Is phase angle an appropriate indicator of malnutrition in different disease states? A systematic review

Malnutrition is a common concern in both chronic and acute disease with many potential negative consequences. It is therefore crucial for clinicians to have accurate methods for nutrition assessment.  Subjective Global Assessment (SGA) is the gold standard nutritional assessment method – it classifies malnutrition severity via a bedside assessment combining dietary, weight, functional, gastrointestinal and disease history with a physical examination to arrive at a category ranking. Phase angle (PhA) is another nutritional assessment method, but unlike SGA, it is a quick, non-invasive, and strictly objective technique that relies on measurements of the resistance and reactance of a current as it passes through tissues of the body via bio-electrical impedance analysis (BIA). This systematic review evaluates the relationship between bio-electrical phase angle and malnutrition severity as measured by the Subjective Global Assessment in acute or chronically ill adults.

Relevant studies were identified by searching 7 electronic bibliographic databases: Scopus, CINAHL, PubMed, ProQuest Nursing and Allied Health, Medline, Cochrane, and ProQuest Dissertation and Thesis. The articles were evaluated by two reviewers using two quality assessment tools: the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) guidelines, and the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Based on GRADE guidelines, PhA evidence quality received a grade of Low. Based on QUADAS-2, 61% of studies had high risk of bias in the index test (PhA), while all other domains had low risk. It is thus not possible to conclude that PhA is an accurate independent indicator of malnutrition. This article is written by HEAL team members Sylvia Rinaldi, Jason Gilliland, Colleen O’Connor, Bert Chesworth, and Janet Madill.

“Is phase angle an appropriate indicator of malnutrition in different disease states? A systematic review” is published in Clinical Nutrition ESPEN,  an official publication of the European Society for Clinical Nutrition and Metabolism focused on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice.

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Keywords: phase angle, malnutrition, subjective global assessment, disease, liver, renal, hospitalized, oncology


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