Malnutrition-Inflammation Score VS Phase Angle in the Era of GLIM Criteria: A Cross-Sectional Study among Hemodialysis Patients in UAE

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Abstract

(1) Background: Malnutrition is prevalent in hemodialysis (HD) patients and is associated with an increased risk of morbidity and mortality. The aim of this study was to explore the prevalence of malnutrition using the malnutrition-inflammation score (MIS) and phase angle (PhA) and compare their concordance with the new Global Leadership Initiative on Malnutrition (GLIM) criteria for the diagnosis of malnutrition. (2) Methods: Seventy HD patients were assessed. Malnutrition was diagnosed based on the GLIM criteria and MIS questionnaire. The agreement between the diagnostic tools (MIS, PhA derived from the bioelectrical impedance analysis (BIA), and GLIM criteria) was assessed. The optimal gender-specific cutoff points were identified for the PhA according to the GLIM criteria. (3) Results: Almost half of the sample was diagnosed as malnourished according to the MIS (48.57%) and GLIM criteria (54.29%). A fair agreement was observed between the GLIM criteria, MIS (k = 0.202), and PhA (k = 0.279) among the malnourished patients. The PhA had better sensitivity but worse specificity compared to the MIS. The optimum cutoff points of PhA to detect malnutrition according to the GLIM criteria were a PhA value of ≤5.7° for males and ≤3.8° for females. (4) Conclusion: The MIS performed slightly better than PhA in the diagnosis of malnutrition among HD patients within the spectrum of the GLIM criteria.

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A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients.

K. Kalantar-Zadeh, J Kopple, G Block … (2001)

Malnutrition inflammation complex syndrome (MICS) occurs commonly in maintenance hemodialysis (MHD) patients and may correlate with increased morbidity and mortality. An optimal, comprehensive, quantitative system that assesses MICS could be a useful measure of clinical status and may be a predictor of outcome in MHD patients. We therefore attempted to develop and validate such an instrument, comparing it with conventional measures of nutrition and inflammation, as well as prospective hospitalization and mortality. Using components of the conventional Subjective Global Assessment (SGA), a semiquantitative scale with three severity levels, the Dialysis Malnutrition Score (DMS), a fully quantitative scoring system consisting of 7 SGA components, with total score ranging between 7 (normal) and 35 (severely malnourished), was recently developed. To improve the DMS, we added three new elements to the 7 DMS components: body mass index, serum albumin level, and total iron-binding capacity to represent serum transferrin level. This new comprehensive Malnutrition-Inflammation Score (MIS) has 10 components, each with four levels of severity, from 0 (normal) to 3 (very severe). The sum of all 10 MIS components ranges from 0 to 30, denoting increasing degree of severity. These scores were compared with anthropometric measurements, near-infrared-measured body fat percentage, laboratory measures that included serum C-reactive protein (CRP), and 12-month prospective hospitalization and mortality rates. Eighty-three outpatients (44 men, 39 women; age, 59 +/- 15 years) on MHD therapy for at least 3 months (43 +/- 33 months) were evaluated at the beginning of this study and followed up for 1 year. The SGA, DMS, and MIS were assessed simultaneously on all patients by a trained physician. Case-mix-adjusted correlation coefficients for the MIS were significant for hospitalization days (r = 0.45; P < 0.001) and frequency of hospitalization (r = 0.46; P < 0.001). Compared with the SGA and DMS, most pertinent correlation coefficients were stronger with the MIS. The MIS, but not the SGA or DMS, correlated significantly with creatinine level, hematocrit, and CRP level. During the 12-month follow-up, 9 patients died and 6 patients left the cohort. The Cox proportional hazard-calculated relative risk for death for each 10-unit increase in the MIS was 10.43 (95% confidence interval, 2.28 to 47.64; P = 0.002). The MIS was superior to its components or different subversions for predicting mortality. The MIS appears to be a comprehensive scoring system with significant associations with prospective hospitalization and mortality, as well as measures of nutrition, inflammation, and anemia in MHD patients. The MIS may be superior to the conventional SGA and the DMS, as well as to individual laboratory values, as a predictor of dialysis outcome and an indicator of MICS.

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Bioelectrical impedance analysis in clinical practice: a new perspective on its use beyond body composition equations.

Maria Cristina G. Barbosa-Silva, Aluísio Barros (2005)

The bioelectrical impedance analysis is not a direct method for estimating body composition. Its accuracy depends on regression equations, and recent papers have suggested that this approach should not be used in several clinical situations. Another option is to obtain information about the electrical properties of tissues by using raw bioelectrical impedance measurements, resistance and reactance. They can be expressed as a ratio (phase angle) or as a plot (bioelectrical impedance vector analysis). This review describes their use in clinical practice. The phase angle changes with sex and age. It is described as a prognostic tool in many clinical situations. There are some controversies about considering it as a nutritional marker. Studies in burn victims and sickle-cell disease corroborate its ability to evaluate cell membrane function. Bioelectrical impedance vector analysis allows a semi-quantitative estimation of body composition from information from tissue hydration and soft-tissue mass in a plot. It can be used in healthy individuals or patients, for a population or individual evaluation of fluid imbalance or an assessment of soft-tissue mass. It has also been used as a prognostic tool in dialysis and cancer patients. The phase angle can be considered a global marker of health, and future studies are needed to prove its utility in intervention studies. Bioelectrical impedance vector analysis has increased its utility in clinical practice, even when the equations may be inaccurate for body composition analysis.

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Bioelectric impedance phase angle and body composition.

Richard A. P. Roche, W Chumlea, Markus Baumgartner (1988)

The use of bioelectric impedance phase angle for predicting body composition was determined in 53 males and 69 females 9-62 y of age. The phase angle describes the amount of reactance (Xc) in a conductor relative to the amount of resistance (R). Bioelectric resistance (R) and reactance (Xc) were determined for the whole body and separately for arm, leg, and trunk. Weight, stature, and skinfold thicknesses were measured. Body composition was determined from densitometry. Phase angles for the trunk (phi t), leg (phi 1), and whole body (phi w) had significant (p less than 0.05) negative correlations with percent body fat (%BF) in each sex, and positive correlations with fat-free mass (FFM) in males. In multiple regression analyses, phi t was associated significantly with %BF after controlling for age, mean skinfold thickness, and weight/stature2 in each sex. Bioelectric phase angle for the trunk may be useful for predicting %BF in clinical and survey research.

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Journal

Journal ID (nlm-ta): Nutrients

Journal ID (iso-abbrev): Nutrients

Journal ID (publisher-id): nutrients

Title: Nutrients

Publisher: MDPI

ISSN (Electronic): 2072-6643

Publication date (Electronic): 14 November 2019

Publication date Collection: November 2019

Volume: 11

Issue: 11

Electronic Location Identifier: 2771

Affiliations

[1 ]Department of Health Sciences, College of Natural Health Sciences, Zayed University, Dubai P.O. Box 19282, UAE; Mirey.Karavetian@ 123456zu.ac.ae

[2 ]School of Nutrition and Translational Research in Metabolism, Faculty of Health Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands

[3 ]Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie, The Lebanese University, Fanar 90-1965, Lebanon; r.rizk@ 123456maastrichtuniversity.nl

[4 ]School of Public Health and Primary Care, Faculty of Health Medicine and Life Sciences, 6200 MD Maastricht, The Netherlands

[5 ]Department of Nutrition and Dietetics, Laiko General Hospital of Athens, 11527 Athens, Greece

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[* ]Correspondence: lpoulia@ 123456gmail.com ; Tel.: +30-21-3206-1666; Fax: +30-21-3206-1212

Author information

Mirey Karavetian https://orcid.org/0000-0001-5916-6740

Nada Salhab https://orcid.org/0000-0001-5305-2793

Rana Rizk https://orcid.org/0000-0002-8850-6502

Kalliopi Anna Poulia https://orcid.org/0000-0002-0023-8102

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Publisher ID: nutrients-11-02771

DOI: 10.3390/nu11112771

PMC ID: 6893836

PubMed ID: 31739568

SO-VID: b5100a33-7ba8-482b-ba6c-def5257a2702

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Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

Malnutrition-Inflammation Score VS Phase Angle in the Era of GLIM Criteria: A Cross-Sectional Study among Hemodialysis Patients in UAE

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Most cited references 24

A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients.

Bioelectrical impedance analysis in clinical practice: a new perspective on its use beyond body composition equations.

Bioelectric impedance phase angle and body composition.

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