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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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Kubo Y, Noritake K, Noguchi T, Hayashi T. Phase Angle as a Nutritional Assessment Method in Patients with Hip Fractures: A Cross-Sectional Study. Ann Geriatr Med Res 2024; 28:95-100. [PMID: 38263547 PMCID: PMC10982439 DOI: 10.4235/agmr.23.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/11/2024] [Accepted: 01/18/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Phase angle, which is associated with cellular health, has attracted attention as a noninvasive and objective method for nutritional assessment. However, the association between malnutrition and phase angle in older inpatients with hip fractures has not been reported. Therefore, this study investigated this association in older inpatients (aged ≥65 years) with hip fractures and determined the cutoff phase angle for determining malnutrition. METHODS This cross-sectional study retrospectively analyzed the data of 96 inpatients with hip fractures who were hospitalized in rehabilitation units after surgery (male, 29.4%; mean age, 82.4±6.2 years). Nutritional status was assessed using the Geriatric Nutritional Risk Index (GNRI), with malnutrition defined as a GNRI ≥98. Bioelectrical impedance analysis was used to measure phase angles. RESULTS The phase angle was associated with malnutrition (B=-1.173; odds ratio=0.310; 95% confidence interval 0.58-0.83; p=0.015). The area under the receiver operating characteristic curve was 0.71. The cutoff phase angle for malnutrition was 3.96° (sensitivity=0.85, specificity=0.63). CONCLUSION Phase angle could be an indicator of malnutrition in older inpatients with hip fractures. Our findings will help formulate rehabilitation strategies for these patients.
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Affiliation(s)
- Yuta Kubo
- Division of Occupational Therapy, Faculty of Rehabilitation and Care, Seijoh University, Tokai, Aichi, Japan
| | - Kento Noritake
- Department of Rehabilitation, Faculty of Health Sciences, Nihon Fukushi University, Handa, Aichi, Japan
| | - Taiji Noguchi
- Department of Social Science, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Takahiro Hayashi
- Division of Physical Therapy, Faculty of Rehabilitation and Care, Seijoh University, Tokai, Aichi, Japan
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Norman K, Herpich C, Müller-Werdan U. Role of phase angle in older adults with focus on the geriatric syndromes sarcopenia and frailty. Rev Endocr Metab Disord 2022; 24:429-437. [PMID: 36456777 PMCID: PMC9715408 DOI: 10.1007/s11154-022-09772-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 12/05/2022]
Abstract
Age-related changes in body composition reflect an increased risk for disease as well as disability. Bioimpedance analysis is a safe and inexpensive bed side method to measure body composition, but the calculation of body compartments with BIA is hampered in older adults. Phase angle, a raw parameter derived from bioimpedance analysis, is free from calculation-inherent errors. It declines with age and disease and is highly predictive of a variety of clinical outcomes as well as mortality. This review summarizes the current evidence linking the phase angle to geriatric syndromes such as malnutrition, sarcopenia and frailty and also investigates whether the phase angle reacts to interventions. Since the majority of studies show an association between the phase angle and these geriatric syndromes, a low phase angle is not suitable to exclusively indicate a specific condition. It does not inform on the underlying cause and as such, a low phase angle mainly indicates increased risk. Phase angle decline over time is reflected by deterioration of e.g. frailty status. It reacts to physical training and detraining, but studies investigating whether these induced changes are also associated with improved outcome are missing.
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Affiliation(s)
- Kristina Norman
- Institute of Nutritional Science, University of Potsdam, 14558, Nuthetal, Germany.
- Department of Geriatrics and Medical Gerontology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany.
- Department of Nutrition and Gerontology, German Institute for Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.
| | - Catrin Herpich
- Institute of Nutritional Science, University of Potsdam, 14558, Nuthetal, Germany
- Department of Geriatrics and Medical Gerontology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Ursula Müller-Werdan
- Department of Geriatrics and Medical Gerontology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
- Evangelisches Geriatriezentrum Berlin gGmbH, Berlin, Germany
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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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do Nascimento TG, Paes-Silva RP, da Luz MCL, Cabral PC, de Araújo Bezerra GK, Gomes ACB. Phase angle, muscle mass, and functionality in patients with Parkinson’s disease. Neurol Sci 2022; 43:4203-4209. [DOI: 10.1007/s10072-022-05975-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 02/23/2022] [Indexed: 12/17/2022]
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Aguilar-Iglesias L, Merino-Merino A, Sanchez-Corral E, Garcia-Sanchez MJ, Santos-Sanchez I, Saez-Maleta R, Perez-Rivera JA. Differences According to Age in the Diagnostic Performance of Cardiac Biomarkers to Predict Frailty in Patients with Acute Heart Failure. Biomolecules 2022; 12:biom12020245. [PMID: 35204746 PMCID: PMC8961634 DOI: 10.3390/biom12020245] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 02/06/2023] Open
Abstract
Frailty has traditionally been studied in the elderly population but scarcely in younger individuals. The objective of the present study is to analyze differences according to age in the diagnostic performance of cardiac biomarkers to predict frailty in patients admitted to the hospital for acute heart failure (AHF). A frailty assessment was performed with the SPPB and FRAIL scales (score > 3). We included 201 patients who were divided according to age: those older and younger than 75 years. In the younger group, no biomarker was related to the presence of frailty. This was mainly determined by age and comorbidities. In the elderly group, NT-proBNP was significantly related to the presence of frailty, but none of the baseline characteristics were. The best cut-off point in the elderly group for NT-proBNP was 4000 pg/mL. The area under the curve (AUC) for proBNP for frailty detection was 0.62 in the elderly. Another similar frailty scale, the SPPB, also showed a similar AUC in this group; however, adding the NT-proBNP (one point if NT-proBNP < 4000 pg/mL), it showed a slightly higher yield (AUC 0.65). The addition of biomarkers could improve frailty detection in members of the elderly population who are admitted to the hospital for AHF.
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Affiliation(s)
- Lara Aguilar-Iglesias
- Department of Cardiology, University Hospital of Burgos, 09006 Burgos, Spain; (L.A.-I.); (A.M.-M.); (E.S.-C.); (M.-J.G.-S.); (I.S.-S.)
| | - Ana Merino-Merino
- Department of Cardiology, University Hospital of Burgos, 09006 Burgos, Spain; (L.A.-I.); (A.M.-M.); (E.S.-C.); (M.-J.G.-S.); (I.S.-S.)
| | - Ester Sanchez-Corral
- Department of Cardiology, University Hospital of Burgos, 09006 Burgos, Spain; (L.A.-I.); (A.M.-M.); (E.S.-C.); (M.-J.G.-S.); (I.S.-S.)
| | - Maria-Jesus Garcia-Sanchez
- Department of Cardiology, University Hospital of Burgos, 09006 Burgos, Spain; (L.A.-I.); (A.M.-M.); (E.S.-C.); (M.-J.G.-S.); (I.S.-S.)
| | - Isabel Santos-Sanchez
- Department of Cardiology, University Hospital of Burgos, 09006 Burgos, Spain; (L.A.-I.); (A.M.-M.); (E.S.-C.); (M.-J.G.-S.); (I.S.-S.)
| | - Ruth Saez-Maleta
- Department Clinical Analysis, University Hospital of Burgos, 09006 Burgos, Spain;
| | - Jose-Angel Perez-Rivera
- Department of Cardiology, University Hospital of Burgos, 09006 Burgos, Spain; (L.A.-I.); (A.M.-M.); (E.S.-C.); (M.-J.G.-S.); (I.S.-S.)
- Facultad de Ciencias de la Salud, Universidad Isabel I, 09003 Burgos, Spain
- Correspondence:
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Malnutrition-Inflammation Score VS Phase Angle in the Era of GLIM Criteria: A Cross-Sectional Study among Hemodialysis Patients in UAE. Nutrients 2019; 11:nu11112771. [PMID: 31739568 PMCID: PMC6893836 DOI: 10.3390/nu11112771] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 10/28/2019] [Accepted: 10/31/2019] [Indexed: 12/27/2022] Open
Abstract
(1) Background: Malnutrition is prevalent in hemodialysis (HD) patients and is associated with an increased risk of morbidity and mortality. The aim of this study was to explore the prevalence of malnutrition using the malnutrition-inflammation score (MIS) and phase angle (PhA) and compare their concordance with the new Global Leadership Initiative on Malnutrition (GLIM) criteria for the diagnosis of malnutrition. (2) Methods: Seventy HD patients were assessed. Malnutrition was diagnosed based on the GLIM criteria and MIS questionnaire. The agreement between the diagnostic tools (MIS, PhA derived from the bioelectrical impedance analysis (BIA), and GLIM criteria) was assessed. The optimal gender-specific cutoff points were identified for the PhA according to the GLIM criteria. (3) Results: Almost half of the sample was diagnosed as malnourished according to the MIS (48.57%) and GLIM criteria (54.29%). A fair agreement was observed between the GLIM criteria, MIS (k = 0.202), and PhA (k = 0.279) among the malnourished patients. The PhA had better sensitivity but worse specificity compared to the MIS. The optimum cutoff points of PhA to detect malnutrition according to the GLIM criteria were a PhA value of ≤5.7° for males and ≤3.8° for females. (4) Conclusion: The MIS performed slightly better than PhA in the diagnosis of malnutrition among HD patients within the spectrum of the GLIM criteria.
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