How can we assess nutritional risk during hospitalization? Preliminary evidence in support of measuring phase angle variations

“Phase angle and hand grip strength are sensitive early markers of energy intake in hypophagic, non-surgical patients at nutritional risk, with contraindications to enteral nutrition”
R Caccialanza, E Cereda, C Klersy, C Bonardi, S Cappello, L Quarleri, A Turri, E Montagna, I Iacona, F Valentino and P Pedrazzoli
Nutrients. 2015; 7: 1828-1840; doi: 10.3390/nu7031828

Hospitalized patients are at risk of nutritional deterioration. When enteral nutrition is not possible, parenteral nutrition is often prescribed, but there is no established method for assessing the effectiveness of this therapy. In the interest of developing a marker of energy intake for use in this clinical setting, researchers in Italy examined two different, easily measured variables, namely bioimpedance phase angle and handgrip strength normalized to skeletal muscle mass (HG/SMM).

This single-center study enrolled 30 non-surgical adult patients who were hypophagic and undergoing parenteral nutrition in hospital for at least one week; patients were allowed to continue eating as much as they could. Phase angle was evaluated using a NutriLAB instrument (Akern/RJL) while handgrip strength was measured on a digital hand dynamometer (DynExTM, Akern/MD Systems), on days 1 and 7.

On day 7, 20 patients were meeting their estimated energy requirements while 10 were not. Between day 1 and day 7, in the group of 10 patients who were not meeting their energy requirements, phase angle and HG/SMM decreased significantly, while these variables underwent no significant change among the 20 patients who were meeting energy needs. A significant correlation was found between phase angle and HG/SMM variations.

The authors concluded that phase angle and HG/SMM are “sensitive early markers of energy intake [whose] variations are correlated in hypophagic, non-surgical patients at nutritional risk, with contraindications to enteral nutrition, treated with supplemental [parenteral nutrition].” However, they noted that because the study had no control group, additional studies are needed “to verify these preliminary observations and to validate the role of [phase angle] variations as early markers of anabolic/catabolic fluctuations.”

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