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.

Figure 1

Variations (mean and SDs) in phase angle (A), body weight (B) and handgrip strength adjusted for skeletal muscle mass (C) by satisfaction of estimated energy requirements. * p-value ≤ 0.01 (baseline vs. end of study).

Figure 1

Variations (mean and SDs) in phase angle (A), body weight (B) and handgrip strength adjusted for skeletal muscle mass (C) by satisfaction of estimated energy requirements. * p-value ≤ 0.01 (baseline vs. end of study).

Figure 2

Mean impedance vectors and confidence ellipses on the bioelectrical impedance vectorial analysis (BIVA) nomogram by sex and satisfaction of estimated energy requirements (blue color = overall population at baseline assessment; red color = patients not satisfying estimated energy requirements at Day 7; black color = patients satisfying estimated energy requirements at Day 7).