Low Phase Angle Values Are Associated with Malnutrition according to the Global Leadership Initiative on Malnutrition Criteria in Kidney Transplant Candidates: Preliminary Assessment of Diagnostic Accuracy in the FRAILMar Study.
[en] Malnutrition has a negative impact on patients with chronic diseases and its early identification is a priority. The primary objective of this diagnostic accuracy study was to assess the performance of the phase angle (PhA), a bioimpedance analysis (BIA)-derived parameter, for malnutrition screening using the Global Leadership Initiative for Malnutrition (GLIM) criteria as the reference standard in patients with advanced chronic kidney disease (CKD) waiting for kidney transplantation (KT); criteria associated with low PhA in this population were also analyzed. Sensitivity, specificity, accuracy, positive and negative likelihood ratios, predictive values, and area under the receiver operating characteristic curve were calculated for PhA (index test) and compared with GLIM criteria (reference standard). Of 63 patients (62.9 years old; 76.2% men), 22 (34.9%) had malnutrition. The PhA threshold with the highest accuracy was ≤4.85° (sensitivity 72.7%, specificity 65.9%, and positive and negative likelihood ratios 2.13 and 0.41, respectively). A PhA ≤ 4.85° was associated with a 3.5-fold higher malnutrition risk (OR = 3.53 (CI95% 1.0-12.1)). Considering the GLIM criteria as the reference standard, a PhA ≤ 4.85° showed only fair validity for detecting malnutrition, and thus cannot be recommended as a stand-alone screening tool in this population.
Disciplines :
Geriatrics
Author, co-author :
Muñoz-Redondo, Elena ; Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar-Hospital de l'Esperança), 08003 Barcelona, Spain ; Rehabilitation Research Group, Hospital del Mar Medical Research Group, 08003 Barcelona, Spain ; PhD Program in Medicine, Department of Medicine, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
Morgado-Pérez, Andrea; Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar-Hospital de l'Esperança), 08003 Barcelona, Spain ; Rehabilitation Research Group, Hospital del Mar Medical Research Group, 08003 Barcelona, Spain
Pérez-Sáez, María-José ; Nephrology Department, Hospital del Mar, 08003 Barcelona, Spain ; Kidney Disease Research Group, Hospital del Mar Medical Research Group, 08003 Barcelona, Spain ; Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Dr Aiguader Building (Mar Campus), 08003 Barcelona, Spain
Faura, Anna; Nephrology Department, Hospital del Mar, 08003 Barcelona, Spain
Sanchez Rodriguez, Maria Dolores Carmen ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé
Tejero-Sánchez, Marta; Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar-Hospital de l'Esperança), 08003 Barcelona, Spain ; Rehabilitation Research Group, Hospital del Mar Medical Research Group, 08003 Barcelona, Spain
Meza-Valderrama, Delky ; Rehabilitation Research Group, Hospital del Mar Medical Research Group, 08003 Barcelona, Spain ; Physical Medicine and Rehabilitation Department, National Institute of Physical Medicine and Rehabilitation (INMFRE), Diagonal a la Universidad Tecnológica de Panamá, Panama City 0819, Panama
Muns, María Dolors; Department of Endocrinology and Nutrition, Hospital del Mar, 08003 Barcelona, Spain
Marco, Ester; Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar-Hospital de l'Esperança), 08003 Barcelona, Spain ; Rehabilitation Research Group, Hospital del Mar Medical Research Group, 08003 Barcelona, Spain ; Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Dr Aiguader Building (Mar Campus), 08003 Barcelona, Spain
Language :
English
Title :
Low Phase Angle Values Are Associated with Malnutrition according to the Global Leadership Initiative on Malnutrition Criteria in Kidney Transplant Candidates: Preliminary Assessment of Diagnostic Accuracy in the FRAILMar Study.
ISCIII - Carlos III Health Institute EU - European Union
Funding text :
This research was funded by FIS-FEDER PI19/00037 (ISCIII) and co-funded by the European Union; it was also supported by a Projecte Estrella de Millora de la Qualitat del Parc de Salut Mar. M.J-.P.-S has been granted by the Spanish Society of Transplant.
Mansur H.N. Colugnati F.A. Grincenkov F.R. Bastos M.G. Frailty and quality of life: A cross-sectional study of Brazilian patients with pre-dialysis chronic kidney disease Health Qual. Life Outcomes 2014 12 27 10.1186/1477-7525-12-27
Wilkinson T.J. McAdams-DeMarco M. Bennett P.N. Wilund K. Advances in exercise therapy in predialysis chronic kidney disease, hemodialysis, peritoneal dialysis, and kidney transplantation Curr. Opin. Nephrol. Hypertens. 2020 29 471 479 10.1097/MNH.0000000000000627
Bellizzi V. Cupisti A. Capitanini A. Calella P. D’Alessandro C. Physical activity and renal transplantation Kidney Blood Press. Res. 2014 39 212 219 10.1159/000355799 25118089
Takahashi A. Hu S.L. Bostom A. Physical Activity in Kidney Transplant Recipients: A Review Am. J. Kidney Dis. 2018 72 433 443 10.1053/j.ajkd.2017.12.005 29482935
Johansen K.L. Dalrymple L.S. Delgado C. Chertow G.M. Segal M.R. Chiang J. Grimes B. Kaysen G.A. Factors Associated with Frailty and Its Trajectory among Patients on Hemodialysis Clin. J. Am. Soc. Nephrol. 2017 12 1100 1108 10.2215/CJN.12131116
Bousquet J. Bourret R. Camuzat T. Augé P. Bringer J. Noguès M. Jonquet O. de la Coussaye J.E. Ankri J. Cesari M. et al. MACVIA-LR (Fighting Chronic Diseases for Active and Healthy Ageing in Languedoc-Roussillon): A Success Story of the European Innovation Partnership on Active and Healthy Ageing J. Frailty Aging 2016 5 233 241 10.14283/jfa.2016.105 27883170
Carrero J.J. Johansen K.L. Lindholm B. Stenvinkel P. Cuppari L. Avesani C.M. Screening for muscle wasting and dysfunction in patients with chronic kidney disease Kidney Int. 2016 90 53 66 10.1016/j.kint.2016.02.025 27157695
Ohkawa S. Odamaki M. Yoneyama T. Hibi I. Miyaji K. Kumagai H. Standardized thigh muscle area measured by computed axial tomography as an alternate muscle mass index for nutritional assessment of hemodialysis patients Am. J. Clin. Nutr. 2000 71 485 490 10.1093/ajcn/71.2.485
Llames L. Baldomero V. Iglesias M.L. Rodota L.P. Values of the phase angle by bioelectrical impedance; nutritional status and prognostic value Nutr. Hosp. 2013 28 286 295 10.3305/nh.2013.28.2.6306 23822677
Uemura K. Doi T. Tsutsumimoto K. Nakakubo S. Kim M.J. Kurita S. Ishii H. Shimada H. Predictivity of bioimpedance phase angle for incident disability in older adults J. Cachexia Sarcopenia Muscle 2020 11 46 54 10.1002/jcsm.12492
Rinaldi S. Gilliland J. O’Connor C. Chesworth B. Madill J. Is phase angle an appropriate indicator of malnutrition in different disease states? A systematic review Clin. Nutr. ESPEN 2019 29 1 14 10.1016/j.clnesp.2018.10.010
Barazzoni R. Jensen G.L. Correia M. Gonzalez M.C. Higashiguchi T. Shi H.P. Bischoff S.C. Boirie Y. Carrasco F. Cruz-Jentoft A. et al. Guidance for assessment of the muscle mass phenotypic criterion for the Global Leadership Initiative on Malnutrition (GLIM) diagnosis of malnutrition Clin. Nutr. 2022 41 1425 1433 10.1016/j.clnu.2022.02.001 35450768
Ding Y. Chang L. Zhang H. Wang S. Predictive value of phase angle in sarcopenia in patients on maintenance hemodialysis Nutrition 2022 94 111527 10.1016/j.nut.2021.111527
Pérez-Sáez M.J. Morgado-Pérez A. Faura A. Muñoz-Redondo E. Gárriz M. Muns M.D. Nogués X. Marco E. Pascual J. The FRAILMar Study Protocol: Frailty in Patients With Advanced Chronic Kidney Disease Awaiting Kidney Transplantation. A Randomized Clinical Trial of Multimodal Prehabilitation Front. Med. 2021 8 675049 10.3389/fmed.2021.675049 34095178
Bossuyt P.M. Reitsma J.B. Bruns D.E. Gatsonis C.A. Glasziou P.P. Irwig L. Lijmer J.G. Moher D. Rennie D. de Vet H.C.W. et al. STARD 2015: An Updated List of Essential Items for Reporting Diagnostic Accuracy Studies Clin. Chem. 2015 61 1446 1452 10.1373/clinchem.2015.246280
Cederholm T. Jensen G.L. Correia M. Gonzalez M.C. Fukushima R. Higashiguchi T. Baptista G. Barazzoni R. Blaauw R. Coats A. et al. GLIM criteria for the diagnosis of malnutrition—A consensus report from the global clinical nutrition community Clin. Nutr. 2019 38 1 9 10.1016/j.clnu.2018.08.002 30181091
Schutz Y. Kyle U.U. Pichard C. Fat-free mass index and fat mass index percentiles in Caucasians aged 18-98 y Int. J. Obes. Relat. Metab. Disord. 2002 26 953 960 10.1038/sj.ijo.0802037 12080449
Tanaka S. Ando K. Kobayashi K. Hida T. Seki T. Suzuki K. Kenyu I. Tsushima M. Morozumi M. Machino M. et al. Relationship between locomotive syndrome and body composition among community-dwelling middle-age and elderly individuals in Japan: The Yakumo study Mod. Rheumatol. 2019 29 491 495 10.1080/14397595.2018.1465645
Lee Y. Kwon O. Shin C.S. Lee S.M. Use of bioelectrical impedance analysis for the assessment of nutritional status in critically ill patients Clin. Nutr. Res. 2015 4 32 40 10.7762/cnr.2015.4.1.32 25713790
Meza-Valderrama D. Chaler J. Marco E. Evaluación de la fuerza muscular en rehabilitación: De las escalas de valoración subjetivas a las exploraciones instrumentales Rehabilitación 2021 55 2 4 10.1016/j.rh.2020.06.007 33077184
Roberts H.C. Denison H.J. Martin H.J. Patel H.P. Syddall H. Cooper C. Sayer A.A. A review of the measurement of grip strength in clinical and epidemiological studies: Towards a standardised approach Age Ageing 2011 40 423 429 10.1093/ageing/afr051 21624928
Luna-Heredia E. Martín-Peña G. Ruiz-Galiana J. Handgrip dynamometry in healthy adults Clin. Nutr. 2005 24 250 258 10.1016/j.clnu.2004.10.007 15784486
Meza-Valderrama D. Sánchez-Rodríguez D. Perkisas S. Duran X. Bastijns S. Dávalos-Yerovi V. Da Costa E. Marco E. The feasibility and reliability of measuring forearm muscle thickness by ultrasound in a geriatric inpatient setting: A cross-sectional pilot study BMC Geriatr. 2022 22 137 10.1186/s12877-022-02811-3 35177006
Perkisas S. Bastijns S. Baudry S. Bauer J. Beaudart C. Beckwée D. Cruz-Jentoft A. Gasowski J. Hobbelen H. Jager-Wittenaar H. et al. Application of ultrasound for muscle assessment in sarcopenia: 2020 SARCUS update Eur. Geriatr. Med. 2021 12 45 59 10.1007/s41999-020-00433-9 33387359
Fried L.P. Tangen C.M. Walston J. Newman A.B. Hirsch C. Gottdiener J. Seeman T. Tracy R. Kop W.J. Burke G. et al. Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: Evidence for a phenotype J. Gerontol. A Biol. Sci. Med. Sci. 2001 56 M146 M156 10.1093/gerona/56.3.M146 11253156
Pérez-Sáez M.J. Redondo-Pachón D. Arias-Cabrales C.E. Faura A. Bach A. Buxeda A. Burballa C. Junyent E. Crespo M. Marco E. et al. Outcomes of Frail Patients While Waiting for Kidney Transplantation: Differences between Physical Frailty Phenotype and FRAIL Scale J. Clin. Med. 2022 11 672 10.3390/jcm11030672 35160125
Landis J.R. Koch G.G. An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers Biometrics 1977 33 363 374 10.2307/2529786 884196
Hayden S.R. Brown M.D. Likelihood ratio: A powerful tool for incorporating the results of a diagnostic test into clinical decisionmaking Ann. Emerg. Med. 1999 33 575 580 10.1016/S0196-0644(99)70346-X
Liu X. Classification accuracy and cut point selection Stat. Med. 2012 31 2676 2686 10.1002/sim.4509
Dumler F. Kilates C. Body composition analysis by bioelectrical impedance in chronic maintenance dialysis patients: Comparisons to the National Health and Nutrition Examination Survey III J. Ren. Nutr. 2003 13 166 172 10.1053/jren.2003.50022
WHO Recommendations A Healthy Lifestyle Available online: https://www.who.int/europe/news-room/fact-sheets/item/a-healthy-lifestyle---who-recommendations (accessed on 21 January 2023)
Liu Z.H. Zhang G.X. Zhang H. Jiang L. Deng Y. Chan F.S.Y. Fan J.K.M. Association of body fat distribution and metabolic syndrome with the occurrence of colorectal adenoma: A case-control study J. Dig. Dis. 2021 22 222 229 10.1111/1751-2980.12979 33656773
Minetto M.A. Caresio C. Menapace T. Hajdarevic A. Marchini A. Molinari F. Maffiuletti N.A. Ultrasound-Based Detection of Low Muscle Mass for Diagnosis of Sarcopenia in Older Adults PM&R 2016 8 453 462 10.1016/j.pmrj.2015.09.014
Hanna R.M. Ghobry L. Wassef O. Rhee C.M. Kalantar-Zadeh K. A Practical Approach to Nutrition, Protein-Energy Wasting, Sarcopenia, and Cachexia in Patients with Chronic Kidney Disease Blood Purif. 2020 49 202 211 10.1159/000504240 31851983
Chan W. Chronic Kidney Disease and Nutrition Support Nutr. Clin. Pract. 2021 36 312 330 10.1002/ncp.10658 33734473
Karavetian M. Salhab N. Rizk R. Poulia K.A. Malnutrition-Inflammation Score VS Phase Angle in the Era of GLIM Criteria: A Cross-Sectional Study among Hemodialysis Patients in UAE Nutrients 2019 11 2771 10.3390/nu11112771
Kaysen G.A. Zhu F. Sarkar S. Heymsfield S.B. Wong J. Kaitwatcharachai C. Kuhlmann M.K. Levin N.W. Estimation of total-body and limb muscle mass in hemodialysis patients by using multifrequency bioimpedance spectroscopy Am. J. Clin. Nutr. 2005 82 988 995 10.1093/ajcn/82.5.988
Pillon L. Piccoli A. Lowrie E.G. Lazarus J.M. Chertow G.M. Vector length as a proxy for the adequacy of ultrafiltration in hemodialysis Kidney Int. 2004 66 1266 1271 10.1111/j.1523-1755.2004.00881.x
Chamney P.W. Wabel P. Moissl U.M. Müller M.J. Bosy-Westphal A. Korth O. Fuller N.J. A whole-body model to distinguish excess fluid from the hydration of major body tissues Am. J. Clin. Nutr. 2007 85 80 89 10.1093/ajcn/85.1.80 17209181
Beberashvili I. Azar A. Sinuani I. Shapiro G. Feldman L.- Stav K. Sandbank J. Averbukh Z. Bioimpedance phase angle predicts muscle function, quality of life and clinical outcome in maintenance hemodialysis patients Eur. J. Clin. Nutr. 2014 68 683 689 10.1038/ejcn.2014.67 24736681
Basile C. Della-Morte D. Cacciatore F. Gargiulo G. Galizia G. Roselli M. Curcio F. Bonaduce D. Abete P. Phase angle as bioelectrical marker to identify elderly patients at risk of sarcopenia Exp. Gerontol. 2014 58 43 46 10.1016/j.exger.2014.07.009
Belarmino G. Gonzalez M.C. Torrinhas R.S. Sala P. Andraus W. D’Albuquerque L.A. Pereira R.M. Caparbo V.F. Ravacci G.R. Damiani L. et al. Phase angle obtained by bioelectrical impedance analysis independently predicts mortality in patients with cirrhosis World J. Hepatol. 2017 9 401 408 10.4254/wjh.v9.i7.401
Kosacka M. Korzeniewska A. Jankowska R. The evaluation of body composition, adiponectin, C-reactive protein and cholesterol levels in patients with obstructive sleep apnea syndrome Adv. Clin. Exp. Med. 2013 22 817 824
Kyle U.G. Soundar E.P. Genton L. Pichard C. Can phase angle determined by bioelectrical impedance analysis assess nutritional risk? A comparison between healthy and hospitalized subjects Clin. Nutr. 2012 31 875 881 10.1016/j.clnu.2012.04.002 22560739
Tomeleri C.M. Cavalcante E.F. Antunes M. Nabuco H.C.G. de Souza M.F. Teixeira D.C. Gobbo L.A. Silva A.M. Cyrino E.S. Phase Angle Is Moderately Associated With Muscle Quality and Functional Capacity, Independent of Age and Body Composition in Older Women J. Geriatr. Phys. Ther. 2019 42 281 286 10.1519/JPT.0000000000000161 29210931
