Phase angle: medical interpretations and applications

Cover Page

Cite item

Full Text

Abstract

Specialists are interested in using bioimpedance technology to assess the rate of metabolic processes and body composition; thus, this study aimed to determine the possibilities of the clinical application of the phase angle, which is a parameter that is specific for the bioimpedance method to obtain body composition information. In nutrition assessment, the phase angle is used as an indirect characteristic of the protein fraction of the body and the rate of metabolic processes.

In the early 2000s, low values of the phase angle in diseased catabolic orientation were shown to assess the survival rate whereas high values assess the muscular system fitness in athletes and other individuals who regularly experience physical exertion. Systematic reviews and Meta-analyzes of subsequent years have summarized the evidence based on these provisions and identified several new applications for sarcopenia, anorexia, and renal failure. Therefore, all the reviews presented in this study confirm that higher phase angle values correspond to a better state of the body and that phase angle can dynamically change in an individual patient. This feature of the parameter requires a detailed understanding of the variability of values depending on measurement conditions.

The phase angle is recognized as a convenient diagnostic tool and a convenient parameter for screening examinations. At high values, it reflects the degree of muscular system fitness, and at low values, the severity of catabolic disorders due to existing diseases or immobilization.

About the authors

Dmitry V. Nikolaev

Scientific Research Center “Medas”

Email: dvn@medass.ru
ORCID iD: 0000-0002-1461-5896
SPIN-code: 5322-6751
Scopus Author ID: 57214509515
Russian Federation, 1, Ostrovityanova street, Moscow, 117997

Svetlana P. Shchelykalina

The Russian National Research Medical University named after N.I. Pirogov

Author for correspondence.
Email: svetlanath@gmail.com
ORCID iD: 0000-0003-3292-8949
SPIN-code: 9804-0820
Scopus Author ID: 56266977600
ResearcherId: K-2225-2016

MD, Cand. Sci. (Med.)

Russian Federation, 1, Ostrovityanova street, Moscow, 117997

References

  1. Barnett A, Bagno S. The physiological mechanisms involved in the clinical measure of phase angle: circuits simulating the phase angle properties of the body; correlations with experimental findings in normal and pathological states. Am J Physiology. 1935;114(2): 366–382. doi: 10.1152/ajplegacy.1935.114.2.366
  2. Barnett A. The phase angle of normal human skin. J Physiol. 1938;93(4):349–366. doi: 10.1113/jphysiol.1938.sp003645
  3. Bozler EL, Cole KS. Electric impedance and phase angle of muscle in rigor. J Cell Comparat Physiology. 1935;6(2):229–241. doi: 10.1002/jcp.1030060205
  4. Cole KS, Curtis HJ. Electric impedance of the squid giant axon during activity. J Gen Physiology .1939;22(5):649–670. doi: 10.1085/jgp.22.5.649
  5. Cole K, Curtis H. Electrical impedance of nerve during activity. Nature. 1938;142:209–210. doi: 10.1038/142209b0
  6. Cole KS. Electric phase angle of cell membranes. J Gen Physiol. 1932;15(6):641–649. doi: 10.1085/jgp.15.6.641
  7. Selberg O, Selberg D. Norms and correlates of bioimpedance phase angle in healthy human subjects, hospitalized patients, and patients with liver cirrhosis. Eur J Appl Physiol. 2002;86(6):509–516. doi: 10.1007/s00421-001-0570-4
  8. Nikolaev DV, Smirnov AV, Bobrinskaya IG, Rudnev SG. Bioelectric impedance analysis of human body composition. Moscow: Nauka; 2009. 392 p. (In Russ).
  9. Chertow GM, Lowrie EG, Wilmore DW, et al. Nutritional assessment with bioelectrical impedance analysis in maintenance hemodialysis patients. J Am Soc Nephrol. 1995;6(1):75–81. doi: 10.1681/ASN.V6175
  10. Marini E, Buffa R, Contreras M, et al. Effect of influenza-induced fever on human bioimpedance values. PLoS One. 2015;10(4):e0125301. doi: 10.1371/journal.pone.0125301
  11. Bosy-Westphal A, Danielzik S, Dörhöfer RP, et al. Phase angle from bioelectrical impedance analysis: population reference values by age, sex, and body mass index. JPEN J Parenter Enteral Nutr. 2006;30(4):309–316. doi: 10.1177/0148607106030004309
  12. Rudnev SG, Soboleva NP, Sterlikov SA, et al. Bioimpedance study of body composition in the Russian population. Moscow: RIO TSNIIOIZ; 2014. 493 p. (In Russ).
  13. Nikolaev DV, Shchelykalina SP. Bioimpedance analysis of the human body composition: Lectures. Moscow: RIO TSNIIOIZ; 2016. 152 p. (In Russ).
  14. Slinde F, Rossander-Hulthén L. Bioelectrical impedance: effect of 3 identical meals on diurnal impedance variation and calculation of body composition. Am J Clin Nutr. 2001;74(4):474–478. doi: 10.1093/ajcn/74.4.474
  15. Malakhov MV, Nikolayev DV, Smirnov AV, et al. Evaluation of blood hematological and biochemical parameters by bioimpedance spectroscopy. Clinical Laboratory Diagnostics. 2011;(1):20–23. (In Russ).
  16. Khubutiya MS, Popova TS, Saltanov AI. Parenteral and enteral nutrition: A national guide. Moscow: GEOTAR-Media; 2014. 800 p. (In Russ).
  17. Norman K, Stobäus N, Pirlich M, Bosy-Westphal A. Bioelectrical phase angle and impedance vector analysis--clinical relevance and applicability of impedance parameters. Clin Nutr. 2012;31(6): 854–861. doi: 10.1016/j.clnu.2012.05.008
  18. Garlini LM, Alves FD, Ceretta LB, et al. Phase angle and mortality: a systematic review. Eur J Clin Nutr. 2019;73(4):495–508. doi: 10.1038/s41430-018-0159-1
  19. Pereira MM, Queiroz MD, de Albuquerque NM, et al. The prognostic role of phase angle in advanced cancer patients: a systematic review. Nutr Clin Pract. 2018;33(6):813–824. doi: 10.1002/ncp.10100
  20. Arab A, Karimi E, Vingrys K, Shirani F. Is phase angle a valuable prognostic tool in cancer patients’ survival? A systematic review and meta-analysis of available literature. Clin Nutr. 2021;40(5): 3182–3190. doi: 10.1016/j.clnu.2021.01.027
  21. Grundmann O, Yoon SL, Williams JJ. The value of bioelectrical impedance analysis and phase angle in the evaluation of malnutrition and quality of life in cancer patients-- a comprehensive review. Eur J Clin Nutr. 2015;69(12):1290–1297. doi: 10.1038/ejcn.2015.126
  22. Fernandes SA, de Mattos AA, Tovo CV, Marroni CA. Nutritional evaluation in cirrhosis: Emphasis on the phase angle. World J Hepatol. 2016;8(29):1205–1211. doi: 10.4254/wjh.v8.i29.1205
  23. Lukaski HC, Kyle UG, Kondrup J. Assessment of adult malnutrition and prognosis with bioelectrical impedance analysis: phase angle and impedance ratio. Curr Opin Clin Nutr Metab Care. 2017;20(5):330–339. doi: 10.1097/MCO.0000000000000387
  24. Małecka-Massalska T, Popiołek J, Teter M, et al. Application of phase angle for evaluation of the nutrition status of patients with anorexia nervosa. Psychiatr Pol. 2017;51(6):1121–1131. doi: 10.12740/PP/67500
  25. Di Vincenzo O, Marra M, Di Gregorio A, et al. Bioelectrical impedance analysis (BIA) — derived phase angle in sarcopenia: A systematic review. Clin Nutr. 2021;40(5):3052–3061. doi: 10.1016/j.clnu.2020.10.048
  26. Di Vincenzo O, Marra M, Scalfi L. Bioelectrical impedance phase angle in sport: a systematic review. J Int Soc Sports Nutr. 2019; 16(1):49. doi: 10.1186/s12970-019-0319-2
  27. Mundstock E, Amaral MA, Baptista RR, et al. Association between phase angle from bioelectrical impedance analysis and level of physical activity: Systematic review and meta-analysis. Clin Nutr. 2019;38(4):1504–1510. doi: 10.1016/j.clnu.2018.08.031
  28. Mattiello R, Amaral MA, Mundstock E, Ziegelmann PK. Reference values for the phase angle of the electrical bioimpedance: Systematic review and meta-analysis involving more than 250,000 subjects. Clin Nutr. 2020;39(5):1411–1417. doi: 10.1016/j.clnu.2019.07.004
  29. Llames L, Baldomero V, Iglesias ML, Rodota LP. Values of the phase angle by bioelectrical impedance; nutritional status and prognostic value. (In Spanish). Nutr Hosp. 2013;28(2):286–295. doi: 10.3305/nh.2013.28.2.6306
  30. Barbosa-Silva MC, Barros AJ, Wang J, et al. Bioelectrical impedance analysis: population reference values for phase angle by age and sex. Am J Clin Nutr. 2005;82(1):49–52. doi: 10.1093/ajcn.82.1.49
  31. Kyle UG, Genon L, Karsegard VL. Percentiles (10, 25, 75 and 90th) for phase angle (PhA), determined by bioelectrical impedance analysis (BIA) in 2740 healthy adults aged 20–75 yr. Clin Nutr 2004;23:758.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Kaplan-Meier plots of patients with liver cirrhosis. The data is grouped by phase angle values. Survival is significantly reduced at phase angle values less than 5.4º [7, 8].

Download (480KB)
Indexing metadata
3. Fig. 2. Phase angle scale according to Selberg O., Selberg D. [7]: (a) population curve with a 2SD corridor of normal values (b), visualization of phase angle values against the background of its centile values (c).

Download (735KB)
Indexing metadata
4. Fig. 3. Male (a) and female (b) population curves obtained in surveys of the population of Russia, the USA, the Federal Republic of Germany and Switzerland [11, 12].

Download (635KB)
Indexing metadata
5. Fig. 4. Bipolar connection of the current generator and voltmeter (a); tetrapolar connection (b); graphs of changes in sinusoidal current and voltage in the test object (c) [13].

Download (517KB)
Indexing metadata
6. Fig. 5. Graphs of age dependences of the 3rd, 10th, 25, 50, 75, 90 and 97th centiles of the phase angle values according to the data of the Health Centers: men (a), women (b) [12].

Download (671KB)
Indexing metadata
7. Fig. 6. Dynamic results sheet of bioimpedance study of a sambo sportsman after data filtering and construction of individual norm corridor.

Download (1MB)
Indexing metadata
8. Fig. 7. Example of values for local measurements of resistance (R), reactance (Xc), phase angle and percentage with integral value phase angle measured in the hand–foot lead.

Download (928KB)
Indexing metadata
9. Fig. 8. Graphs of changes in the values of extracellular fluid (a–d) and phase angle (e–h) for the right arm (a, e), for the trunk (b, f), for the right leg (c, g), in the hand–foot abduction (d, h). Records of the background state, of measurement artifacts during the exercise, of 30-minute recovery process are continuously visible from left to right in each part of the registration.

Download (1MB)
Indexing metadata

Copyright (c) 2021 Nikolaev D.V., Shchelykalina S.P.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies