsugu Fukuda
- Department of Cardiovascular Surgery, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (I.S.); (H.F.)
| | - Teruo Inoue
- Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan; (S.H.); (A.H.); (H.Y.); (S.Y.); (S.T.); (T.I.)
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de Oliveira JM, Bernardes PS, Serpa GHC, Siqueira GDDJ, Noll M, Venâncio PEM, Soares V. BIOELECTRICAL VECTOR ANALYSIS IN OBESE ADOLESCENTS. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2020; 38:e2019017. [PMID: 32667470 PMCID: PMC7357597 DOI: 10.1590/1984-0462/2020/38/2019017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/23/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the hydration of obese and non-obese adolescents by vectorial bioimpedance analysis, in addition to verifying the associations between obesity and bioelectrical impedance vectorial analysis (BIVA) parameters. METHODS A cross-sectional study with adolescents between 14 and 18 years old (n=489, 300 boys and 189 girls). Electric bioimpedance (BIA; Quantum_II, RJL system, Rome, Italy) provided resistance and reactance parameters to calculate phase angle (PA), fat-free mass (FFM) and body fat (%BF). The confidence ellipses were compared, and the construction of the tolerance ellipses allowed individual and qualitative evaluation of the vectors and classification in dehydrated, normohydrated and hyperhydrated. RESULTS 78 obese and 411 eutrophic adolescents participated. Resistance (p<0.001) and reactance (p<0.001) and their normalization by stature (p<0.001) were reduced in the obese, whereas the PA was higher (p=0.003). %BF was 11.3% higher in obese adolescents. The main vector of the obese, both male (D=1.38; p<0.001) and female (D=1.49; p<0.001), indicated greater hydration. The ellipse of tolerance of the total sample showed that 25 (32.1%) were hyperhydrated and 02 (2.6%) vectors positioned in the sense of dehydration. A total of 17 (53.2%) girls and 16 (34.8%) boys were hyperhydrated. Logistic regression showed an inverse relation of BMI with resistance (p<0.001), reactance (p<0.001) and both normalized by stature. Adolescents with increased PA (p<0.001) were twice as likely to present obesity. CONCLUSIONS Obese adolescents were hyperhydrated and there was an inverse relationship of BMI with resistance and direct with PA.
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Maia FDCP, Silva TA, Generoso SDV, Correia MITD. Malnutrition is associated with poor health-related quality of life in surgical patients with gastrointestinal cancer. Nutrition 2020; 75-76:110769. [DOI: 10.1016/j.nut.2020.110769] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/12/2020] [Accepted: 01/14/2020] [Indexed: 02/06/2023]
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Yasui-Yamada S, Oiwa Y, Saito Y, Aotani N, Matsubara A, Matsuura S, Tanimura M, Tani-Suzuki Y, Kashihara H, Nishi M, Shimada M, Hamada Y. Impact of phase angle on postoperative prognosis in patients with gastrointestinal and hepatobiliary-pancreatic cancer. Nutrition 2020; 79-80:110891. [PMID: 32731162 DOI: 10.1016/j.nut.2020.110891] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/13/2020] [Accepted: 05/27/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Phase angle (PhA), by bioelectrical impedance analysis, has been used in patients with several diseases; however, its prognostic value in patients with gastrointestinal (GI) and hepatobiliary-pancreatic (HBP) cancer is unclear. The aim of the present study was to investigate the effects of PhA on postoperative short- outcomes and long-term survival in these patients. METHODS This retrospective study reviewed data from 501 patients with GI and HBP cancers who underwent first resection surgery. The data were divided into the following groups according to the preoperative PhA quartile values by sex: high-PhA group with the highest quartile (Q4), normal-PhA group with middle quartiles (Q3 and Q2), and low-PhA group with the lowest quartile (Q1). Preoperative nutritional statuses, postoperative short-term outcomes during hospitalization, and 5-y survival between three groups were compared. Cox proportional hazard models were used to evaluate the prognostic effect of PhA. RESULTS PhA positively correlated with body weight, skeletal muscle mass, and handgrip strength, and negatively correlated with age and levels of C-reactive protein. The low-PhA group showed a higher prevalence of malnutrition (48%) than normal-PhA (25%), and high-PhA groups (9%; P < 0.001). The incidence of postoperative severe complications was 10% for all patients (14% in low-PhA, 12% in normal-PhA, and 4% in high-PhA; P = 0.018). The incidence of prolonged stays in a postoperative high-care or intensive care unit was 8% in all patients (16% in low-PhA, 8% in normal-PhA, and 2% in high-PhA; P < 0.001). The 5-y survival rate was 74% in all patients (68% in low-PhA, 74% in normal-PhA, and 79% in high-PhA; P < 0.001). The multivariate analysis demonstrated that a low-PhA group was an independent risk factor for mortality (hazard ratio, 1.99; 95% confidence interval, 1.05-3.90; P = 0.034). CONCLUSION PhA is a useful short-term and long-term postoperative prognostic marker for patients with GI and HBP cancers.
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Affiliation(s)
- Sonoko Yasui-Yamada
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan; Department of Nutrition, Tokushima University Hospital, Japan.
| | - Yu Oiwa
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan
| | - Yu Saito
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan; Department of Digestive Surgery and Transplantation, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan
| | - Nozomi Aotani
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan
| | - Atsumi Matsubara
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan
| | - Sayaka Matsuura
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan
| | - Mayu Tanimura
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan
| | - Yoshiko Tani-Suzuki
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan; Department of Nutrition, Tokushima University Hospital, Japan
| | - Hideya Kashihara
- Department of Nutrition, Tokushima University Hospital, Japan; Department of Digestive Surgery and Transplantation, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan
| | - Masaaki Nishi
- Department of Digestive Surgery and Transplantation, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan
| | - Mitsuo Shimada
- Department of Digestive Surgery and Transplantation, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan
| | - Yasuhiro Hamada
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan; Department of Nutrition, Tokushima University Hospital, Japan
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Langer RD, de Fatima Guimarães R, Gonçalves EM, Guerra-Junior G, de Moraes AM. Phase Angle is Determined by Body Composition and Cardiorespiratory
Fitness in Adolescents. Int J Sports Med 2020; 41:610-615. [DOI: 10.1055/a-1152-4865] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
AbstractThe phase angle is used to evaluate nutritional status and is an indicator of
cellular health. Cardiorespiratory fitness and body composition are strong
indicators of health during adolescence. We aimed to evaluate if body
composition and cardiorespiratory fitness have an association with phase angle
among adolescents. 203 girls and 220 boys (12.8±1.3 years) were
evaluated. Peak height velocity, percentage fat mass, fat-free mass,
cardiorespiratory fitness, and phase angle measurements were collected. Linear
regression adjusted by peak height velocity was used to verify if predictor
variables were associated with phase angle among adolescents. Phase angle showed
correlation with fat-free mass (girls: r=0.42 and boys: r=0.37);
with percent fat mass (girls: r=0.23); and with cardiorespiratory
fitness (boys: r=0.19). Linear regression showed that percentage fat
mass (in girls) and cardiorespiratory fitness (in boys) had an effect of 11 and
17% in phase angle, respectively, while fat-free mass had an effect of
22 and 26% in phase angle for girls and boys, respectively. Changes in
phase angle seem to be more associated with the percentage fat mass in girls,
cardiorespiratory fitness in boys, and fat-free mass in both when controlled by
peak height velocity.
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Affiliation(s)
- Raquel David Langer
- Faculty of Medical Sciences, Growth and Development Laboratory
– Center for Investigation in Pediatrics (CIPED), State University of
Campinas, Campinas, Brazil
| | | | - Ezequiel Moreira Gonçalves
- Faculty of Medical Sciences, Growth and Development Laboratory
– Center for Investigation in Pediatrics (CIPED), State University of
Campinas, Campinas, Brazil
| | - Gil Guerra-Junior
- Faculty of Medical Sciences, Growth and Development Laboratory
– Center for Investigation in Pediatrics (CIPED), State University of
Campinas, Campinas, Brazil
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Can Bioelectrical Impedance Analysis and BMI be a Prognostic Tool in Head and Neck Cancer Patients? A Review of the Evidence. Cancers (Basel) 2020; 12:cancers12030557. [PMID: 32121058 PMCID: PMC7139769 DOI: 10.3390/cancers12030557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/23/2020] [Accepted: 02/25/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Malnutrition can significantly affect disease progression and patient survival. The efficiency of weight loss and bioimpedance analysis (BIA)-derived measures in the evaluation of malnutrition, and disease progression and prognosis in patients with head and neck cancer (HNC) are an important area of research. Method: The PubMed database was thoroughly searched, using relative keywords in order to identify clinical trials that investigated the role of BIA-derived measures and weight loss on the disease progression and prognosis of patients with HNC. Twenty-seven studies met the criteria. More specifically, six studies examined the prognostic role of the tissue electrical properties in HNC patients; five examined the role of the tissue electrical properties on identifying malnutrition; four studies looked at the changes in the tissue electrical properties of HNC patients; and 12 examined the prognostic role of weight loss on survival and/or treatment outcomes. Results: Several studies have investigated the role of nutritional status tools on prognosis in HNC patients. Current studies investigating the potential of BIA-derived raw data have shown that phase angle (PA) and capacitance of the cell membrane may be considered prognostic factors of survival. Weight loss may be a prognostic factor for treatment toxicity and survival, despite some conflicting evidence. Conclusions: Further studies are recommended to clarify the role of BIA-derived measures on patients’ nutritional status and the impact of PA on clinical outcomes as well as the prognostic role of weight loss.
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Yates SJ, Lyerly S, Manuel M, Tooze JA, Klepin HD, Powell BL, Dralle S, Uprety A, Pardee TS. The prognostic value of standardized phase angle in adults with acute leukemia: A prospective study. Cancer Med 2020; 9:2403-2413. [PMID: 32049445 PMCID: PMC7131844 DOI: 10.1002/cam4.2835] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/16/2019] [Accepted: 12/27/2019] [Indexed: 12/13/2022] Open
Abstract
Standardized phase angle (SPhA) is a tool used to estimate body composition and cell membrane integrity. Standardized phase angle has been shown to predict survival in solid malignancies and hematopoietic stem cell transplant patients. We investigated the predictive value of SPhA on 60-day mortality, overall survival (OS), and length of hospital stay (LHS) for adults with acute myelogenous and lymphoblastic leukemia (AML and ALL). Consecutive patients ≥18 years with newly diagnosed acute leukemia receiving intensive chemotherapy were enrolled. Phase angle measurements were taken on day 1 of therapy for all patients and on the day of nadir marrow for AML patients. Measurements were standardized by BMI, gender, and age to calculate the SPhA. The difference between SPhA at nadir bone marrow compared to day 1 of induction was used to calculate change in SPhA. A cutoff of 25th percentile was used to dichotomize baseline SPhA. Among 100 patients, 88% were AML, 56% were female, and mean age was 59 years. Though not statistically significant, OS by Kaplan-Meier analysis was shorter for those below the 25th percentile SPhA compared to those above (median OS: 11.0 months vs 19.5 months; P = .09). Lower baseline SPhA was associated with increased incidence of 60-day mortality in univariable (odds ratio [OR] = 5.25; 1.35, 20.44; P = .02) but not multivariable analysis (OR = 3.12; 0.67, 14.48; P = .15) adjusted for age, creatinine, and cytogenetics. Increased change in SPhA was associated with worse OS (hazard ratio = 1.15; 1.00,1.33; P = .05) in multivariable analysis. Standardized phase angle is a rapid, noninvasive, and objective measure that may be used to inform risk stratification.
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Affiliation(s)
| | - Susan Lyerly
- Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC, USA
| | - Megan Manuel
- Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC, USA
| | - Janet A Tooze
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Heidi D Klepin
- Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC, USA
| | - Bayard L Powell
- Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC, USA
| | - Sarah Dralle
- Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC, USA
| | - Alok Uprety
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Timothy S Pardee
- Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC, USA
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Jansen AK, Gattermann T, da Silva Fink J, Saldanha MF, Dias Nascimento Rocha C, de Souza Moreira TH, Silva FM. Low standardized phase angle predicts prolonged hospitalization in critically ill patients. Clin Nutr ESPEN 2019; 34:68-72. [PMID: 31677714 DOI: 10.1016/j.clnesp.2019.08.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/10/2019] [Accepted: 08/26/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Evaluate the performance of phase angle (PA) in identifying malnutrition and in predicting clinical outcomes in critical adult patients. METHODS A longitudinal observational study with secondary data from Nossa Senhora da Conceição Hospital (Porto Alegre) and Risoleta Tolentino Neves Hospital (Belo Horizonte) involving critically ill patients assessed for nutritional status by subjective global assessment (SGA) and by anthropometry in the first 48 h after admission to the intensive care unit (ICU). The PA was evaluated from the realization of the bioelectrical impedance. Patients were followed up until hospital discharge to verify the other outcomes of interest: death, hospitalization time and in ICU, and duration of mechanical ventilation. RESULTS A total of 169 patients (60.3 ± 16.7 years, 56.7% men, 46.7% surgical) were followed for 23.0 (14.0-40.8) days. The accuracy of standardized PA (SPA) reduced in identifying malnourished patients was 60.6% (ROC curve AUC = 0.606, 95% CI 0.519-0.694). Reduced SPA increased in about three times the chance of having malnutrition (OR = 2.79, 95% CI 1.39-5.61) and 2 times the chance of prolonged hospital stay (OR = 2.27; 95% CI 1.18-4.34) in an adjusted analysis for the origin hospital and for the severity score. CONCLUSION Reduced SPA showed satisfactory predictive validity for malnutrition and prolonged hospital stay in critically ill patients, reinforcing the applicability of BIA in the routine of nutritional care in ICU, since it is a simple, fast and low cost method.
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Affiliation(s)
- Ann Kristine Jansen
- Department of Nutrition at Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Thainá Gattermann
- Intensive Care Therapy by the Integrated Multiprofessional Residency Program of the Hospital Group Conceição, Porto Alegre, Brazil
| | - Jaqueline da Silva Fink
- Medical Sciences by Federal University of Rio Grande do Sul, Clinical Nutritionist at Nossa Senhora da Conceição hospital, Porto Alegre, Brazil
| | - Marcelle Ferreira Saldanha
- Nutritionist of the Multiprofessional Support Team of the Health Department in the Municipality of Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
| | | | | | - Flávia Moraes Silva
- Nutrition Department and Graduation Program in Nutrition Sciences at Federal University of Health Sciences, Porto Alegre, Brazil.
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Cavagnari MAV, Vidigal VM, Silva TD, Barão K, Forones NM. ADIPONECTIN, VITAMIN D AND NUTRITIONAL STATUS IN PATIENTS WITH ADVANCED COLORECTAL CANCER OR DURING FOLLOW-UP. ARQUIVOS DE GASTROENTEROLOGIA 2019; 56:172-177. [PMID: 31460582 DOI: 10.1590/s0004-2803.201900000-34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 06/11/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Considering the high incidence of colorectal cancer (CRC) related deaths, many studies have investigated variables that can affect survival, with the aim of prolonging survival. The nutritional status can also be predict survival in patients with CRC. OBJECTIVE The aim of the present study was to evaluate if BMI, %FAT, PhA, PG-SGA, adiponectin levels, and vitamin D levels are relevant to the characterization and differentiation of patients with advanced CRC and patients with a history of CRC. METHODS The study was carried out by patients with advanced colorectal cancer (Group 1) and patients in follow-up after colorectal cancer treatment (Group 2). Nutritional status was assessed using the body mass index, body fat percentage, phase angle from bioelectrical impedance, Patient-Generated Subjective Global Assessment score. Adiponectin concentrations were determined using an enzyme-linked immunosorbent assay, and vitamin D levels were measured using high performance liquid chromatography. RESULTS Groups 1 and 2 consisted of 23 and 27 patients, respectively. The body mass index, body fat percentage, phase angle, vitamin D and adiponectin levels were not significantly different between the groups. The mean Patient-Generated Subjective Global Assessment score was significantly higher in group 1 compared with group 2, and was significantly correlated with the long-term mortality risk. CONCLUSION Among the nutritional status parameters, only the Patient-Generated Subjective Global Assessment score was significantly different between the groups and was an important predictor of survival in patients with advanced colorectal cancer.
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Affiliation(s)
- Mariana Abe Vicente Cavagnari
- Universidade Federal de São Paulo (UNIFESP), Setor de Oncologia, Disciplina de Gastroenterologia Clínica, Departamento de Medicina, São Paulo, SP, Brasil
| | - Verônica Marques Vidigal
- Universidade Federal de São Paulo (UNIFESP), Setor de Oncologia, Disciplina de Gastroenterologia Clínica, Departamento de Medicina, São Paulo, SP, Brasil
| | - Tiago Donizetti Silva
- Universidade Federal de São Paulo (UNIFESP), Setor de Oncologia, Disciplina de Gastroenterologia Clínica, Departamento de Medicina, São Paulo, SP, Brasil
| | - Katia Barão
- Universidade Federal de São Paulo (UNIFESP), Setor de Oncologia, Disciplina de Gastroenterologia Clínica, Departamento de Medicina, São Paulo, SP, Brasil
| | - Nora Manoukian Forones
- Universidade Federal de São Paulo (UNIFESP), Setor de Oncologia, Disciplina de Gastroenterologia Clínica, Departamento de Medicina, São Paulo, SP, Brasil
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Mundstock E, Amaral MA, Baptista RR, Sarria EE, dos Santos RRG, Filho AD, Rodrigues CAS, Forte GC, Castro L, Padoin AV, Stein R, Perez LM, Ziegelmann PK, Mattiello R. Association between phase angle from bioelectrical impedance analysis and level of physical activity: Systematic review and meta-analysis. Clin Nutr 2019; 38:1504-1510. [DOI: 10.1016/j.clnu.2018.08.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 12/22/2022]
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Langer RD, Silva AM, Borges JH, Cirolini VX, Páscoa MA, Guerra‐Júnior G, Gonçalves EM. Physical training over 6 months is associated with improved changes in phase angle, body composition, and blood glucose in healthy young males. Am J Hum Biol 2019; 31:e23275. [PMID: 31187509 DOI: 10.1002/ajhb.23275] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/11/2019] [Accepted: 05/19/2019] [Indexed: 01/10/2023] Open
Affiliation(s)
- Raquel D. Langer
- Growth and Development Laboratory, Centre for Investigation in Paediatrics (CIPED), School of Medical SciencesUniversity of Campinas (UNICAMP) Campinas‐SP Brazil
| | - Analiza M. Silva
- Exercise and Health Laboratory, Department of Sport and Health of the Faculty of Human KineticsUniversity of Lisbon Cruz Quebrada Portugal
| | - Juliano H. Borges
- Growth and Development Laboratory, Centre for Investigation in Paediatrics (CIPED), School of Medical SciencesUniversity of Campinas (UNICAMP) Campinas‐SP Brazil
| | - Vagner X. Cirolini
- Growth and Development Laboratory, Centre for Investigation in Paediatrics (CIPED), School of Medical SciencesUniversity of Campinas (UNICAMP) Campinas‐SP Brazil
| | - Mauro A. Páscoa
- Growth and Development Laboratory, Centre for Investigation in Paediatrics (CIPED), School of Medical SciencesUniversity of Campinas (UNICAMP) Campinas‐SP Brazil
| | - Gil Guerra‐Júnior
- Growth and Development Laboratory, Centre for Investigation in Paediatrics (CIPED), School of Medical SciencesUniversity of Campinas (UNICAMP) Campinas‐SP Brazil
| | - Ezequiel M. Gonçalves
- Growth and Development Laboratory, Centre for Investigation in Paediatrics (CIPED), School of Medical SciencesUniversity of Campinas (UNICAMP) Campinas‐SP Brazil
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Roche S, Lara-Pompa NE, Macdonald S, Fawbert K, Valente J, Williams JE, Hill S, Wells JC, Fewtrell MS. Bioelectric impedance vector analysis (BIVA) in hospitalised children; predictors and associations with clinical outcomes. Eur J Clin Nutr 2019; 73:1431-1440. [PMID: 31076656 DOI: 10.1038/s41430-019-0436-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/31/2019] [Accepted: 04/18/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Clinical use of bioelectric impedance is limited by variability in hydration. Analysis of raw bioelectric impedance vectors (BIVA), resistance (R), reactance (Xc) and phase angle (PA) may be an alternative for monitoring disease progression/treatment. Clinical experience of BIVA in children is limited. We investigated predictors of BIVA and their ability to predict clinical outcomes in children with complex diagnoses. METHODS R, Xc and PA were measured (BODYSTAT Quadscan 4000) on admission in 108 patients (4.6-16.8 years, mean 10.0). R and Xc were indexed by height (H) and BIVA-SDS for age and sex calculated using data from healthy children. Potential predictors and clinical outcomes (greater-than-expected length-of-stay (LOS), complications) were recorded. RESULTS Mean R/H-SDS was significantly higher (0.99 (SD 1.32)) and PA-SDS lower (-1.22 (1.68))) than expected, with a wide range for all parameters. In multivariate models, the Strongkids risk category predicted R/H-SDS (adjusted mean for low, medium and high risk = 0.49, 1.28, 2.17, p = 0.009) and PA-SDS (adjusted mean -0.52, -1.53, -2.36, p = 0.01). BIVA-SDS were not significantly different in patients with or without adverse outcomes. CONCLUSIONS These complex patients had abnormal mean BIVA-SDS suggestive of reduced hydration and poor cellular health according to conventional interpretation. R/H-SDS was higher and PA-SDS lower in those classified as higher malnutrition risk by the StrongKids tool. Further investigation in specific patient groups, including those with acute fluid shifts and using disease-specific outcomes, may better define the clinical role of BIV.
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Affiliation(s)
- S Roche
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - N E Lara-Pompa
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - S Macdonald
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - K Fawbert
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - J Valente
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - J E Williams
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - S Hill
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - J C Wells
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK.,Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - M S Fewtrell
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK. .,Great Ormond Street Hospital for Children NHS Trust, London, UK.
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Lundberg M, Dickinson A, Nikander P, Orell H, Mäkitie A. Low-phase angle in body composition measurements correlates with prolonged hospital stay in head and neck cancer patients. Acta Otolaryngol 2019; 139:383-387. [PMID: 30900483 DOI: 10.1080/00016489.2019.1566779] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Bioelectrical impedance analysis (BIA) is a method for estimating body composition. Clinically the most important parameter is the phase angle (PA), which decreases with progressing malnutrition and is highly predictive for impaired survival and mortality. AIM To evaluate the association of low PA with the complication rate and length of hospital stay. MATERIAL AND METHODS A cohort of 61 head and neck cancer (HNC) patients underwent BIA prior to surgical treatment. Information on patient and tumour characteristics, treatment, and surgical complications were gathered from hospital records and correlated with BIA results. RESULTS The median PA was 4.5 (range, 2.7-6.5), and, in 67% of the patients, it was lower than reference values. Low PA was associated with longer hospital stay (p = .002) in the whole cohort and in the patient group with radical neck dissections it correlated with a higher surgical complication rate (p = .014), but not with Clavien-Dindo scoring for surgical complications. CONCLUSIONS AND SIGNIFICANCE BIA is a feasible instrument for analysing body composition that reflects nutritional status in cancer patients. Our results show that HNC patients have a low PA at diagnosis. Low PA is associated with a long hospital stay and an increase in the complication rate. BIA can be of clinical value in preoperative risk evaluation.
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Affiliation(s)
- Marie Lundberg
- Department of Otorhinolaryngology - Head Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Amy Dickinson
- Department of Otorhinolaryngology - Head Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Pia Nikander
- Clinical Nutrition Unit, HUS Helsinki University Hospital, Helsinki, Finland
| | - Helena Orell
- Clinical Nutrition Unit, HUS Helsinki University Hospital, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
- Division of Ear, Nose, and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
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de Souza A, Campos DJ, Schieferdecker MEM, Funke VAM, Vilela RM. Phase angle as a screening tool for mortality risk among hematopoietic stem cell transplanted adult patients. Clin Nutr ESPEN 2019; 29:65-71. [DOI: 10.1016/j.clnesp.2018.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 12/07/2018] [Indexed: 10/27/2022]
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