title: Phase angle as a nutritional evaluation tool in all stages of chronic liver disease.
abstract: BACKGROUND
  Malnutrition is commonly and frequently under-diagnosed in clinical settings in patients with chronic liver disease (CLD) due to the limitations of nutritional evaluation methods in this population. We hypothesized that the bioelectrical impedance analysis derived phase angle (BIA-derived PhA) might be considered as a nutritional indicator in CLD since it represents either cell death or malnutrition characterized by changes in cellular membrane integrity.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the BIA-derived PhA as a nutritional evaluation tool in all stages of CLD, including chronic hepatitis, liver cirrhosis and hepatocellular carcinoma (HCC). Liver-related death and survival were evaluated.
  
  
  METHODS
  A total of 66 patients were enrolled in a cross-sectional study. For the nutritional diagnosis, mid-arm circumference (MAC), triceps skinfold thickness (TST), mid-arm muscle circumference (MAMC) and Subject Global Assessment (SGA) were evaluated. Biochemical and clinical evaluations were performed.
  
  
  RESULTS
  Our results showed that PhA was higher in well-nourished patients, according to SGA and in the patients without hepatic encephalopathy. PhA correlated significantly with MAMC, MAC and albumin and was inversely correlated with age. No correlation was found between PhA values and the Child-Pugh score and ascites. PhA was strongly associated with survival and PhA ≤ 5.18º with relative risk increase of 2.5 for death.
  
  
  CONCLUSIONS
  We conclude that the BIA-derived PhA is a relevant nutritional evaluation tool in chronic hepatitis, liver cirrhosis and HCC and the role of PhA in the prediction of survival in CLD should be examined further in a controlled study.
authors.affiliation: Department of Nutrition and Dietetics, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. wilza@nutricao.ufrj.br
authors.forename: W A F
authors.initials: WA
authors.lastname: Peres
authors.forename: D F
authors.initials: DF
authors.lastname: Lento
authors.forename: K
authors.initials: K
authors.lastname: Baluz
authors.forename: A
authors.initials: A
authors.lastname: Ramalho
mesh_terms: D000328:Adult; D000368:Aged; D000886:Anthropometry; D001132:Arm / Q000033:anatomy & histology; D003430:Cross-Sectional Studies; D017097:Electric Impedance; D058625:End Stage Liver Disease / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006505:Hepatitis / Q000150:complications; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000175:diagnosis*; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D016133:Polymerase Chain Reaction; D012885:Skinfold Thickness; D013534:Survival