Nutritional evaluation in cirrhosis: Emphasis on the phase angle

Abstract

Protein-calorie malnutrition (PCM) is a common condition in cirrhotic patients, leading to a worse prognosis, complications, poor quality of life and lower survival rates. Among ways of assessing nutritional status, there are anthropometric methods such as the evaluation of the triceps skinfold, the arm circumference, the arm muscle circumference and the body mass index, and non-anthropometric methods such as the subjective global assessment, the handgrip strength of non-dominant hand, and the bioelectrical impedance analysis (BIA). PCM is frequently under-diagnosed in clinical settings in patients with cirrhosis due to the limitations of nutritional evaluation methods in this population. BIA is a useful method, but cannot be indicated in patients with abnormal body composition. In these situations, the phase angle (PA) has been used, and can become an important tool in assessing nutritional status in any situation. The PA is superior to anthropometric methods and might be considered as a nutritional indicator in cirrhosis. The early characterization of the nutritional status in patients with cirrhosis means an early nutritional intervention, with a positive impact on patients’ overall prognosis. Among the usually accepted methods for nutritional diagnosis, the PA provides information in a quick and objective manner.

Bioelectrical Impedance Analysis–Derived Measurements in Chronic Hepatitis C: Clinical Relevance of Fat‐Free Mass and Phase Angle Evaluation

“…In agreement with a previous study, we found that cirrhosis and malnourishment were associated with low PhA, which has been considered a predictor of poor survival in patients with chronic liver disease . Importantly, this is the first study to demonstrate an association between low PhA and low FFM in patients with CHC.…”

“…Phase angle (PhA) is another nutrition BIA-derived measurement that has also been used in the management of patients with chronic liver diseases. 13 Particularly in cirrhotic patients, a low level of PhA has been found to be a predictor of poor survival. 13 The pathogenesis of MM loss in patients with CHC is multifactorial and not fully understood.…”

“…13 Particularly in cirrhotic patients, a low level of PhA has been found to be a predictor of poor survival. 13 The pathogenesis of MM loss in patients with CHC is multifactorial and not fully understood. We hypothesized that host factors beyond the cirrhotic liver and the nutrition status, including clinical comorbidities and lifestyle data, would have an influence on FFMI and PhA in these patients.…”

The value of grip test, lysophosphatidlycholines, glycerophosphocholine, ornithine, glucuronic acid decrement in assessment of nutritional and metabolic characteristics in hepatitis B cirrhosis

“…In view of the limitations of BIA, the clinically established bioelectrical impedance parameter is the phase angle [41]. BIA is represented by the vector Z, which is a combination of the perpendicular vectors R and Xc.…”

The Challenges of Nutritional Assessment in Cirrhosis

“…More specifically, R is associated with hydration, whereas Xc reflects cellularity and cells integrity. The PA data correlated significantly with the presence of malnutrition and with the stage of liver disease, indicating that it might be considered a good prognostic marker in patients with cirrhosis, with and without edema and/or ascites [30]. This information appears clinically relevant and it should be confirmed by larger clinical trials during long term follow-up.…”