The Bioimpedance Phase Angle Predicts Low Muscle Strength, Impaired Quality of Life, and Increased Mortality in Old Patients With Cancer

Norman, Kristina; Wirth, Rainer; Neubauer, M; Eckardt, Rahel; Stobäus, N.

doi:10.1016/j.jamda.2014.10.024

Cited by 150 publications

(121 citation statements)

References 33 publications

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“…Norman et al found that patients below the fifth reference PA percentile had a higher fatigue score than did patients above the fifth percentile, using EORTC QLQ-C30 fatigue (fatigue score of 59.4 vs 46.4, P < 0.0001). 28 The same study also demonstrated a significant correlation between PA and other objective measures, including handgrip strength and others, which was observed and published in our original report as well. 31 …”

Section: Discussionsupporting

confidence: 83%

Could Objective Tests Be Used to Measure Fatigue in Patients With Advanced Cancer?

Schvartsman

Park

Liu

et al. 2017

Journal of Pain and Symptom Management

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Context Assessment of cancer-related fatigue is currently based on patient-reported outcomes. We asked whether objective assessments such as muscle strength and nutritional markers can be used as surrogate measures of cancer-related fatigue. Objective We examined the association among three fatigue scales, muscle strength, and nutritional markers in patients with advanced cancer. Methods In this prospective study, we enrolled hospitalized cancer patients who had been seen in palliative care consultation at MD Anderson Cancer Center. We assessed fatigue with use of three fatigue scales—the Brief Fatigue Inventory (BFI), the Edmonton Symptom Assessment System (ESAS), and the European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire 30 (EORTC QLQ-C30)—and determined their association with objective assessments, including handgrip strength, maximal inspiratory pressure (MIP), lean body mass, phase angle, and albumin. Spearman’s correlation test was used to assess associations. Results Among 222 patients, the mean age was 55 years; 59% were female. The median overall survival was 106 days. The total BFI score had weak association with handgrip strength (ρ = −0.18, P = 0.007) and no association with the remaining objective measures. ESAS fatigue and EORTC fatigue showed similar findings. Total BFI had moderate to strong association with ESAS (ρ = 0.54, P < 0.0001) and EORTC (ρ = 0.60, P < 0.0001) fatigue. Conclusion Our study showed that subjective assessment of fatigue based on patient-reported outcomes correlates only weakly with muscle strength and nutritional markers; thus, patient-reported outcomes remain the gold standard for fatigue assessment.

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Section: Discussionsupporting

confidence: 83%

Could Objective Tests Be Used to Measure Fatigue in Patients With Advanced Cancer?

Schvartsman

Park

Liu

et al. 2017

Journal of Pain and Symptom Management

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“…Aside from the effectiveness as a prognostic indicator of survival, as previously reported, our results support the predictive ability of phase angle for health adverse events among community‐dwelling elderly. Largely, phase angle has been validated among patient populations, such as cancer and haemodialysis patients, as predictors of disease prognosis, impaired quality of life, malnutrition, and increased mortality . Findings of the present study suggested the usefulness of phase angle as a routine assessment in community‐based health screening and indicated simple and highly prognostic cut‐off values for the detection of older individuals at high risk of disability in the near future.…”

Section: Discussionmentioning

confidence: 64%

“…Recently, there is a growing body of evidence indicating that phase angle could be used as a notable prognostic marker to predict impaired nutritional status, disease prognosis, and mortality risk in patient populations. In community‐dwelling general populations, phase angle has been shown to decrease with aging and correlates positively with muscle strength .…”

Section: Introductionmentioning

confidence: 99%

Predictivity of bioimpedance phase angle for incident disability in older adults

Uemura

Doi

Tsutsumimoto

et al. 2019

J cachexia sarcopenia muscle

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Background Bioelectrical impedance analysis (BIA)‐derived phase angle is expected to be an efficient prognostic marker of health adverse events with aging as an alternative of muscle mass. We aimed to examine the predictive ability of phase angle for incident disability in community‐dwelling elderly and determine the optimal cut‐off values. Methods Community‐dwelling elderly aged ≥65 years (n = 4452; mean age = 71.8 ± 5.3 years, 48.3% women) without disability at baseline participated in this prospective cohort study. Phase angle and appendicular skeletal muscle mass (ASM) were examined using a multi‐frequency BIA at baseline. Other potential confounding factors (demographics, cognitive function, depressive symptoms, medications, and physical performance) were also assessed. Incident disability was monitored on the basis of long‐term care insurance certification. Results Over a follow‐up of 24 months, 4.0% (n = 174) experienced disability, with an overall incidence rate of 20.6 per 1000 person‐years. The Cox hazard regression analysis showed that phase angle, as a continuous variable, was independently associated with incident disability after adjusting the covariates [male: hazard ratios (HRs) = 0.61, 95% confidence interval (CI) = 0.37–0.98; female: HR = 0.58, 95% CI = 0.37–0.90], although body mass index adjusted ASM was not. Receiver operating characteristic analysis indicated moderate predictive abilities of phase angle for incident disability [male: area under the receiver operating characteristic curve (AUC) = 0.76, 95% CI = 0.70–0.83; female: AUC = 0.71, 95% CI = 0.65–0.76], while those of body mass index adjusted ASM were low (male: AUC = 0.59, 95% CI = 0.521–0.66; female: AUC = 0.58, 95% CI = 0.52–0.63). Multivariate Cox regression analysis showed that low phase angle categorized by cut‐off value (male, ≤4.95°; female, ≤4.35°) was independently related to increased risk of incident disability (HR = 1.95, 95% CI = 1.37–2.78). Conclusions Lower phase angle independently predicts the incident disability separately from known risk factors. BIA‐derived phase angle can be used as a valuable and simple prognostic tool to identify the elderly at risk of disability as targets of preventive treatment.

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“…Observational studies have found a direct association between phase angle and different functional indexes, such as handgrip strength, knee extension strength, and maximum quadriceps strength . Phase angle was also directly associated with nutritional status in adults, and in children and adolescents .…”

Section: Introductionmentioning

confidence: 91%

“…Phase angle is a marker of health and cellular integrity and is associated with nutritional status and disease prognosis . The phase angle may range from 2.0 to 9.5 degrees, with lower values being found in individuals diagnosed with cancer, kidney disease, and HIV + .…”

Section: Introductionmentioning

confidence: 99%

Phase angle is associated with the physical fitness of HIV‐infected children and adolescents

Martins

Lima

Silva

et al. 2019

Scandinavian Med Sci Sports

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The objective of this study was to identify the association of phase angle with physical fitness in children and adolescents infected with HIV. Sixty‐four children and adolescents infected with HIV (8‐15 years old) were tested for vertical transmission. The electrical bioimpedance was used to obtain the phase angle. Body fat (BF) and lean soft tissue mass (LSTM) were measured by x‐ray absorptiometry, and the manual grip strength was evaluated by dynamometry. The peak oxygen consumption (VO2 peak) was measured by respiratory change in a submaximal incremental test. Moderate‐vigorous physical activity (MVP) and sedentary behavior were measured using accelerometers and were used as covariates. Multiple linear regression was used. The linear correlation analyses demonstrated that the phase angle was inversely proportional to relative BF (r = −0.26), but was not associated with absolute body fat (r = −0.02). The phase angle was directly associated with LSTM (r = 0.57), handgrip strength, and (r = 0.43) peak VO2 (r = 0.55). The phase angle was not associated with absolute BF (β = −0.017, P = 0.413) and relative (β = −0.014, P = 0.175). The phase angle presented a direct association with LSTM (β = 0.041, P = 0.019) and peak VO2 (β = 0.005; P = 0.019), regardless of age, sex, sexual maturation, MVPA, sedentary behavior, antiretroviral drugs, and viral load. No association was found between phase angle and handgrip strength (β = 0.153; P = 0.199). It was concluded that phase angle was associated with LSTM and the aerobic fitness in HIV‐infected children and adolescents.

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The Bioimpedance Phase Angle Predicts Low Muscle Strength, Impaired Quality of Life, and Increased Mortality in Old Patients With Cancer

Cited by 150 publications

References 33 publications

Could Objective Tests Be Used to Measure Fatigue in Patients With Advanced Cancer?

Could Objective Tests Be Used to Measure Fatigue in Patients With Advanced Cancer?

Predictivity of bioimpedance phase angle for incident disability in older adults

Phase angle is associated with the physical fitness of HIV‐infected children and adolescents

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