title: Phase angle and handgrip strength are sensitive early markers of energy intake in hypophagic, non-surgical patients at nutritional risk, with contraindications to enteral nutrition.
abstract: The assessment of nutritional intakes during hospitalization is crucial, as it is known that nutritional status tends to worsen during the hospital stay, and this can lead to the negative consequences of malnutrition. International guidelines recommend the use of parenteral nutrition (PN) in hypophagic, non-surgical patients at nutritional risk, with contraindications to enteral nutrition. However, to date, there are no published data regarding either energy intake or objective measurements associated with it in this patient population. The aim of the present exploratory methodological study was to evaluate whether phase angle (PhA) and handgrip strength normalized for skeletal muscle mass (HG/SMM) are sensitive early markers of energy intake in hypophagic, non-surgical patients at nutritional risk, with contraindications to enteral nutrition. We evaluated 30 eligible patients, who were treated with personalized dietary modifications and supplemental PN for at least one week during hospitalization. In a liner regression model adjusted for age, gender, basal protein intake and the basal value of each variable, a trend toward improvement of PhA and preservation of HG/SMM was observed in patients satisfying the estimated calorie requirements (N = 20), while a significant deterioration of these parameters occurred in those who were not able to reach the target (N = 10). The mean adjusted difference and 95% CI were +1.4° (0.5-2.3) (p = 0.005) for PhA and +0.23 (0.20-0.43) (p = 0.033) for HG/SMM. A significant correlation between PhA and HG/SMM variations was also observed (r = 0.56 (95% CI, 0.23-0.77); p = 0.0023). PhA and HG/SMM were able to distinguish between hypophagic, non-surgical patients at nutritional risk who satisfied their estimated caloric requirements and those who did not after a one-week personalized nutritional support. Clinical studies are warranted, in order to verify these preliminary observations and to validate the role of PhA variations as early markers of anabolic/catabolic fluctuations.
authors.affiliation: Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy. r.caccialanza@smatteo.pv.it.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Caccialanza
authors.affiliation: Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy. e.cereda@smatteo.pv.it.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Cereda
authors.affiliation: Biometry and Clinical Epidemiology Service, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy. klersy@smatteo.pv.it.
authors.forename: Catherine
authors.initials: C
authors.lastname: Klersy
authors.affiliation: Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy. c.bonardi@smatteo.pv.it.
authors.forename: Chiara
authors.initials: C
authors.lastname: Bonardi
authors.affiliation: Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy. cappellosilvia@hotmail.it.
authors.forename: Silvia
authors.initials: S
authors.lastname: Cappello
authors.affiliation: Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy. laraquarleri@libero.it.
authors.forename: Lara
authors.initials: L
authors.lastname: Quarleri
authors.affiliation: Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy. terrianna@libero.it.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Turri
authors.affiliation: Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy. e.montagna@smatteo.pv.it.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Montagna
authors.affiliation: Pharmacy Unit, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy. i.iacona@smatteo.pv.it.
authors.forename: Isabella
authors.initials: I
authors.lastname: Iacona
authors.affiliation: Division of Medical Oncology, Department of Hemato-Oncology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy. f.valentino@smatteo.pv.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Valentino
authors.affiliation: Division of Medical Oncology, Department of Hemato-Oncology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy. p.pedrazzoli@smatteo.pv.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pedrazzoli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001823:Body Composition; D000075202:Contraindications; D017097:Electric Impedance; D002149:Energy Intake / Q000502:physiology*; D004750:Enteral Nutrition; D005260:Female; D018737:Hand Strength; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D044342:Malnutrition / Q000209:etiology / Q000503:physiopathology*; D008875:Middle Aged; D009751:Nutritional Requirements; D009752:Nutritional Status; D018529:Nutritional Support / Q000379:methods*; D010288:Parenteral Nutrition