Use of Bioelectrical Impedance Analysis for the Assessment of Nutritional Status in Critically Ill Patients

Abstract

Malnutrition is common in the critically ill patients and known to cause a variety of negative clinical outcomes. However, various conventional methods for nutrition assessment have several limitations. We hypothesized that body composition data, as measured using bioelectrical impedance analysis (BIA), may have a significant role in evaluating nutritional status and predicting clinical outcomes in critically ill patients. We gathered clinical, biochemical, and BIA data from 66 critically ill patients admitted to an intensive care unit. Patients were divided into three nutritional status groups according to their serum albumin level and total lymphocyte counts. The BIA results, conventional indicators of nutrition status, and clinical outcomes were compared and analyzed retrospectively. Results showed that the BIA indices including phase angle (PhA), extracellular water (ECW), and ECW/total body water (TBW) were significantly associated with the severity of nutritional status. Particularly, PhA, an indicator of the health of the cell membrane, was higher in the well-nourished patient group, whereas the edema index (ECW/TBW) was higher in the severely malnourished patient group. PhA was positively associated with albumin and ECW/TBW was negatively associated with serum albumin, hemoglobin, and duration of mechanical ventilation. In non-survivors, PhA was significantly lower and both ECW/TBW and %TBW/fat free mass were higher than in survivors. In conclusion, several BIA indexes including PhA and ECW/TBW may be useful for nutritional assessment and represent significant prognostic factors in the care of critically ill patients.

Optimization of Nutrition Therapy with the Use of Calorimetry to Determine and Control Energy Needs in Mechanically Ventilated Critically Ill Patients: The ONCA Study, a Randomized, Prospective Pilot Study

“…PhA has also been suggested to be a prognostic marker for nutrition status in ICU patients . Accordingly, we showed that inadequate nutrition support in the SC group led to a lower PhA and, thus, to reduced nutrition status.…”

“…PhA has also been suggested to be a prognostic marker for nutrition status in ICU patients. 21,28 Accordingly, we showed that inadequate nutrition support in the SC group led to a lower PhA and, thus, to reduced nutrition status. In some studies, further relationships have been reported, eg, between PhA and mortality, 22,[29][30][31] or between PhA and length of hospital 22,37 and ICU stay.…”

“…We selected a particular outcome parameter for the assessment of nutrition status: the PhA measured by BIA. PhA is one of the few nutritionrelated parameters with a proven prognostic effect for risk of malnutrition, [21][22][23]28 survival in cancer patients, 29 and severity of illness or mortality in ICU patients. [30][31][32] Our results strongly suggested that intensified nutrition therapy, including the measurement of energy expenditure by IC instead of estimation with a formula, leads to an intensified adaptation of nutrition to individual needs and, thus, might be relevant for the general outcome of ICU patients.…”

Методичні Рекомендації ESPEN Щодо Клінічного Харчування У Відділенні Інтенсивної Терапії

“…Á³îåëåêòðè÷íèé îï³ð ìîaeå âèêîðèñòîâóâàòèñü äëÿ îö³íêè ñêëàäó òêàíèí ò³ëà ³, ïåðåâàaeíî, áåçaeèðîâî¿ ìàñè ò³ëà КЛІНІЧНІ РЕКОМЕНДАЦІЇ / НАСТАНОВИ ó ñòàá³ëüíîãî ïàö³ºíòà, ùî íå ñòðàaeäຠíà ïîðóøåííÿ ð³äèííèõ êîìïàðòìåíò³â [34]. Ó ðÿä³ äîñë³äaeåíü îïèñàí³ ïåðåâàãè á³î³ìïåäàíñó [35][36][37][38] ³ ïåðåâàaeíî ôàçîâîãî êóòà [39] â îö³íö³ ïðîãíîçó äëÿ òÿaeêîõâîðèõ ïàö³ºíò³â. Ïðîòå éîãî çàñòîñóâàííÿ íå º ïîøèðåíîþ ïðàêòèêîþ.…”

Assessment methods of body composition

“…Dnevna kolebanja sadržaja telesne vode uslovljenih unosom hrane, vode i fizičkom aktivnošću [18] mogu imati uticaja na preciznost i tačnost metode. Pouzdanost dobijenih vrednosti zavisi i od drugih faktorapoložaja tela, trajanja merenja, hidriranosti, faze mensturalnog ciklusa kod žena i dr. Metoda ima svoju primenu u različitim populacijama zdravih i bolesnih ljudi, kada se može koristiti i za procenu malnutricije kod kritično obolelih [19,20].…”