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Body Composition Highlights Review

The value of bioelectrical impedance analysis and phase angle in the evaluation of malnutrition and quality of life in cancer patients—a comprehensive review

European Journal of Clinical Nutrition volume 69, pages 1290–1297 (2015)Cite this article

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Abstract

Bioelectrical impedance analysis (BIA) and especially its derived parameter phase angle have been widely used in different populations. The variability of BIA measures has often been cited as a major limitation for its clinical use in evaluating nutritional status and overall health of patients. Cancer patients often present with malnourishment and cachexia, which complicate the course of treatment and affect outcomes. PubMed, CINAHL, EBSCO and Cochrane Library have been searched for relevant publications in English for BIA in cancer patients. Out of 197 total results, 27 original research articles related to BIA measures in cancer patients were included in this review. Studies indicate that the use of BIA and phase angle measures can benefit in the clinical management of cancer patients in multiple ways: in the prevention; diagnosis; prognosis; and outcomes related to treatments that affect nutritional and overall health status. Phase angle and fat-free mass measures were most commonly evaluated and correlated with nutritional status and survival rate. One limitation of BIA measures is the high interpatient variability which requires careful interpretation of results in the context of the individual patient rather than comparison with population data. The BIA and phase angle provide practitioners for the evaluation of nutritional and overall health status in cancer patients with a convenient and non-invasive technique and should be encouraged.

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References

  1. Barbosa-Silva MC, Barros AJ, Wang J, Heymsfield SB, Pierson RN Jr . Bioelectrical impedance analysis: population reference values for phase angle by age and sex. Am J Clin Nutr 2005; 82: 49–52.

    Article  CAS  PubMed  Google Scholar 

  2. MacInnis RJ, English DR, Hopper JL, Haydon AM, Gertig DM, Giles GG . Body size and composition and colon cancer risk in men. Cancer Epidemiol Biomarkers Prev 2004; 13: 553–559.

    PubMed  Google Scholar 

  3. Norman K, Stobaus N, Pirlich M, Bosy-Westphal A . Bioelectrical phase angle and impedance vector analysis—clinical relevance and applicability of impedance parameters. Clin Nutr 2012; 31: 854–861.

    Article  PubMed  Google Scholar 

  4. Pelzer U, Arnold D, Govercin M, Stieler J, Doerken B, Riess H et al. Parenteral nutrition support for patients with pancreatic cancer. Results of a phase II study. BMC Cancer 2010; 10: 86.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Fritz T, Hollwarth I, Romaschow M, Schlag P . The predictive role of bioelectrical impedance analysis (BIA) in postoperative complications of cancer patients. Eur J Surg Oncol 1990; 16: 326–331.

    CAS  PubMed  Google Scholar 

  6. Pierson RN Jr., Wang J, Heymsfield SB, Russell-Aulet M, Mazariegos M, Tierney M et al. Measuring body fat: calibrating the rulers. Intermethod comparisons in 389 normal Caucasian subjects. Am J Physiol 1991; 261: E103–E108.

    PubMed  Google Scholar 

  7. Ward LC, Dyer JM, Byrne NM, Sharpe KK, Hills AP . Validation of a three-frequency bioimpedance spectroscopic method for body composition analysis. Nutrition 2007; 23: 657–664.

    Article  CAS  PubMed  Google Scholar 

  8. Barbosa-Silva MC, Barros AJ . Bioelectrical impedance analysis in clinical practice: a new perspective on its use beyond body composition equations. Curr Opin Clin Nutr Metab Care 2005; 8: 311–317.

    Article  PubMed  Google Scholar 

  9. Bower JE, Ganz PA, Tao ML, Hu W, Belin TR, Sepah S et al. Inflammatory biomarkers and fatigue during radiation therapy for breast and prostate cancer. Clin Cancer Res 2009; 15: 5534–5540.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Eng JW, Kokolus KM, Reed CB, Hylander BL, Ma WW, Repasky EA . A nervous tumor microenvironment: the impact of adrenergic stress on cancer cells, immunosuppression, and immunotherapeutic response. Cancer Immunol Immunother 2014; 63: 1115–1128.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Baracos VE . Cancer-associated cachexia and underlying biological mechanisms. Annu Rev Nutr 2006; 26: 435–461.

    Article  CAS  PubMed  Google Scholar 

  12. Bosaeus I . Nutritional support in multimodal therapy for cancer cachexia. Support Care Cancer 2008; 16: 447–451.

    Article  PubMed  Google Scholar 

  13. Toso S, Piccoli A, Gusella M, Menon D, Crepaldi G, Bononi A et al. Bioimpedance vector pattern in cancer patients without disease versus locally advanced or disseminated disease. Nutrition 2003; 19: 510–514.

    Article  PubMed  Google Scholar 

  14. Norman K, Stobaus N, Zocher D, Bosy-Westphal A, Szramek A, Scheufele R et al. Cutoff percentiles of bioelectrical phase angle predict functionality, quality of life, and mortality in patients with cancer. Am J Clin Nutr 2010; 92: 612–619.

    Article  CAS  PubMed  Google Scholar 

  15. Gupta D, Lammersfeld CA, Burrows JL, Dahlk SL, Vashi PG, Grutsch JF et al. Bioelectrical impedance phase angle in clinical practice: implications for prognosis in advanced colorectal cancer. Am J Clin Nutr 2004; 80: 1634–1638.

    Article  CAS  PubMed  Google Scholar 

  16. Lee SY, Lee YJ, Yang JH, Kim CM, Choi WS . The Association between Phase Angle of Bioelectrical Impedance Analysis and Survival Time in Advanced Cancer Patients: Preliminary Study. Korean J Fam Med 2014; 35: 251–256.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Santarpia L, Marra M, Montagnese C, Alfonsi L, Pasanisi F, Contaldo F . Prognostic significance of bioelectrical impedance phase angle in advanced cancer: preliminary observations. Nutrition 2009; 25: 930–931.

    Article  PubMed  Google Scholar 

  18. Di Sebastiano KM, Mourtzakis M . A critical evaluation of body composition modalities used to assess adipose and skeletal muscle tissue in cancer. Appl Physiol Nutr Metab 2012; 37: 811–821.

    Article  PubMed  Google Scholar 

  19. Gupta D, Lammersfeld CA, Vashi PG, King J, Dahlk SL, Grutsch JF et al. Bioelectrical impedance phase angle as a prognostic indicator in breast cancer. BMC Cancer 2008; 8: 249.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Gupta D, Lammersfeld CA, Vashi PG, King J, Dahlk SL, Grutsch JF et al. Bioelectrical impedance phase angle in clinical practice: implications for prognosis in stage IIIB and IV non-small cell lung cancer. BMC Cancer 2009; 9: 37.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Castanho IA, Lopes AJ, Koury JC, Tessarollo B, Silva AC, Nunes RA . Relationship between the phase angle and volume of tumours in patients with lung cancer. Ann Nutr Metab 2013; 62: 68–74.

    Article  CAS  PubMed  Google Scholar 

  22. Sanchez-Lara K, Turcott JG, Juarez E, Guevara P, Nunez-Valencia C, Onate-Ocana LF et al. Association of nutrition parameters including bioelectrical impedance and systemic inflammatory response with quality of life and prognosis in patients with advanced non-small-cell lung cancer: a prospective study. Nutr Cancer 2012; 64: 526–534.

    Article  CAS  PubMed  Google Scholar 

  23. Moseley A, Piller N . Reliability of bioimpedance spectroscopy and tonometry after breast conserving cancer treatment. Lymphat Res Biol 2008; 6: 85–87.

    Article  CAS  PubMed  Google Scholar 

  24. de Abreu DS . Bioimpedance and chronoamperometry as an adjunct to prostate-specific antigen screening for prostate cancer. Cancer Manag Res 2011; 3: 109–116.

    PubMed  PubMed Central  Google Scholar 

  25. Halpern-Silveira D, Susin LR, Borges LR, Paiva SI, Assuncao MC, Gonzalez MC . Body weight and fat-free mass changes in a cohort of patients receiving chemotherapy. Support Care Cancer 2010; 18: 617–625.

    Article  PubMed  Google Scholar 

  26. Burden ST, Hill J, Shaffer JL, Todd C . Nutritional status of preoperative colorectal cancer patients. J Hum Nutr Diet 2010; 23: 402–407.

    Article  CAS  PubMed  Google Scholar 

  27. Berstad P, Haugum B, Helgeland M, Bukholm I, Almendingen K . Preoperative body size and composition, habitual diet, and post-operative complications in elective colorectal cancer patients in Norway. J Hum Nutr Diet 2013; 26: 359–368.

    Article  CAS  PubMed  Google Scholar 

  28. Davis MP, Yavuzsen T, Khoshknabi D, Kirkova J, Walsh D, Lasheen W et al. Bioelectrical impedance phase angle changes during hydration and prognosis in advanced cancer. Am J Hosp Palliat Care 2009; 26: 180–187.

    Article  PubMed  Google Scholar 

  29. Norman K, Stubler D, Baier P, Schutz T, Ocran K, Holm E et al. Effects of creatine supplementation on nutritional status, muscle function and quality of life in patients with colorectal cancer—a double blind randomised controlled trial. Clin Nutr 2006; 25: 596–605.

    Article  CAS  PubMed  Google Scholar 

  30. Abe Vicente M, Barao K, Silva TD, Forones NM . What are the most effective methods for assessment of nutritional status in outpatients with gastric and colorectal cancer? Nutr Hosp 2013; 28: 585–591.

    PubMed  Google Scholar 

  31. Schutte K, Tippelt B, Schulz C, Rohl FW, Feneberg A, Seidensticker R et al. Malnutrition is a prognostic factor in patients with hepatocellular carcinoma (HCC). Clin Nutr. e-pub ahead of print 2 December 2014; doi:10.1016/j.clnu.2014.11.007.

  32. Gupta D, Lis CG, Granick J, Grutsch JF, Vashi PG, Lammersfeld CA . Malnutrition was associated with poor quality of life in colorectal cancer: a retrospective analysis. J Clin Epidemiol 2006; 59: 704–709.

    Article  PubMed  Google Scholar 

  33. Gupta D, Lis CG, Dahlk SL, King J, Vashi PG, Grutsch JF et al. The relationship between bioelectrical impedance phase angle and subjective global assessment in advanced colorectal cancer. Nutr J 2008; 7: 19.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Mauricio SF, da Silva JB, Bering T, Correia MI . Relationship between nutritional status and the Glasgow prognostic score in patients with colorectal cancer. Nutrition 2013; 29: 625–629.

    Article  PubMed  Google Scholar 

  35. Malecka-Massalska T, Smolen A, Morshed K . Extracellular-to-body cell mass ratio and subjective global assessment in head-and-neck cancers. Curr Oncol 2014; 21: e62–e66.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Shang E, Weiss C, Post S, Kaehler G . The influence of early supplementation of parenteral nutrition on quality of life and body composition in patients with advanced cancer. JPEN J Parenter Enteral Nutr 2006; 30: 222–230.

    Article  PubMed  Google Scholar 

  37. Grundmann O, Yoon SL, Williams JJ . Influence of acupuncture on bioelectrical impedance measures in patients with gastrointestinal cancer: results of a pilot study. Acupunct Med 2015; 33: 16–22.

    Article  PubMed  Google Scholar 

  38. Yoon SL, Grundmann O, Williams JJ, Carriere G . Novel intervention with acupuncture for anorexia and cachexia in patients with gastrointestinal tract cancers: a feasibility study. Oncol Nurs Forum 2015; 42: E102–E109.

    Article  PubMed  Google Scholar 

  39. Sukkar SG, Bogdanovic A . Interrelationships between body composition and energy expenditure in cancer malnutrition. The role of bioimpedance assessment. Minerva Gastroenterol Dietol 2003; 49: 195–200.

    CAS  PubMed  Google Scholar 

  40. Cao DX, Wu GH, Zhang B, Quan YJ, Wei J, Jin H et al. Resting energy expenditure and body composition in patients with newly detected cancer. Clin Nutr 2010; 29: 72–77.

    Article  PubMed  Google Scholar 

  41. Ellegard LH, Ahlen M, Korner U, Lundholm KG, Plank LD, Bosaeus IG . Bioelectric impedance spectroscopy underestimates fat-free mass compared to dual energy X-ray absorptiometry in incurable cancer patients. Eur J Clin Nutr 2009; 63: 794–801.

    Article  CAS  PubMed  Google Scholar 

  42. Jager-Wittenaar H, Dijkstra PU, Earthman CP, Krijnen WP, Langendijk JA, van der Laan BF et al. Validity of bioelectrical impedance analysis to assess fat-free mass in patients with head and neck cancer: an exploratory study. Head Neck 2014; 36: 585–591.

    Article  PubMed  Google Scholar 

  43. Wang YY, Lo GH, Lai KH, Cheng JS, Lin CK, Hsu PI . Increased serum concentrations of tumor necrosis factor-alpha are associated with disease progression and malnutrition in hepatocellular carcinoma. J Chin Med Assoc 2003; 66: 593–598.

    PubMed  Google Scholar 

  44. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009; 339: b2700.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

This manuscript and the associated research did not receive any funding.

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Authors and Affiliations

  1. Department of Medicinal Chemistry, Collge of Pharmacy, University of Florida, Gainesville, FL, USA

    O Grundmann

  2. Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA

    O Grundmann & S L Yoon

  3. Sunshine Integrative Health, Gainesville, FL, USA

    J J Williams

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  1. O Grundmann
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Correspondence to O Grundmann.

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Grundmann, O., Yoon, S. & Williams, J. The value of bioelectrical impedance analysis and phase angle in the evaluation of malnutrition and quality of life in cancer patients—a comprehensive review. Eur J Clin Nutr 69, 1290–1297 (2015). https://doi.org/10.1038/ejcn.2015.126

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