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      A Comprehensive Review of Bioelectrical Impedance Analysis and Other Methods in the Assessment of Nutritional Status in Patients with Liver Cirrhosis

      review-article
      Author(s): * ,
      Publication date (Electronic):
      Journal: Gastroenterology Research and Practice
      Publisher: Hindawi

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          Abstract

          It is assumed that approximately 24–66% of patients with liver cirrhosis develop malnutrition. Numerous pathological processes lead to serious disorders of nutritional status in this group of patients. Malnutrition in the course of liver cirrhosis is associated with increased morbidity, complications, and low quality of life. Under these conditions, detection of malnutrition is of crucial importance. This review explores the complex mechanisms that lead to malnutrition in the course of liver cirrhosis and focuses on methods used in the assessment of nutritional status in cirrhotic patients. Among others, the role of bioelectrical impedance is highlighted. This noninvasive tool is promising and quite an accurate method of estimating body composition.

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          Cutoff percentiles of bioelectrical phase angle predict functionality, quality of life, and mortality in patients with cancer.

          Kristina Norman, Nicole Stobäus, Daniela Zocher … (2010)
          The bioelectrical phase angle has shown predictive potential in various diseases, but general cutoffs are lacking in the clinical setting. This study evaluated the prognostic value of the fifth percentile of sex-, age-, and body mass index-stratified phase angle reference values in patients with cancer with respect to nutritional and functional status, quality of life, and 6-mo mortality. In a second step, we also studied the effect of the standardized phase angle (with a z score to determine individual deviations from the population average) on these variables. A total of 399 patients with cancer were studied. Phase angle was obtained with bioelectrical impedance analysis; muscle function was assessed by handgrip strength and peak expiratory flow. Quality of life was determined by the European Organization for Research and Treatment of Cancer questionnaire. Nutritional status was assessed by using Subjective Global Assessment. Survival of patients was documented after 6 mo. Patients with a phase angle of less than the fifth reference percentile had significantly lower nutritional and functional status, impaired quality of life (P lt 0.0001), and increased mortality (P lt 0.001). The standardized phase angle emerged as a significant predictor for malnutrition and impaired functional status in generalized linear model regression analyses. It was also a stronger indicator of 6-mo survival than were malnutrition and disease severity in the Cox regression model (P lt 0.0001) and according to the receiver operating characteristic curve. The standardized phase angle is an independent predictor for impaired nutritional and functional status and survival. The fifth phase angle reference percentile is a simple and prognostically relevant cutoff for detection of patients with cancer at risk for these factors.
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            Bioelectrical impedance phase angle in clinical practice: implications for prognosis in advanced colorectal cancer.

            Digant Gupta, Carolyn Lammersfeld, Jessica Burrows … (2004)
            Phase angle, determined by bioelectrical impedance analysis (BIA), detects changes in tissue electrical properties and has been found to be a prognostic indicator in several chronic conditions-such as HIV, liver cirrhosis, chronic obstructive pulmonary disease, and lung cancer-and in patients receiving dialysis. This study was conducted to investigate the prognostic role of phase angle in advanced colorectal cancer. We evaluated a case series of 52 patients with histologically confirmed stage IV colorectal cancer. BIA was conducted on all patients and phase angle was calculated. The Kaplan-Meier method was used to calculate survival. Cox proportional hazard models were constructed to evaluate the prognostic effect of phase angle independent of other clinical and nutritional variables. Patients with a phase angle 5.57 had a median survival of 40.4 mo (95% CI: 21.9, 58.8; n=26; P=0.0001). Phase angle is a prognostic indicator in patients with advanced colorectal cancer. Similar studies of other cancer types with larger sample sizes are needed to further validate the prognostic significance of phase angle in cancer treatment settings.
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              Clinical relevance of sarcopenia in patients with cirrhosis.

              Aldo Montano-Loza (2014)
              The most commonly recognized complications in cirrhotic patients include ascites, hepatic encephalopathy, variceal bleeding, susceptibility for infections, kidney dysfunction, and hepatocellular carcinoma; however, severe muscle wasting or sarcopenia are the most common and frequently unseen complications which negatively impact survival, quality of life, and response to stressor, such as infections and surgeries. At present, D'Amico stage classification, Child-Pugh, and MELD scores constitute the best tools to predict mortality in patients with cirrhosis; however, one of their main limitations is the lack of assessing the nutritional and functional status. Currently, numerous methods are available to evaluate the nutrition status of the cirrhotic patient; nevertheless, most of these techniques have limitations primarily because lack of objectivity, reproducibility, and prognosis discrimination. In this regard, an objective and reproducible technique, such as muscle mass quantification with cross-sectional imaging studies (computed tomography scan or magnetic resonance imaging) constitute an attractive index of nutritional status in cirrhosis. Sarcopenia is part of the frailty complex present in cirrhotic patients, resulting from cumulative declines across multiple physiologic systems and characterized by impaired functional capacity, decreased reserve, resistance to stressors, and predisposition to poor outcomes. In this review, we discuss the current accepted and new methods to evaluate prognosis in cirrhosis. Also, we analyze the current knowledge regarding incidence and clinical impact of malnutrition and sarcopenia in patients with cirrhosis and their impact after liver transplantation. Finally, we discuss existing and potential novel therapeutic approaches for malnutrition in cirrhosis, emphasizing the recognition of sarcopenia in an effort to reduced morbidity related and improved survival in cirrhosis.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Gastroenterol Res Pract
                Journal ID (iso-abbrev): Gastroenterol Res Pract
                Journal ID (publisher-id): GRP
                Title: Gastroenterology Research and Practice
                Publisher: Hindawi
                ISSN (Print): 1687-6121
                ISSN (Electronic): 1687-630X
                Publication date (Print): 2017
                Publication date (Electronic): 13 August 2017
                Volume: 2017
                Electronic Location Identifier: 6765856
                Affiliations
                Department of Gastroenterology, Medical University of Lublin, 20-094 Lublin, Poland
                Author notes
                *Halina Cichoż-Lach: lach.halina@ 123456wp.pl

                Academic Editor: Kazuhiko Uchiyama

                Author information
                http://orcid.org/0000-0002-7337-835X
                Article
                DOI: 10.1155/2017/6765856
                PMC ID: 5574293
                PubMed ID: 28894465
                SO-VID: 49f4aa8d-221e-462d-a110-c5ddd4911a90
                Copyright © Copyright © 2017 Halina Cichoż-Lach and Agata Michalak.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 3 April 2017
                Date accepted : 11 July 2017
                Categories
                Subject: Review Article

                ScienceOpen disciplines: Gastroenterology & Hepatology
                Data availability:
                ScienceOpen disciplines: Gastroenterology & Hepatology

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