Phase Angle and Handgrip Strength as a Predictor of Disease-Related Malnutrition in Admitted Patients: 12-Month Mortality

Rocío Fernández-Jiménez; Lara Dalla-Rovere; María García-Olivares; José Abuín-Fernández; Francisco José Sánchez-Torralvo; Viyey Kishore Doulatram-Gamgaram; Agustín M Hernández-Sanchez; José Manuel García-Almeida

doi:10.3390/nu14091851

Phase Angle and Handgrip Strength as a Predictor of Disease-Related Malnutrition in Admitted Patients: 12-Month Mortality

Nutrients. 2022 Apr 28;14(9):1851. doi: 10.3390/nu14091851.

Authors

Rocío Fernández-Jiménez^{1

2

3}, Lara Dalla-Rovere¹, María García-Olivares^{1

3

4}, José Abuín-Fernández¹, Francisco José Sánchez-Torralvo^{3

4

5}, Viyey Kishore Doulatram-Gamgaram^{3

4

5}, Agustín M Hernández-Sanchez⁶, José Manuel García-Almeida^{1

2

3

5}

Affiliations

¹ Departmento de Endocrinologia y Nutrición, Quironsalud Málaga Hospital Av. Imperio Argentina, 29004 Málaga, Spain.
² Unidad de Gestion Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria de Málaga, 29010 Málaga, Spain.
³ Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain.
⁴ Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain.
⁵ Departamento de Medicina y Dermatología, Facultad de Medicina, University of Malaga, 29010 Málaga, Spain.
⁶ Departamento de Hematología, Quironsalud Málaga Hospital Av. Imperio Argentina, 29004 Málaga, Spain.

Abstract

Background: Phase Angle (PhA) value measured by bioelectrical impedance analysis (BIA) could be considered a good marker of the patient’s cell mass and cellular damage. Various studies have shown that the value of PhA is associated with an increased nutritional risk in several pathologies. However, not many studies have focused on the use of PhA as a screening tool in admitted patients. The aim of this study is to evaluate the prognostic value of PhA to determine disease-related malnutrition (DRM) and the risk that this entails for mortality and length of stay (LOS). Methods: 570 patients admitted to the hospital for different causes were included in this retrospective observational study. Patients’ nutritional risk was assessed by screening tests such as the Malnutrition Universal Screening tool (MUST) and Subjective Global Assessment (SGA), in addition to non-invasive functional techniques, such as BIA and handgrip strength (HGS), 24−48 h after admission. After performing an SGA as the gold standard to assess malnutrition, PhA and SPhA values were used to determine DRM. Furthermore, both samples: malnutrition status (MS) and non-malnutrition status (NMS) were compared, with SphA-Malnutrition corresponding to a diagnosis of malnutrition. Statistical analysis of the sample was conducted with JAMOVI version 2.2.2. Results: Patients with MS had lower PhA and SPhA than patients with NMS (p < 0.001). The ROC curve analysis (AUC = 0.81) showed a cut-off point for MS for PhA = 5.4° (sensitivity 77.51% and specificity 74.07%) and AUC = 0.776 with a cut-off point for SPhA = −0.3 (sensitivity 81.74% and specificity 63.53%). Handgrip strength (HGS) was also observed to be a good predictor in hospitalized patients. Carrying out a comparative analysis between MS and NMS, length of stay (LOS) was 9.0 days in MS vs. 5.0 days in NMS patients (OR 1.07 (1.04−1.09, p < 0.001)). A low SPhA-malnutrition value (SPhA < −0.3) was significantly associated with a higher mortality hazards ratio (HR 7.87, 95% CI 2.56−24.24, p < 0.001). Conclusion: PhA, SPhA and HGS are shown to be good prognostic markers of DRM, LOS and mortality and could therefore be useful screening tools to complement the nutritional assessment of admitted patients.

Keywords: admitted patient; assessment tools; malnutrition; mortality; phase angle.

Publication types

Observational Study

MeSH terms

Electric Impedance
Hand Strength*
Hospitalization
Humans
Malnutrition* / diagnosis
Nutrition Assessment
Nutritional Status

Grants and funding

This study was a collaboration between the Institution and Fresenius Kabi Spain. The company covered the publication cost and carried out the project. No other funding was provided.