Ângulo de fase como preditor de massa muscular em pacientes com doença inflamatória intestinal / Phase angle as a predictor of muscle mass in patients with inflammatory bowel disease

ABSTRACT Malnutrition/sarcopenia is frequent in patients with inflammatory bowel diseases (IBD), and results in muscle catabolism, impacting treatment response, postoperative complications, and quality of life. Objective: This study aims to assess whether the phase angle (PhA) is a parameter for predicting reduced muscle mass in patients with IBD. Methods: Adult patients with IBD were included in this cross-sectional study. For the estimation of muscle mass and the calculation of the PhA, we used bioelectrical impedance analysis (BIA). Crohn's disease (CD) and ulcerative colitis (UC) activity scores were defined using the Harvey-Bradshaw index and partial Mayo score, respectively. The area under the ROC curve was calculated to identify the PhA cut-off point for reduced muscle mass. Results: The sample consisted of 145 patients, with 39 (26.9%) with IBD in the active phase. There was a correlation of the PhA with skeletal muscle mass (SMM) (rs 0.35, P<0.001) and with the skeletal muscle mass index (SMI) (rs 0.427, P<0.001), and the associations remained in the most active form (moderate or severe) of IBD. The ROC curve analysis indicated that the cut-offs points of the PhA ≤5.042 for female and PhA ≤6.079 for male can be used to predict muscle mass reduction. Conclusion: The PhA can be considered a predictor of muscle mass reduction in IBD patients, and we can use it for screening and monitoring the evolution of malnutrition.

RESUMO A desnutrição/sarcopenia é frequente em pacientes com doenças inflamatórias intestinais (DII), resultando em catabolismo muscular, com impacto nas respostas aos tratamentos, complicações cirúrgicas e na qualidade de vida. Objetivo: Este estudo tem como objetivo, avaliar se o ângulo de fase (AF) é um parâmetro para a predição de redução de massa muscular em pacientes com DII. Métodos: Pacientes adultos com DII foram incluídos neste estudo transversal. A estimativa da massa muscular e o cálculo do AF foram realizados a partir do exame de bioimpedância elétrica (BIA). As atividades da doença de Crohn e retocolite ulcerativa foram definidas pelo índice Harvey-Bradshaw e escore parcial de Mayo, respectivamente. A área de curva ROC foi calculada para identificar o ponto de corte do AF para a massa muscular reduzida. Resultados: A amostra foi composta por 145 pacientes, sendo 39 (26.9%) com DII em fase ativa. Houve correlação do AF com massa muscular esquelética (MME) (rs 0.35, P<0.001) e com o índice de massa muscular esquelética (IMME) (rs 0.427, P<0.001), mantendo-se as associações na forma mais ativa (moderada ou grave) da DII. A análise da curva ROC indicou que os pontos de corte de AF ≤5.042 para mulheres e ≤6.079 para homens podem ser usados para prever a redução da massa muscular. Conclusão: O AF pode ser considerado um preditor de redução de massa muscular nos pacientes com DII e ser utilizado para triagem e acompanhamento da evolução da desnutrição.

Associação entre força de preensão manual e ângulo de fase em idosos da Estratégia Saúde da Família: um estudo transversal / Association between handgrip strength and phase angle in older adults from the Family Health Strategy: a cross-sectional study

Introdução: a Força de Preensão Manual (FPM) é um indicador de saúde e funcionalidade do idoso, que diminui com o passar do tempo, impactada por aspectos como mudanças na composição corporal. Objetivo: investigar a associação entre o Ângulo de Fase Padronizado (AFP) e FPM em idosos comunitários da Atenção Primária à Saúde (APS). Metodologia: estudo transversal, com pessoas de 60 anos ou mais, atendidos na APS. A variável dependente foi a FPM medida com dinamômetro e a independente principal foi o AFP com base no sexo e faixa etária, calculado a partir do ângulo de fase obtido pela bioimpedância. Foi realizada a regressão logística com entrada por bloco, sendo incluídas no modelo as variáveis que apresentaram associação com nível crítico menor do que 10%. Resultados: dos 296 indivíduos avaliados, 28,0% exibiram baixa FPM e 15,9% apresentaram AFP < ­ 1,65°. As variáveis inseridas no modelo final de regressão logística, juntamente com o AFP, foram sexo, faixa etária, Índice de Massa Corporal (IMC) e Circunferência da Panturrilha (CP). A análise mostrou que o AFP < ­ 1,65° aumenta a chance do idoso apresentar baixa FPM, tanto na análise sem ajuste (OR = 2,71; IC 95% 1,43-5,15), quanto no modelo final (OR = 2,35; IC 95% 1,14-4,87). Conclusão: o AFP mostrou-se associado à FPM, independentemente da interação com sexo, faixa etária, IMC e CP. A sua utilização pode contribuir na avaliação de idosos, especialmente quando a aferição da FPM não for possível.

Introduction: Handgrip Strength (HGS) is an indicator of health and functionality of the older adults, which decreases over time, impacted by aspects including changes in body composition. Objective: to investigate the association between the Standardized Phase Angle (SPA ) and HGS in community-dwelling older adults in Primary Health Care (PHC). Methodology: cross-sectional study, with people aged 60 or over, assisted in the PHC. The dependent variable was the HGS measured using a dynamometer. The main independent variable was the SPA based on gender and age range, calculated from the phase angle obtained by bioimpedance. Block-by-block logistic regression was performed, including variables that were associated with a critical level lower than 10% in the model. Results: of the 296 individuals assessed, 28.0% had low HGS and 15.9% had SPA < ­ 1.65°. The variables inserted in the final logistic regression model, together with the SPA , were gender, age group, Body Mass Index (BMI) and Calf Circumference (CC). The analysis showed that SPA < ­ 1.65° increases the chance of the older adults having low HGS, both in the unadjusted analysis (OR = 2.71; 95% CI 1.43-5.15) and in the final model (OR = 2.35; 95%CI 1.14-4.87). Conclusion: the SPA was associated with HGS, regardless of the interaction with sex, age group, BMI and CC. Its use can contribute to the evaluation of the older adults, especially when HGS measurement is not possible.

Correlation between phase angle and loss of muscle mass in elderly diabetic patients / 中华老年医学杂志

Objective:To investigate the correlation between phase angle and muscle mass reduction in elderly diabetic patients.Methods:This paper retrospectively collected and analyzed the data of human composition and laboratory index in elderly patients with diabetes(n=106)and non-diabetic(n=153)patients in the Nutrition Department of Beijing Hospital, compared the differences between two groups, and explored the correlation between phase angle and muscle mass reduction in elderly diabetic patients.Phase angle was detected by bioelectrical impedance which was calculated as reactance/resistance× 180/π.Results:Phase angle was lower in elderly diabetic patients(5.17±0.65)°than in non-diabetic elderly patients(5.37±0.76)°( t=-2.075. P<0.05); age and fasting blood glucose were higher in elderly diabetic patients than in non-diabetic elderly patients(all P<0.05).There was no significant difference between the two groups in body mass index, fat, body fat percentage, visceral fat area, skeletal muscle index, body cell mass, total protein, albumin, and hemoglobin(all P>0.05).Correlation analysis results showed that in elderly diabetic patients, the phase angle was negatively correlated with body mass index( r=0.288, P<0.01), age( r=-0.680, P<0.01), was positively correlated with skeletal muscle( r=0.477, P<0.01), skeletal muscle index( r=0.505, P<0.01)and hemoglobin( r=0.382, P<0.01); and in the elderly non-diabetic group, phase angle was negatively correlated with age( r=-0.666, P<0.01)and positively correlated with body mass index( r=0.296, P<0.01), skeletal muscle( r=0.504, P<0.01), fat free mass( r=0.161, P<0.05), skeletal muscle index( r=0.441, P<0.01), body cell volume( r=0.496, P<0.01), and hemoglobin( r=0.420, P<0.01).The bioelectrical impedance apectroscopy detected skeletal muscle mass index<7.0 kg/m 2 for male and<5.7 kg/m 2 for female were used as the diagnosis standard for reduced muscle mass.The detection rate of muscle mass reduction was higher in elderly diabetic patients(17 cases, 16.04%)than in elderly non-diabetic patients(12 cases, 7.84%, χ2=4.229, P<0.05).The results of multiple regression analysis showed that the decrease of muscle mass in elderly diabetic patients was related to low phase angle( OR=0.413, 95% CI: 0.280-0.973, P<0.05)and aging( OR=2.174, 95% CI: 1.574-3.003, P<0.01). Conclusions:The phase angle is lower in diabetic elderly patients than in non-diabetic elderly patients, and the incidence of muscle mass reduction is higher in diabetic elderly patients than in non-diabetic elderly people.Decreased phase angle and increased age are related to the decrease of muscle mass in elderly diabetic patients.

Exploration of phase angle used to construct PG-SGA nutritional assessment and prediction model for malignant tumor patients / 中华肿瘤杂志

Objective: To explore the value of phase angle (PA) in constructing a predictive model of nutrition evaluation for tumor patients. Methods: A retrospective analysis was performed on 1 129 patients with malignant tumors hospitalized in the Cancer Center of Changzhi People's Hospital from June 2020 to February 2021. PA values of six parts of the body were measured by the body composition analyzer, including: left arm (LA), right arm (RA), left leg (LL), right leg (RL), the trunk (TR), and the whole body (WB). Patients' body mass index (BMI) was calculated and patient-generated subjective global assessment (PG-SGA) was assessed. The differences of PA values of six parts were compared and their correlations with BMI and PG-SGA in combination with age, gender and tumor disease types were analyzed, binary classification regression on BMI and PG-SGA was performed, and the functions of the best prediction model was fitted. Decision tree, random forest, Akaike information criterion in a Stepwise Algorithm (stepAIC) and generalized likelihood ratio test were used to select appropriate variables, and the logit logistic regression model was used to fit the data. Results: Comparing the PA values of six parts in pairs, it was found that the PA values of LA and RA, LL and RL, and TR and WB were linearly correlated and the coefficient was close to 1 (P<0.001). Binary classification regression was performed for BMI and PG-SGA, respectively. In order to make the data have clinical significance, 18.5 kg/m(2) was used as the classification point for BMI, 4 and 9 were used as the classification points for PG-SGA score, and the models of A, B and C were obtained. Suitable variables including PA-LA, PA-TR and tumor disease types were used as variables to fit BMI classification; BMI, PA-LA and age were used as variables to fit the PG-SGA model with 9 as the classification point. PA-LA, PA-TR, BMI, age and tumor disease types were used as variables to fit the PG-SGA model with 4 as the classification point. In this study, the predicted values of models A, B and C obtained by R-studio were imported into SPSS 26.0 software, and the cut-off values of classification were obtained by the receiver operating characteristic (ROC) curve. The ROC analytic results showed that the best cut-off values of Model A, B and C were 0.155, 0.793 and 0.295. Model A recommended when the probability is >0.155, a patient's nutritiond tatus should be classified as BMI < 18.5 kg/m(2) group. Model B recommended that PG-SGA<9 group be classified as the probability is >0.793. Model C recommended that PG-SGA < 4 group should be classified when probability is >0.295. Conclusions: The PG-SGA classification prediction model is simple to operate, and the nutritional status of patients can be roughly divided into three groups: normal or suspected malnutrition group (PG-SGA<4), moderate malnutrition group (4≤PG-SGA<9), and severe malnutrition group (PG-SGA≥9). This model can more efficiently predict the nutritional status of cancer patients, greatly simplify the nutritional assessment process, and better guide the standardized treatment of clinical malnutrition.

Valoración del impacto del confinamiento por SARS-CoV-2 sobre la composición corporal de una población de futbolistas de élite / Assessment of the impact of confinement by SARS-CoV-2 on the body composition of elite soccer players

RESUMEN: El confinamiento por pandemia por SARS-CoV-2 ha agravado la condición física y nutricional de los deportistas de élite, modificando la rutina de los entrenamientos. La bioimpedancia (BIA) estudia la composición corporal y es utilizada para valorar la evolución de las intervenciones médicas, deportivas y nutricionales. El objetivo del estudio fue observar si una intervención nutricional y una prescripción de actividad física específicas pudieron atenuar los cambios hídricos, de composición corporal, y ángulo de fase (PhA) tras el confinamiento por la pandemia SARS-CoV-2 en una población de futbolistas de élite. En un grupo de 22 futbolistas profesionales (Serie A, Calcio, Italia) se evaluó la BIA antes (febrero 2020) y después (mayo 2020) del confinamiento por la pandemia SARS-CoV-2. Durante el periodo de confinamiento se aplicó una intervención nutricional y prescripción de actividad física específicas. Las medidas de los participantes se realizaron de forma protocolizada, usando material antropométrico y un impedanciómetro multifrecuencia, octopolar y segmental de la marca Tanita modelo MC-780MA. Se aplicó la prueba t de Student para muestras relacionadas. No se observaron diferencias significativas antes y después del periodo de intervención, en el grado de hidratación y composición corporal (masa muscular y masa grasa). Por el contrario, se evidenció un cambio significativo en el PhA. Estos datos nos permiten poder tener una referencia de que intervenciones nutricionales y de actividad física pueden minimizar o disminuir el impacto de un confinamiento en la composición corporal. No obstante, este tipo intervención no fue capaz de atenuar los efectos del confinamiento sobre el PhA, considerado un indicador de la salud celular. Así mismo, aportamos una gráfica vectorial de referencia, mediante SpecificBIVA, de esta población.

SUMMARY: The confinement due to a SARS-CoV-2 pandemic has aggravated the physical and nutritional condition of elite athletes, modifying their training routine. Bioimpedance (BIA) studies body composition and is used to assess the evolution of medical, sports and nutritional interventions. The objective of the study was to observe if a specific nutritional intervention and prescription of physical activity could attenuate the changes in water, body composition, and phase angle (PhA) after confinement due to the SARS-CoV-2 pandemic in a population of professional soccer players. In a group of (22 professional soccer players (Serie A, Calcio, Italy) the BIA was evaluated before (February 2020) and after (May 2020) the confinement due to the SARS-CoV-2 pandemic. During the confinement period, a specific nutritional intervention and prescription of physical activity was applied. The measurements of the participants were carried out in a standardized way, using anthropometric material and a multifrequency, octopolar and segmental impedance measurer of the "Tanita" brand model MC-780MA. Student's T test was applied for related samples. No significant differences were observed before and after the intervention period, in the degree of hydration and body composition (muscle mass and fat mass). On the contrary, a significant change in PhA was evidenced. These data allow us to hav a reference for nutritional and physical activity interventions that can minimize or reduce the impact of confinement on body composition. However, this type of intervention was not able to attenuate the effects of confinement on PhA, considered an indicator of cellular health. Likewise, we provide a reference vector graph, using Specific BIVA, of this population.

Relation of Phase Angle with Nutritional Status and Clinical Outcomes of Primary Liver Cancer Patients / 肿瘤防治研究

Objective To observe the relation of phase angle (PA) measured by bioelectrical impedance method with nutritional status of patients with primary liver cancer, and to explore its influence on clinical outcomes. Methods We collected 120 inpatients with primary liver cancer for nutritional risk screening, patient-generated subjective nutrition assessment(PG-SGA), anthropometry, biochemical examination and body composition analysis. According to the phase angle, the patients were divided into low PA group and normal PA group. The correlation between PA and nutrition-related indicators was analyzed. The survival and complications of the two groups were compared after 1-year follow-up. Results There were 56.7% (68/120) of primary liver cancer patients with lower PA. TP, ALB, CHE, HB, AMC, GS, BCM, FFM and ASMI in low PA group were lower while ECW/TBW was higher than those in normal PA group (all P < 0.05). The correlation analysis showed that PA was negatively correlated with ECW/TBW (P < 0.05), but positively correlated with TP, ALB, CHE, HB, AMC, GS, BCM, FFM and ASMI (all P < 0.05). Low PA was significantly associated with nutritional risk, deterioration of liver function, progress of liver cancer staging and severe malnutrition (all P < 0.05). During the follow-up period, the mortality of the low PA group was higher than that of the normal PA group (P < 0.05). The risk of death in the low PA group increased by 2.738 times (OR=3.738, 95%CI: 1.465-9.535). Conclusion Phase angle is an economic and effective index to reflect the nutritional status of patients with primary liver cancer, and closely related to the risk of death. Phase angle measurement is helpful for assessing nutritional status and predicting clinical outcome of patients with primary liver cancer.

Effect of temperature and time on rheological properties of Daphnes Giraldii Cortex post-crosslinking gel plaster / 中草药

Objective: To provide scientific basis for the temperature condition of Daphnes Giraldii Cortex (DGC) post-cross-linked gel plaster during storage and transportation. Methods: Taking linear viscoelastic region, modulus, yield stress, phase angle, composite viscosity and creep compliance as evaluation indexes, amplitude scanning, frequency scanning, temperature scanning and creep testing were carried out on the cross-linked gel plaster matrix after DGC by an advanced rotary rheometer, and relevant data of elastic modulus, viscosity modulus, phase angle, composite viscosity, creep compliance and yield stress of the samples which were stored at room temperature, -20 ℃ and -50 ℃ for 1, 3, 8, and 13 d were respectively obtained. Results: All samples of DGC post-crosslinking gel plaster showed elastic characteristics and stable state. After storage under different conditions, the state is still stable and the dispersibility is better. The peel strength of samples stored for 8 d and 13 d was decreased. The retention of samples stored at -50 ℃ for 13 d was decreased. Conclusion: DGC plaster containing post-crosslinked gel matrix had stable state, good dispersibility, initial adhesion, peel strength and shape retention when samples were stored below 0 ℃ for 3 d.

Determinación del estado nutricional mediante el ángulo de fase en pacientes en hemodiálisis / Determination of nutritional status by phase angle in hemodialysis patients

Resumen Introducción: La bioimpedancia eléctrica multifrecuencia (BIE) evalúa con precisión la composición corporal. Objetivo: Investigar el estado nutricional y su relación con el índice de masa corporal (IMC) o el ángulo fase obtenido por BIE en pacientes con enfermedad renal terminal (ERT) en hemodiálisis. Método: En 99 pacientes en hemodiálisis (43.6 ± 17.2 años, 58.8 % varones) se evaluó IMC, BIE y puntuación de desnutrición (DMS, Dialysis Malnutrition Score). La independencia de las asociaciones del IMC y el ángulo fase con el DMS se determinó con regresión lineal múltiple. Resultados: El riesgo de desnutrición (DMS > 13) se incrementó gradualmente entre los sujetos con IMC y ángulo fase normales (44.4 %), IMC bajo (45.8 %), ángulo fase bajo (64.0 %) y en aquellos con ambos parámetros anormales (68.0 %). El ángulo fase fue la única variable asociada independientemente con el estado nutricional de los pacientes (coeficiente beta estandarizado −0.372, p < 0.001), lo que explicó 13.8 % de la variación en el DMS. Conclusiones: El ángulo fase se asocia inversa e independientemente con el riesgo de desnutrición en pacientes con ERT, lo que sugiere que la composición corporal evaluada por BIE pudiera ser mejor que el IMC en la valoración clínica de pacientes con esta enfermedad.

Abstract Introduction: Multi-frequency bio-impedance analysis (BIA) accurately evaluates body composition. Objective: To assess nutritional status and its relationship with body mass index (BMI) or with BIA-obtained phase angle in patients with end-stage renal disease (ESRD) on hemodialysis. Method: BMI, BIA and dialysis malnutrition score (DMS) were assessed in 99 patients on hemodialysis (43.6 ± 17.2 years of age, 58.8% males). Multivariate linear regression analysis was used to determine BMI and phase angle independent associations with DMS. Results: Malnutrition risk (DMS > 13) showed a gradual increase among patients with normal BMI and phase angle (44.4%), low BMI (45.8%), low phase angle (64.0%), and in those with both parameters at abnormal ranges (68.0%). The phase angle was the only variable that was independently associated with patient nutritional status (standardized coefficient beta −0.372, p < 0.001), accounting for 13.8% of DMS variation. Conclusion: Phase angle is inversely and independently associated with malnutrition risk in patients with ESRD, which suggests that BIA-assessed body composition might be better than BMI in the clinical assessment of patients with ESRD.

Asociación del ángulo de fase con parámetros de evaluación del estado nutricional en pacientes en hemodiálisis / Association of the phase angle with nutritional status assessment parameters in hemodialysis patients

RESUMEN La desnutrición energético-proteica es altamente prevalente en pacientes en tratamiento con diálisis, siendo un importante marcador de riesgo para morbimortalidad. Entre los diversos parámetros disponibles para evaluación de la condición nutricional, la medida del Ángulo de Fase (AF) se ha señalado como marcador útil para evaluar a pacientes en hemodiálisis (HD). Objetivo: Evaluar la asociación del AF con parámetros de evaluación del estado nutricional en pacientes en HD. Métodos: Se realizó un estudio transversal entre febrero y julio de 2016 en dos unidades de hemodiálisis, de Recife, Nordeste brasileño. Resultados: Se evaluó a 101 pacientes, con edades de 51,7±16,8 años e IMC de 24,3±4,5 kg/m². El promedio del AF fue 5,6±1,7° y se correlacionó inversamente con la edad (r= −0,222; p= 0,024) y con el % grasa (r= −0,219; p= 0,026) y directamente con la altura (r= 0,286; p= 0,003), con el índice de masa muscular esquelética (r= 0,269; p= 0,006), con la fuerza de agarre palmar (r= 0,627;p <0,001), velocidad de marcha (r= 0,263; p= 0,008), masa libre de grasa (r= 0,303; p= 0,002) y creatininemia (r= 0,278; p= 0,004). Conclusiones: El AF presentó asociación con algunos parámetros de evaluación nutricional, que puede ser una medida útil adicional para reflejar la condición nutricional y evaluar la sarcopenia en pacientes en HD.

ABSTRACT Energy-protein malnutrition is highly prevalent in dialysis patients, being an important marker of risk for morbidity and mortality. Among the various parameters available for assessing nutritional status, the phase angle (PA) measurement has been indicated as a useful marker for evaluating patients on hemodialysis (HD). Objective: To evaluate the association of PA with parameters of nutritional status in patients on HD. Methods: We performed a cross-sectional, observational study from February to July, 2016, in two hemodialysis units, in the city of Recife, Northeastern Brazil. Results: A total of 101 patients were evaluated, with a mean age of 51.7±16.8 years and mean BMI of 24.3±4.5kg/m². The mean PA was 5.6±1.7°. PA was inversely correlated with age (r= −0.222; p= 0.024), fat% (r= −0.219; p= 0.026) and positively with height (r= 0.267; p= 0.003), velocity speed (r= 0.267; p= 0.003), skeletal muscle mass index (r= 0.269; p= 0.006), fat free mass (r= 0.303; p= 0.002) and serum creatinine (r= 0.278; p= 0.004). Conclusions: PA was associated with some parameters of nutritional status. Thus, it may be an additional useful measure to reflect nutritional status and to evaluate sarcopenia in patients on HD.

Bioelectrical Impedance Analysis for Prediction of Early Complications after Gastrectomy in Elderly Patients with Gastric Cancer: the Phase Angle Measured Using Bioelectrical Impedance Analysis

PURPOSE: Phase angle obtained using bioelectrical impedance analysis (BIA) provides a relatively precise assessment of the nutritional status of elderly patients. This study aimed to evaluate the significance of phase angle as a risk factor for complications after gastrectomy in elderly patients. MATERIALS AND METHODS: We evaluated 210 elderly patients (aged ≥65 years) who had undergone gastrectomy for gastric cancer between August 2016 and August 2017. The phase angle cutoff value was calculated using receiver operating characteristic curve analysis according to sex. A retrospective analysis regarding the correlation between early postoperative complications and well-known risk factors, including the phase angle, was performed. RESULTS: Multivariate analysis revealed that the presence of two or more comorbidities (odds ratio [OR], 3.675) and hypoalbuminemia (OR, 4.059) were independent risk factors for overall complications, and female sex (OR, 2.993) was independent risk factor for severe complications. A low phase angle (OR, 2.901 and 4.348, respectively) and total gastrectomy (OR, 4.718 and 3.473, respectively) were independent risk factors for both overall and severe complications. CONCLUSIONS: Our findings show that preoperative low phase angle predicts the risk of overall and severe complications. Our findings suggest that BIA should be performed to assess the risk of postoperative complications in elderly patients with gastric cancer.

Ângulo de fase e indicadores de risco do (e indicadores de riesgo del) estado nutricional em pacientes pré-cirúrgicos / The phase angle and indicators of risk and nutritional status in pre-surgical patients

Introduction: Malnutrition is an important risk factor for postoperative complications and the phase angle (PA) marker, since it is interpreted as an indicator of membrane integrity and as a predictor of body cell mass. It has been described as a useful parameter to identify malnutrition. Objective: To verify the association between PA and indicators of risk screening and assessment of nutritional status in pre-surgical patients. Methods: Observational study performed in the period from May to December 2014 in a university hospital in the Northeast of Brazil, including 83 patients in the preoperative period. We studied demographic, clinical, anthropometric variables (body mass index (BMI), arm circumference (AC)), Nutritional Risk Screening (NRS, 2002), and PA through bioelectrical impedance. Results: The mean age was 51.3 ± 14.9 years, predominantly female (73.5%). There was a predominance of oncological surgeries (53%). A prevalence of 27.7% of low PA, 30.1% of nutritional risk and 27.7% of malnutrition was observed, according to AC. A positive correlation with the other parameters (BMI and AC) was observed in relation to age (r = -0.421; p <0.001) and nutritional screening (r = -0.216; p = 0.049). Conclusion: FA showed moderate correlation with anthropometric and nutritional risk parameters, suggesting caution in the isolated adoption of this parameter as a diagnostic method and nutritional risk indicator in surgical patients.

Introdução: A desnutrição é um fator de risco (La desnutrición es un factor de riesgo) importante de complicações pós-operatórias e o ângulo de fase (AF), por ser interpretado (y el ángulo de fase, al ser interpretado) como indicador de integridade de membrana e preditor de massa celular corporal, tem sido descrito como um (se describe como un) parâmetro útil para identificar a desnutrição. Objetivo: Verificar a associação entre o AFe indicadores de triagem de risco e de avaliação do (de clasificación del riesgo y de evaluación del) estado nutricional em pacientes pré-cirúrgicos. Métodos: Estudo observacional realizado no período de maio a dezembro/2014 em hospital universitário localizado no Nordeste brasileiro, envolvendo 83 pacientes no período (incluyendo 83 pacientes en el período) pré-operatório. Foram estudadas variáveis (Se estudiaron variables) demográficas, clínicas, antropométricas (índice de massa corporal (IMC), circunferência do braço (del brazo) (CB), triagem de risco nutricional através da Nutritional Risk Screening (NRS, 2002), e o AF através da impedância bioelétrica. Resultados: A média de idade foi (La media de edad fue de) 51.3 ± 14.9 anos, predominando o sexo feminino (73.5%). Verificou-se predomínio das cirurgias oncológicas (53%). Foi observada prevalência de 27.7% de baixo (de bajo) AF, 30.1% de risco nutricional 27.7% de desnutrição, segundo a (según la) CB. Foi observada uma correlação inversa do AF com a idade (Se observó una correlación inversa del AF en relación con la edad) (r =-0.421; p < 0.001), e triagem nutricional (r = -0.216; p = 0.049), e correlação positiva com os demais (con los otros) parâmetros (IMC e CB). Conclusão: O AF mostrou correlação moderada com os parâmetros antropométricos e de risco nutricional, sugerindo cautela na adoção isolada desse (y de riesgo nutricional, lo que sugiere cautela en la adopción aislada de este) parâmetro como método diagnóstico e indicador de risco nutricional em pacientes cirúrgicos.

Feedback of Dynamic Responses from the Middle Ear for Round Window Closure with Different Pathology / 医用生物力学

Objective To analyze the influence of round window lesion on dynamic responses from the middle ear. Methods Based on CT scan images of healthy human ear, the three-dimensional finite element model of human ear was rebuilt by PATRAN software, then NASTRAN software was applied to conduct coupled solid-fluid frequency response analysis. The feedback of round window lesion on dynamic response of the middle ear was investigated by numerical simulation. Results Round window closure caused by sclerosis led to more decline in amplitude of stapes than congenital round window closed, maximally can reach 30.2 dB, and the latter had no obvious influence on velocity of stapes. In term of phase angle, on condition of sclerosis, change of phase for stapes and round window reached 90° at most and kept a difference value of 180°. In contrast, on condition of congenital round window closed, change of phase for stapes reached 270° at most，meanwhile change of phase for round window disappeared. Conclusions The dynamic response of the middle ear showed different feedback to congenital and otosclerotic round window fixation based on amplitude, velocity and phase. The research findings provide the theoretical basis for diagnosing and fixing round window lesion in future.

High C-reactive protein instead of metabolic syndrome is associated with lower bioimpedance phase angle in individuals clinically screened for a lifestyle modification program

BACKGROUND: Phase angle (PhA) value is a useful tool for identifying cell membrane integrity dysfunction. It is known that metabolic syndrome (MetS) increases oxidative stress and inflammation; and consequently can promote cellular damage. We hypothesized that MetS and inflammatory blood markers could be associated with lower PhA values. Therefore, the aim of this study was to identify the association of PhA values with MetS and blood markers in individuals clinically screened for a lifestyle modification program. METHODS: In a cross-sectional study, 417 selected subjects (76 men and 341 women, 53.9 ± 9.4 years old) were evaluated. Assessments included clinics, anthropometric measures, body composition by bioimpedance, and laboratory blood markers, including plasma lipids, glucose, and C-reactive protein concentrations. According to the PhA median values, subjects were classified in low (≤6.3°) and high (>6.3°) PhA groups. RESULTS: Subjects with lower PhA values were older and showed lower body mass index, waist circumference, muscle mass index, creatinine, and uric acid; and higher gamma-GT and HDL cholesterol. Neither the presence of MetS nor the presence of the increasing number of MetS components was associated with PhA values. The logistic regression analysis adjusted for age, gender, body mass index, and muscle mass index showed that higherC-reactive protein concentrations (>3.0 mg/L) increased the odds of low PhA values (OR = 1.62; CI = 1.01­2.60).CONCLUSION: Higher C-reactive protein concentrations increased the odds of low PhA independently of the presence of MetS. Additionally, contrary to our hypothesis, MetS was not associated with PhA values.

Phase angle is associated with the length of ICU stay in patients with non-ST elevation acute coronary syndrome

Background: The aim of this study was to evaluate the associations between phase angle (PhA), sarcopenia, and the length of stay (LOS) in the coronary intensive care unit (ICU) in patients with non-ST acute coronary syndrome(NSTE-ACS).Methods: This was a prospective observational study that evaluated 80 patients with NSTE-ACS over the age of18 years, admitted to the ICU from January to June 2014. Upon admission, the patients'demographic information was recorded. Handgrip strength and bioelectrical impedance analysis (BIA) were performed, and blood samples were taken within the first 72 h of admission. All of the patients were followed during their ICU stays. Results: We evaluated 80 patients, five were excluded due to impossibility of assessing handgrip strength, and seven patients were not subjected to BIA. Thus, 68 patients with a mean age of 63.3 ± 13.1 years were included in the analysis. Among these patients, 60.1% were male, 27.9% of the patients had sarcopenia, 8.8% had LOSs≥8 days, and median phase angle was 6.5 (6.1­7.3)°. Multiple logistic regression adjusted for age and gender revealed tha PhA was not associated with the presence of sarcopenia. Additionally, PhA (OR 0.337; CI 95% 0.118­0.961;p= 0.04)but not sarcopenia (OR 0.517; CI 95% 0.055­4.879;p= 0.56) was associated with an increased LOS. Conclusions: PhA is associated with LOS in patients with NSTE-ACS. Additionally, there was no association between PhA and sarcopenia.

Características clínicas y bioeléctricas determinadas por bioimpedancia en pacientes con enfermedad pulmonar obstructiva crónica / Clinical and bioelectric characteristics determined by bioimpedance in patients with chronic obstructive pulmonary disease

Se realizó un estudio descriptivo y transversal de 99 pacientes con enfermedad pulmonar obstructiva crónica, atendidos en consulta de Neumología del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba, del 1 al 15 de febrero de 2015, con vistas a determinar algunos compartimientos de la composición corporal, según el modelo de organización bicompartimental del cuerpo humano y el método de la bioimpedancia eléctrica. En la serie predominaron el sexo masculino y las edades de 50 a 69 años de edad, y los grados III y II, en ese orden de frecuencia, fueron los más representativos de la enfermedad. Por su parte, la desnutrición y la disfunción muscular resultaron 2 factores determinantes de la gravedad clínica y el pronóstico de la afección. De los parámetros bioeléctricos analizados, se ratificó la masa muscular esquelética como el de supervivencia y de morbilidad y mortalidad; asimismo se demostró el ángulo de fase como parámetro de la bioimpedancia, mayormente establecido para el diagnóstico y el pronóstico clínicos

A descriptive and cross-sectional study of 99 patients with chronic obstructive pulmonary disease was carried out. They were assisted in the Pneumology Service Dr Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, from February 1st to 15th, 2015 aimed at determining some compartments of body composition, according to the pattern of bicompartment organization of the human body and the method of the electric bioimpedance. In the series there was a prevalence of the male sex aged 50 to 69, and a higher frequency of III and II degrees (in that order) of the disease. On the other hand, malnutrition and muscular dysfunction were the 2 determining factors of clinical severity and prognosis of the disorder. Of the bioelectric parameters analyzed, the skeletal muscular mass was ratified as that of survival, morbidity and mortality; also the phase angle was demonstrated as bioimpedance parameter, mostly established for the clinical diagnosis and prognosis

Modificación del volumen de los compartimientos líquidos corporales en pacientes tratados con cirugía correctora por cardiopatía isquémica / Volume modification of body fluids compartments in patients treated with corrective surgery due to ischemic heart disease

Se realizó un estudio descriptivo, longitudinal y prospectivo de 36 pacientes del sexo masculino con cardiopatía isquémica, intervenidos mediante cirugía correctora sin circulación extracorpórea en el Centro Territorial de Cirugía Cardiovascular de Santiago de Cuba, durante el primer cuatrimestre de 2010, a fin de identificar las modificaciones del vector de impedancia ante cambios del volumen del agua corporal por estrés quirúrgico en comparación con una población de referencia, para lo cual se utilizó el método de bioimpedancia eléctrica a 50 kHz. En la serie se apreciaron diferencias significativas en el eje mayor de las elipses de tolerancia (asociado al estado de hidratación) y en el eje menor (asociado a cambios de estructura), y la distribución del agua fue significativamente diferente entre la población de referencia y los pacientes en los estados preoperatorio y posoperatorio. Pudo concluirse que el método del análisis vectorial por bioimpedancia resulta útil para detectar las modificaciones del volumen de agua corporal provocadas por el estrés quirúrgico

A descriptive, longitudinal and prospective study of 36 patients of the male sex with ischemic heart disease was carried out. They were surgically treated by means of corrective surgery without extracorporeal circulation in the Territorial Center of Cardiovascular Surgery in Santiago de Cuba, during the first quarter of 2010, in order to identify the modifications of the impedance vector because of volume changes in body water due to surgical stress in comparison with a reference population, for which the electric bioimpedance method was used at 50 kHz. In the series significant differences in the highest axis of the tolerance ellipses were seen (associated to the hydration state) and in the smallest axis (associated to structure changes), and the distribution of water was significantly different between the reference population and the patients in the preoperative and postoperative conditions. It was concluded that the method of the vectorial analysis through bioimpedance is useful to detect the volume modifications of the body water caused by surgical stress

The use of bioelectrical impedance phase angle for predicting protein-energy wasting in hemodialysis patients / 中华临床营养杂志

Objective To evaluate the use of bioelectrical impedance phase angle (PhA) for predicting protein-energy wasting (PEW) in hemodialysis patients.Methods This cross-sectional study involved 144 patients who were on maintenance hemodialysis (MHD) in the blood purification centers of two tertiary hospitals in Guangzhou,where the body impedance analysis (BIA) was performed after the hemodialysis procedure and the prevalence of protein-energy wasting (PEW) was investigated by the 7-point subjective global assessment (SGA) among.Nutritional indices of the patients with PEW were compared with the well-nourished patients to identify independent variables that can predict PEW and determine the cut-off value of PhA as a predictor.Results The patients with PEW had significantly lower PhA values than the Non-PEWpatients (t =8.68,P=0.00).PhA was positively related with the nutritional indices reflecting function of body proteins or muscles,such as serum albumin (rs=0.25,P=0.00),prealbumin (rs=0.31,P=0.00),free fat mass index (rs=0.25,P=0.00),and mid-arm muscle circumference (rs =O.44,P =O.00).However,the correlations of PhA with fat mass (rs =0.04,P=0.66) and body fat percentage (rs =-0.04,P=0.66) were no statistical significance.Multivariate logistic regression analysis revealed that PhA (OR =4.48,P =0.00) and body mass index (OR =1.59,P =0.00) were independent predictors of PEW,but PhA was more potent than BMI.Receiver operating characteristic curve analysis suggested that the optimum PhA cut-off point for predicting PEW was 4.6.Conclusion PhA can be a useful independent predictor for PEW in hemodialysis patients and its cut-off value is 4.6.

The predicting role of bioelectrical impedance phase angle analysis in the evaluation of nutrition risk and hospital length of stay in thoracic surgery patients / 肠外与肠内营养

Objective:To explore the association between phase angle (PA) of bioelectrical impedance analysis (BIA) and nutritional risk assessed by Nutritional Risk Screening (NRS-2002) Subjective Global Assessment (SGA),and hospital length of stay (LOS) in patients undergoing thoracic surgery.Methods:60 patients who underwent thoracic surgery were evaluated for nutrition risk and hospital length of stay (LOS) by NRS2002,SGA,albumin and bioelectrical impedance analysis.Results:The PA values were lower in the patients [men(3.85 ± 1.0)°,women(4.9 ± 0.6)°] than the control group [men(6.0 ± 1.0)°,women(5.4 ± 0.9)°,P ＜ 0.01].Patients were more likely to have lower PA values than the control group.NRS 2002:no risk (relative risk (RR) 2.8,95％ confidence interval (CI) =1.2 ～ 6.9),moderate risk (RR 3.9,95％ CI =1.8 ～ 8.6) and severe risk (RR 4.2,95％ CI =2.0 ～ 8.7);similar results were obtained by SGA:eutrophy (RR 2.5,95％ CI =0.9 ～ 6.9),Moderate malnutrition (RR 4.4,95％ CI =2.1 ～ 9.4),severe malnutrition (RR 3.9,95％CI =1.9 ～ 8.0);Patients with low PA values were more inclined to be hospitalized for more than 21 days compared with the control group (LOS ≥ 21 days,RR =4.4,95％ CI =2.2 ～ 2.8).Conclusion:There is a significant association between low PA values and nutritional risk and prolonged LOS.PA is helpful to identify patients who are at nutritional risk at hospital admission in order to provide an objective basis for determining the nutritional interventions of patients and judging the outcomes of the diseases.

Application of phase angle in estimating malnutrition and clinical practice / 中华临床营养杂志

Phase angle (PA), derived by bioelectrical impedance analysis, has been used to evaluate nutritional status.It has a unique advantage in diagnosing early malnutrition related to diseases by the detection of human body cell membrane integrity and fluid composition change, and being associated with bad disease prognosis in part of clinical research.Because of its non-invasive, convenient, accurate and affordable technique, it has a wide prospect of clinical application.However, lack of uniform PA reference value somehow limited its application.We summarize the latest clinical research and application situation of PA, and explore the characteristics and the influence factors of PA in different disease group, in order to provide theoretical basis for the Chinese PA reference range.

Phase angle and World Health Organization criteria for the assessment of nutritional status in children with osteogenesis imperfecta / Ângulo de fase e critérios da Organização Mundial de Saúde na avaliação do estado nutricional em crianças com osteogênese imperfeita

Abstract Objective: To compare the phase angle of patients with osteogenesis imperfecta treated at a tertiary university hospital with patients in a control group of healthy children, and to assess the nutritional status of these patients through the body mass index proposed by the World Health Organization. Methods: Cross-sectional study carried out in a university hospital that included seven patients with osteogenesis imperfecta and a control group of 17 healthy children of the same gender and age. Weight and height were measured and bioelectrical impedance was performed. Subsequently, the phase angle was calculated based on resistance and reactance values. Results: The phase angle of the group of children with osteogenesis imperfecta was significantly lower than that of the control group (p<0.05). The body mass index criterion for age of the World Health Organization showed no difference between groups. Conclusions: Children with osteogenesis imperfecta have a nutritional risk detected by the phase angle, which is a useful tool for nutritional screening. The calculation result could help in the diet therapy of patients with osteogenesis imperfecta.

Resumo Objetivo: Comparar o ângulo de fase de pacientes com osteogênese imperfeita atendidos em um hospital universitário terciário com pacientes de um grupo controle de crianças saudáveis, bem como avaliar o estado nutricional desses pacientes pelo índice de massa corporal proposto pela Organização Mundial de Saúde. Métodos: Estudo transversal feito em hospital universitário que incluiu sete pacientes com osteogênese imperfeita e um grupo controle composto por 17 crianças saudáveis de mesmo sexo e idade. Foram aferidos peso e estatura e foi feito o exame de impedância bioelétrica. Posteriormente, o ângulo de fase foi calculado a partir dos valores de resistência e reactância. Resultados: O ângulo de fase do grupo de crianças com osteogênese imperfeita foi significativamente menor do que o do grupo controle (p<0,05). O critério de índice de massa corporal por idade da Organização Mundial de Saúde não mostrou diferença entre os grupos. Conclusões: Crianças com osteogênese imperfeita têm um risco nutricional detectado pelo ângulo de fase, é uma ferramenta útil para triagem nutricional. O resultado do cálculo poderia auxiliar a dietoterapia de pacientes com osteogênese imperfeita.