The utility of bioelectrical impedance analysis to assess nutritional status of patients with severe motor and intellectual disabilities.

We aimed to evaluate the usefulness of the bioelectrical impedance analysis method in the nutritional assessment of patients with severe motor and intellectual disabilities. Eighty patients with severe motor and intellectual disabilities were included in the study, and the samples collected were biochemical and body composition data were obtained from regular blood samples and using the bioelectrical impedance analysis method. Nutritional status was scored from the biochemical data, and the subjects were divided into three groups: well-nourished, mildly malnourished, and moderately malnourished. The data that changed significantly with worsening nutritional status were serum albumin, total lymphocyte count, skeletal muscle ratio, phase angle, edema index, and body cell mass normalized by height. There were no significant differences in total lymphocyte count and body cell mass normalized by height between the groups. phase angle and edema index, which have been reported to be useful in nutritional assessment, responded sensitively to this nutritional score. Skeletal muscle ratio, which has been reported less frequently, has also been suggested to be useful in the nutritional assessment of severe motor and intellectual disabilities. Low skeletal muscle ratio, low phase angle, and high edema index were significantly suggestive of malnutrition in patients with severe motor and intellectual disabilities, and correlated significantly with biochemical data, a conventional nutritional index. Therefore, bioelectrical impedance analysis is a useful method for nutritional assessment in patients with severe motor and intellectual disabilities.

Yano N ，Iwashita D ，Ohwatashi A 《Clinical Nutrition ESPEN》

The utility of a phase angle analysis in patients with severe motor and intellectual disabilities.

The purpose of the present study was to evaluate whether evaluating the phase angle (PhA), in a bioelectrical impedance analysis (BIA) is useful for estimating the nutritional status of severe motor and intellectual disabilities (SMID) patients. This retrospective study included 31 SMID patients (mean age: 33.9±13.5years, median age: 29years (range: 18-58years), male/female: 23/8). First, each of the parameters from the total study population and the male and female SMID patients were compared with those of healthy Asian subjects. Second, correlation analyses were conducted to investigate the correlation between the PhA and the other BIA parameters (appendicular skeletal muscle mass index (ASMI), appendicular muscle mass (AMM), extracellular water (ECW)/total body water (TBW)) as well as subjective global assessment and serum nutritional markers. Finally, all patients were divided into 2 groups according to their albumin (Alb) (<3.5 or ≥3.5) values and PhA of the 2 groups were compared. The mean PhA and ASMI were a considerably low, whereas ECW/TBW was considerably high in comparison to the healthy Asian subjects. Significant negative correlations were observed between the PhA and ECW/TBW, whereas there were significant positive correlations between PhA and AMM, ASMI, total protein and albumin levels. Furthermore, PhA of Alb ≥3.5 group was significantly higher than that of Alb <3.5 group. The present study indicated that SMID patients demonstrate the low PhA, which were similar to sarcopenia and a certain proportion of them also potentially have nutritional disturbances.

Yoshida M ，Asagiri K ，Fukahori S ，Tanaka Y ，Hashizume N ，Ishii S ，Saikusa N ，Higashidate N ，Masui D ，Komatsuzaki N ，Nakahara H ，Yagi M ，Yamashita Y ... -  《-》

Bioelectrical impedance analysis (BIA)-derived phase angle (PA) is a practical aid to nutritional assessment in hospital in-patients.

Nutritional status can be difficult to assess. Bioelectrical impedance analysis (BIA)-derived phase angle (PA), and the plasma markers citrulline and transthyretin (pre-albumin) have the potential to assist, but the protocol of fasting and resting for BIA renders the investigation impractical for routine use, especially so in populations at high risk of malnutrition. 1 To clarify whether starving and resting are necessary for reliable measurement of PA. 2 To identify whether PA, citrulline and transthyretin correlate with nutritional status. Eighty consenting adult in-patients were recruited. Nutritional status was determined by subjective global assessment (SGA) used as gold standard. The Malnutrition Universal Screening Tool (MUST) was used and anthropometric measurements were performed. Serum was analysed for citrulline and transthyretin. PA was measured using Bodystat 4000. The PA was considered to define malnutrition when lower than reference ranges for sex and age, and severe malnutrition if more than 2 integers below the lower limit. Anthropometric measurements were categorised according to WHO reference centiles. Ordinal logistic regression estimated the strength of association of PA, citrulline and transthyretin with SGA. PA values in the different metabolic states were compared using paired t tests. All 80 subjects completed the BIA and the nutritional assessments in the 3 different states; 14 declined to provide blood samples for the biochemical assays. Malnutrition was identified in 32 cases, severe malnutrition in 14 cases, the remaining 34 cases were deemed not to be malnourished. PA was strongly inversely associated with SGA (Odds Ratio [OR] per unit increase = 0.21, CI 0.12-0.37, p < 0.001). PA was not influenced by exercise (p = 0.134) or food intake (p = 0.184). Transthyretin was inversely associated with malnourished/severely malnourished states (OR = 0.98, 95% CI 0.97-0.99, p = 0.001), but had poorer predictive values than PA. There was no significant association between citrulline concentration and SGA (OR = 1.01, 95% CI 0.99-1.04, p = 0.348). The BIA-derived PA reliably identifies malnutrition. It is strongly associated with SGA but requires less skill and experience, and out-performs circulating transthyretin, rendering it a promising and less operator-dependent tool for assessing nutritional status in hospital patients. Our novel demonstration that fasting and bed-rest are unnecessary consolidates that position.

Player EL ，Morris P ，Thomas T ，Chan WY ，Vyas R ，Dutton J ，Tang J ，Alexandre L ，Forbes A ... -  《-》

Association of Bioelectrical Impedance Analysis-Derived Phase Angle and Sarcopenia in Older Adults.

Kilic MK ，Kizilarslanoglu MC ，Arik G ，Bolayir B ，Kara O ，Dogan Varan H ，Sumer F ，Kuyumcu ME ，Halil M ，Ulger Z ... -  《-》

Body protein index based on bioelectrical impedance analysis is a useful new marker assessing nutritional status: applications to patients with chronic renal failure on maintenance dialysis.

Nakao T ，Kanazawa Y ，Nagaoka Y ，Iwasawa H ，Uchinaga A ，Matsumoto H ，Okada T ，Yoshino M ... -  《Contributions to Nephrology》