Phase Angle as an Indicator of Sarcopenia, Malnutrition, and Cachexia in Inpatients with Cardiovascular Diseases.

Suguru Hirose,Teruo Inoue,Suomi Yamaguchi,Yohei Toyama,Ikuko Shibasaki,Naohiro Nozawa,Shigeru Toyoda,Akiko Haruyama,Hayato Ishizaka,Hiroko Yazawa,Kaori Nishikawa,Satoshi Katayanagi,Takashi Mizushima,Yuta Mizushima,Tomohiro Yasuda,Tomoe Arakawa,Kazuhisa Matsumoto,Reiko Takahashi,Hirotsugu Fukuda,Toshiaki Nakajima

doi:10.3390/jcm9082554

Abstract

Malnutrition is associated with sarcopenia, cachexia, and prognosis. We investigated the usefulness of phase angle (PhA) as a marker of sarcopenia, cachexia, and malnutrition in 412 hospitalized patients with cardiovascular disease. We analyzed body composition with bioelectrical impedance analysis, and nutritional status such as controlling nutritional status (CONUT) score. Both skeletal muscle mass index (SMI) and PhA correlated with age, grip strength and knee extension strength (p < 0.0001) in both sexes. The SMI value correlated with CONUT score, Hb, and Alb in males. Phase angle also correlated with CONUT score, Hb, and Alb in males, and more strongly associated with these nutritional aspects. In females, PhA was correlated with Hb and Alb (p < 0.001). In both sexes, sarcopenia incidence was 31.6% and 32.4%; PhA cut-off in patients with sarcopenia was 4.55° and 4.25°; and cachexia incidence was 11.5% and 14.1%, respectively. The PhA cut-off in males with cachexia was 4.15°. Multivariate regression analysis showed that grip strength and brain natriuretic peptide (BNP) were independent determinants of SMI, whereas grip strength, BNP, and Hb were independent determinants of PhA. Thus, PhA appears to be a useful marker for sarcopenia, malnutrition, and cachexia in hospitalized patients with cardiovascular disease.

Highlights

Malnutrition and increased nutritional risk are frequently observed among hospitalized patients and cardiovascular disease (CVD) patients [1,2]
Age and % body fat were greater in females than in males (p < 0.0001), but standing height, body weight, and body mass index (BMI) were greater in males than in females (p < 0.0001) (Table 1)
The phase angle (PhA) cut-off obtained from the Receiver operating characteristic (ROC) curve for men with cachexia was 4.15◦. (4) Multivariate regression analysis showed that hand grip strength and brain natriuretic peptide (BNP) level were independent determinants of skeletal muscle mass index (SMI), whereas grip strength, BNP, and Hb level were independent determinants of the PhA, after adjusting for age and BMI in men

Summary

Introduction

Malnutrition and increased nutritional risk are frequently observed among hospitalized patients and cardiovascular disease (CVD) patients [1,2]. As life expectancy increases, sarcopenia, the skeletal muscle loss, and diminished physical function (grip strength, walking speed) common in the elderly population [5], is becoming a major health issue [6]. It is frequently associated with CVD [7] including heart failure (HF) and chronic kidney disease (CKD) [5,8]. It is generally accepted that increased nutritional risk, malnutrition, and sarcopenia are predictors of survival in patients with CVD, and they increase the risk of complications and mortality [6,9]. Sarcopenia in chronic HF may lead to tissue wasting and cardiac cachexia which is associated with an extremely poor prognosis [12,13,14]

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Conclusion