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Cited by 122Body Composition Measurement TechniquesClinical Nutrition and GastroenterologyNutrition and Health in Aging

Use of Bioelectrical Impedance Analysis for the Assessment of Nutritional Status in Critically Ill Patients

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Lee, Yoojin, Kwon, Oran, Shin, Cheung Soo, Lee, Song Mi·2015·Clinical Nutrition Research
DOI 10.7762/cnr.2015.4.1.32PMC PMC4337921
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Abstract

Malnutrition is common in the critically ill patients and known to cause a variety of negative clinical outcomes. However, various conventional methods for nutrition assessment have several limitations. We hypothesized that body composition data, as measured using bioelectrical impedance analysis (BIA), may have a significant role in evaluating nutritional status and predicting clinical outcomes in critically ill patients. We gathered clinical, biochemical, and BIA data from 66 critically ill patients admitted to an intensive care unit. Patients were divided into three nutritional status groups according to their serum albumin level and total lymphocyte counts. The BIA results, conventional indicators of nutrition status, and clinical outcomes were compared and analyzed retrospectively. Results showed that the BIA indices including phase angle (PhA), extracellular water (ECW), and ECW/total body water (TBW) were significantly associated with the severity of nutritional status. Particularly, PhA, an indicator of the health of the cell membrane, was higher in the well-nourished patient group, whereas the edema index (ECW/TBW) was higher in the severely malnourished patient group. PhA was positively associated with albumin and ECW/TBW was negatively associated with serum albumin, hemoglobin, and duration of mechanical ventilation. In non-survivors, PhA was significantly lower and both ECW/TBW and %TBW/fat free mass were higher than in survivors. In conclusion, several BIA indexes including PhA and ECW/TBW may be useful for nutritional assessment and represent significant prognostic factors in the care of critically ill patients.

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  • Several studies have described advantages of bioimpedance and mainly phase angle in the evaluation of the prognosis of critically ill patients.

    “Several studies have described the advantages of bio impedance (36,37,38,39) and mainly phase angle (40) in the evaluation of the prognosis of critically ill patients.”

    From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [38]

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  1. [1]Giner M Laviano A Meguid MM Gleason JR In 1995 a correlation between malnutrition and poor outcome in critically ill patients still exists Nutrition 1996 12 23 29 8838832
  2. [2]Barr J Hecht M Flavin KE Khorana A Gould MK Outcomes in critically ill patients before and after the implementation of an evidence-based nutritional management protocol Chest 2004 125 1446 1457 15078758
  3. [3]Kyle UG Pirlich M Schuetz T Lochs H Pichard C Is nutritional depletion by Nutritional Risk Index associated with increased length of hospital stay? A population-based study JPEN J Parenter Enteral Nutr 2004 28 99 104 15080604
  4. [4]National Alliance for Infusion Therapy and the American Society for Parenteral and Enteral Nutrition Public Policy Committee and Board of Directors Disease-related malnutrition and enteral nutrition therapy: a significant problem with a cost-effective solution Nutr Clin Pract 2010 25 548 554 20802144
  5. [5]Jensen GL Bistrian B Roubenoff R Heimburger DC Malnutrition syndromes: a conundrum vs continuum JPEN J Parenter Enteral Nutr 2009 33 710 716 19892905
  6. [6]Jensen GL Mirtallo J Compher C Dhaliwal R Forbes A Grijalba RF Hardy G Kondrup J Labadarios D Nyulasi I Castillo Pineda JC Waitzberg D International Consensus Guideline Committee Adult starvation and disease-related malnutrition: a proposal for etiology-based diagnosis in the clinical practice setting from the International Consensus Guideline Committee JPEN J Parenter Enteral Nutr 2010 34 156 159 20375423
  7. [7]Kyle UG Bosaeus I De Lorenzo AD Deurenberg P Elia M Gómez JM Heitmann BL Kent-Smith L Melchior JC Pirlich M Scharfetter H Schols AM Pichard C Composition of the ESPEN Working Group Bioelectrical impedance analysis--part I: review of principles and methods Clin Nutr 2004 23 1226 1243 15380917
  8. [8]Kyle UG Bosaeus I De Lorenzo AD Deurenberg P Elia M Manuel Gómez J Lilienthal Heitmann B Kent-Smith L Melchior JC Pirlich M Scharfetter H M W J Schols A Pichard C ESPEN Bioelectrical impedance analysis-part II: utilization in clinical practice Clin Nutr 2004 23 1430 1453 15556267
  9. [9]Kyle UG Genton L Pichard C Low phase angle determined by bioelectrical impedance analysis is associated with malnutrition and nutritional risk at hospital admission Clin Nutr 2013 32 294 299 22921419
  10. [10]Kyle UG Soundar EP Genton L Pichard C Can phase angle determined by bioelectrical impedance analysis assess nutritional risk? A comparison between healthy and hospitalized subjects Clin Nutr 2012 31 875 881 22560739
  11. [11]Ott M Fischer H Polat H Helm EB Frenz M Caspary WF Lembcke B Bioelectrical impedance analysis as a predictor of survival in patients with human immunodeficiency virus infection J Acquir Immune Defic Syndr Hum Retrovirol 1995 9 20 25 7712230
  12. [12]Schwenk A Beisenherz A Römer K Kremer G Salzberger B Elia M Phase angle from bioelectrical impedance analysis remains an independent predictive marker in HIV-infected patients in the era of highly active antiretroviral treatment Am J Clin Nutr 2000 72 496 501 10919947
  13. [14]Selberg O Selberg D Norms and correlates of bioimpedance phase angle in healthy human subjects, hospitalized patients, and patients with liver cirrhosis Eur J Appl Physiol 2002 86 509 516 11944099
  14. [15]Maggiore Q Nigrelli S Ciccarelli C Grimaldi C Rossi GA Michelassi C Nutritional and prognostic correlates of bioimpedance indexes in hemodialysis patients Kidney Int 1996 50 2103 2108 8943496
  15. [16]Fein PA Gundumalla G Jorden A Matza B Chattopadhyay J Avram MM Usefulness of bioelectrical impedance analysis in monitoring nutrition status and survival of peritoneal dialysis patients Adv Perit Dial 2002 18 195 199 12402618
  16. [17]Liu MH Wang CH Huang YY Tung TH Lee CM Yang NI Liu PC Cherng WJ Edema index established by a segmental multifrequency bioelectrical impedance analysis provides prognostic value in acute heart failure J Cardiovasc Med (Hagerstown) 2012 13 299 306 22367574
  17. [18]Moore FD The body cell mass and its supporting environment: body composition in health and disease Philadelphia (PA) W.B. Saunders Co. 1963
  18. [19]Hoffer LJ Clinical nutrition: 1. Protein-energy malnutrition in the inpatient CMAJ 2001 165 1345 1349 11760983 PMC81630
  19. [20]Barak N Wall-Alonso E Cheng A Sitrin MD Use of bioelectrical impedance analysis to predict energy expenditure of hospitalized patients receiving nutrition support JPEN J Parenter Enteral Nutr 2003 27 43 46 12549597
  20. [21]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 15809535
  21. [22]Bosy-Westphal A Danielzik S Dörhöfer RP Later W Wiese S Müller MJ Phase angle from bioelectrical impedance analysis: population reference values by age, sex, and body mass index JPEN J Parenter Enteral Nutr 2006 30 309 316 16804128
  22. [23]Lee S Choi M Kim Y Lee J Shin C Nosocomial infection of malnourished patients in an intensive care unit Yonsei Med J 2003 44 203 209 12728458
  23. [24]Gupta D Lammersfeld CA Vashi PG King J Dahlk SL Grutsch JF Lis CG Bioelectrical impedance phase angle as a prognostic indicator in breast cancer BMC Cancer 2008 8 249 18727837 PMC2527613
  24. [25]White JV Guenter P Jensen G Malone A Schofield M Academy of Nutrition and Dietetics Malnutrition Work Group A.S.P.E.N. Malnutrition Task Force A.S.P.E.N. Board of Directors Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition) J Acad Nutr Diet 2012 112 730 738 22709779
  25. [26]Robert S Zarowitz BJ Hyzy R Eichenhorn M Peterson EL Popovich J Jr Bioelectrical impedance assessment of nutritional status in critically ill patients Am J Clin Nutr 1993 57 840 844 8503350
  26. [27]Fan S Sayed RH Davenport A Extracellular volume expansion in peritoneal dialysis patients Int J Artif Organs 2012 35 338 345 22466994
  27. [29]Schuller D Mitchell JP Calandrino FS Schuster DP Fluid balance during pulmonary edema. Is fluid gain a marker or a cause of poor outcome? Chest 1991 100 1068 1075 1914560
  28. [30]Jacobs DO Use of bioelectrical impedance analysis measurements in the clinical management of critical illness Am J Clin Nutr 1996 64 498S 502S 8780370
  29. [31]Gupta D Lammersfeld CA Vashi PG King J Dahlk SL Grutsch JF Lis CG 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 19175932 PMC2637288
  30. [32]Mushnick R Fein PA Mittman N Goel N Chattopadhyay J Avram MM Relationship of bioelectrical impedance parameters to nutrition and survival in peritoneal dialysis patients Kidney Int Suppl 2003 S53 S56 14531774
  31. [33]Oliveros H Villamor E Obesity and mortality in critically ill adults: a systematic review and meta-analysis Obesity (Silver Spring) 2008 16 515 521 18239602
  32. [34]Akinnusi ME Pineda LA El Solh AA Effect of obesity on intensive care morbidity and mortality: a meta-analysis Crit Care Med 2008 36 151 158 18007266

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Authors
Lee, Y., Kwon, O., Shin, C. S., & Lee, S. M.
Affiliations
  • Ewha Womans University (KR)
  • Yonsei University (KR)
  • Gangnam Severance Hospital (KR)
Corresponding author
Lee, Song Mi
ORCID
Venue
Clinical Nutrition Research
Publisher
Korean Society of Clinical Nutrition
Published
2015
Volume
4
Issue
1
Pages
32
ISSN
  • 2287-3732 (ISSN-L)
  • 2287-3740
DOI
10.7762/cnr.2015.4.1.32
PMC
PMC4337921
OpenAlex
W2088042433
Cited by
122
References
0
Citations by year
2026: 6 · 2025: 8 · 2024: 14 · 2023: 16 · 2022: 13 · 2021: 16 · 2020: 10 · 2019: 11 · 2018: 14 · 2017: 8 · 2016: 4 · 2015: 2
FWCI
6.88
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Nutrition Research (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • YUHSpace (Yonsei University Medical Library) (submittedVersion, cc-by-nc-nd)
Topics
  • Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
Keywords
bioelectrical impedance analysis, nutritional assessment, malnutrition, critically ill patients, intensive care unit, phase angle, extracellular water, edema index, serum albumin, total lymphocyte count, body composition, fat-free mass, mechanical ventilation duration, mortality prediction, prognostic factors

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