Hostname: page-component-8448b6f56d-sxzjt Total loading time: 0 Render date: 2024-04-23T08:16:03.664Z Has data issue: false hasContentIssue false
  • English
  • Français

Bioelectrical impedance phase angle as a prognostic indicator in advanced pancreatic cancer

Published online by Cambridge University Press:  09 March 2007

Digant Gupta ,
Christopher G. Lis ,
Sadie L. Dahlk ,
Pankaj G. Vashi ,
James F. Grutsch  and
Carolyn A. Lammersfeld
Digant Gupta*
Affiliation:
Cancer Treatment Centers of America (CTCA) at Midwestern Regional Medical Center, 2520 Elisha Avenue, Zion, IL 60099, USA
Christopher G. Lis
Affiliation:
Cancer Treatment Centers of America (CTCA) at Midwestern Regional Medical Center, 2520 Elisha Avenue, Zion, IL 60099, USA
Sadie L. Dahlk
Affiliation:
Cancer Treatment Centers of America (CTCA) at Midwestern Regional Medical Center, 2520 Elisha Avenue, Zion, IL 60099, USA
Pankaj G. Vashi
Affiliation:
Cancer Treatment Centers of America (CTCA) at Midwestern Regional Medical Center, 2520 Elisha Avenue, Zion, IL 60099, USA
James F. Grutsch
Affiliation:
Cancer Treatment Centers of America (CTCA) at Midwestern Regional Medical Center, 2520 Elisha Avenue, Zion, IL 60099, USA
Carolyn A. Lammersfeld
Affiliation:
Cancer Treatment Centers of America (CTCA) at Midwestern Regional Medical Center, 2520 Elisha Avenue, Zion, IL 60099, USA
*
*Corresponding author: Dr Digant Gupta, fax +1 847 746 4329, email digant.gupta@mrmc-ctca.com
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Bioelectrical impedance analysis (BIA) is an easy-to-use, non-invasive and reproducible technique to evaluate changes in body composition and nutritional status. Phase angle, determined by BIA, has been found to be a prognostic indicator in several chronic conditions, such as HIV, liver cirrhosis, chronic obstructive pulmonary disease and lung cancer, and in patients undergoing dialysis. The present study investigated the prognostic role of phase angle in advanced pancreatic cancer. We evaluated a case series of fifty-eight stage IV pancreatic cancer patients treated at Cancer Treatment Centers of America® at Midwestern Regional Medical Center (Zion, IL, USA) between January 2000 and July 2003. BIA was conducted on all patients using a bioelectrical impedance analyser that operated at 50kHz. The phase angle was calculated as capacitance (Xc)/resistance (R) and expressed in degrees. The Kaplan–Meier method was used to calculate survival. Cox proportional hazard models were constructed to evaluate the prognostic effect of phase angle independent of other clinical and nutritional variables. The correlations between phase angle and traditional nutritional measures were evaluated using Pearson and Spearman coefficients. Patients with phase angle <5·0° had a median survival time of 6·3 (95% CI 3·5, 9·2) months (n 29), while those with phase angle >5·0° had a median survival time of 10·2 (95% CI 9·6, 10·8) months (n 29); this difference was statistically significant (P=0·02). The present study demonstrates that phase angle is a strong prognostic indicator in advanced pancreatic cancer. Similar studies in other cancer settings with larger sample sizes are needed to further validate the prognostic significance of the phase angle.

Keywords

Pancreatic cancerBioelectrical impedance analysisPhase angleSurvival time
Type
Review Article
Information
British Journal of Nutrition , Volume 92 , Issue 6 , December 2004 , pp. 957 - 962
Copyright
Copyright © The Nutrition Society 2004

References

Adami, GF, Marinari, G, Gandolfo, P, Cocchi, F, Friedman, D & Scopinaro, N (1993) The use of bioelectrical impedance analysis for monitoring body composition changes during nutritional support. Surg Today 23, 867–870.CrossRefGoogle ScholarPubMed
Anon (1996) Bioelectrical impedance analysis in body composition measurement: National Institutes of Health Technology Assessment Conference Statement. Am J Clin Nutr 64, 524S–532S.CrossRefGoogle Scholar
Azcue, M, Fried, M & Pencharz, PB (1993) Use of bioelectrical impedance analysis to measure total body water in patients with cystic fibrosis. J Pediatr Gastroenterol Nutr 16, 440–445.Google ScholarPubMed
Barbosa-Silva, MC, Barros, AJ, Post, CL, Waitzberg, DL & Heymsfield, SB (2003) Can bioelectrical impedance analysis identify malnutrition in preoperative nutrition assessment?. Nutrition 19, 422–426.CrossRefGoogle ScholarPubMed
Bauer, J, Capra, S & Ferguson, M (2002) Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr 56, 779–785.CrossRefGoogle ScholarPubMed
Baumgartner, RN, Chumlea, WC & Roche, AF (1988) Bioelectric impedance phase angle and body composition. Am J Clin Nutr 48, 16–23.CrossRefGoogle ScholarPubMed
Bohmig, M & Rosewicz, S (2004) Pancreatic carcinoma. Z Gastroenterol 42, 261–268.Google ScholarPubMed
Carney, DE & Meguid, MM (2002) Current concepts in nutritional assessment. Arch Surg 137, 42–45.CrossRefGoogle ScholarPubMed
Chertow, GM, Lazarus, JM, Lew, NL, Ma, L & Lowrie, EG (1997) Bioimpedance norms for the hemodialysis population. Kidney Int 52, 1617–1621.CrossRefGoogle ScholarPubMed
Chertow, GM, Lowrie, EG, Wilmore, DW, Gonzalez, J, Lew, NL, Ling, J, Leboff, MS, Gottlieb, MN, Huang, W & Zebrowski, B (1995) Nutritional assessment with bioelectrical impedance analysis in maintenance hemodialysis patients. J Am Soc Nephrol 6, 75–81.CrossRefGoogle ScholarPubMed
Desport, JC, Preux, PM, Bouteloup-Demange, C, Clavelou, P, Beaufrere, B, Bonnet, C & Couratier, PP (2003) Validation of bioelectrical impedance analysis in patients with amyotrophic lateral sclerosis. Am J Clin Nutr 77, 1179–1185.CrossRefGoogle ScholarPubMed
Detsky, AS, Baker, JP, Mendelson, RA, Wolman, SL, Wesson, DE & Jeejeebhoy, KN (1984) Evaluating the accuracy of nutritional assessment techniques applied to hospitalized patients: methodology and comparisons. J Parenter Enteral Nutr 8, 153–159.CrossRefGoogle ScholarPubMed
Dittmar, M (2003) Reliability and variability of bioimpedance measures in normal adults: effects of age, gender, and body mass. Am J Phys Anthropol 122, 361–370.CrossRefGoogle ScholarPubMed
Elia, M (1993) The bioimpedance ‘craze’. Eur J Clin Nutr 47, 825–827.Google ScholarPubMed
Faisy, C, Rabbat, A, Kouchakji, B & Laaban, JP (2000) Bioelectrical impedance analysis in estimating nutritional status and outcome of patients with chronic obstructive pulmonary disease and acute respiratory failure. Intensive Care Med 26, 518–525.CrossRefGoogle ScholarPubMed
Fein, PA, Gundumalla, G, Jorden, A, Matza, B, Chattopadhyay, J & Avram, MM (2002) Usefulness of bioelectrical impedance analysis in monitoring nutrition status and survival of peritoneal dialysis patients. Adv Perit Dial 18, 195–199.Google ScholarPubMed
Foster, KR & Lukaski, HC (1996) Whole-body impedance – what does it measure?. Am J Clin Nutr 64 388S – 396SCrossRefGoogle ScholarPubMed
Fredrix, EW, Saris, WH, Soeters, PB, Wouters, EF, Kester, AD, von Meyenfeldt, MF & Westerterp, KR (1990) Estimation of body composition by bioelectrical impedance in cancer patients. Eur J Clin Nutr 44, 749–752.Google ScholarPubMed
Higashiguchi, T, Kita, T, Noguchi, T, Kawarada, Y & Mizumoto, R (1988) Importance of nutritional management for the treatment of carcinoma of the pancreas. Gan To Kagaku Ryoho 15, 847–853.Google ScholarPubMed
Lukaski, HC (1999) Requirements for clinical use of bioelectrical impedance analysis (BIA). Ann NY Acad Sci 873, 72–76.CrossRefGoogle ScholarPubMed
Lukaski, HC, Johnson, PE, Bolonchuk, WW & Lykken, GI (1985) Assessment of fat-free mass using bioelectrical impedance measurements of the human body. Am J Clin Nutr 41, 810–817.CrossRefGoogle ScholarPubMed
Maggiore, Q, Nigrelli, S, Ciccarelli, C, Grimaldi, C, Rossi, GA & Michelassi, C (1996) Nutritional and prognostic correlates of bioimpedance indexes in hemodialysis patients. Kidney Int 50, 2103–2108.CrossRefGoogle ScholarPubMed
Marken Lichtenbelt, WD, Westerterp, KR, Wouters, L & Luijendijk, SC (1994) Validation of bioelectrical-impedance measurements as a method to estimate body-water compartments. Am J Clin Nutr 60, 159–166.CrossRefGoogle ScholarPubMed
Mushnick, R, Fein, PA, Mittman, N, Goel, N, Chattopadhyay, J & Avram, MM (2003) Relationship of bioelectrical impedance parameters to nutrition and survival in peritoneal dialysis patients. Kidney Int 83, S53–S56.CrossRefGoogle Scholar
Nagano, M, Suita, S & Yamanouchi, T (2000) The validity of bioelectrical impedance phase angle for nutritional assessment in children. J Pediatr Surg 35, 1035–1039.CrossRefGoogle ScholarPubMed
Ott, M, Fischer, H, Polat, H, Helm, EB, Frenz, M, Caspary, WF & Lembcke, B (1995) Bioelectrical impedance analysis as a predictor of survival in patients with human immunodeficiency virus infection. J Acquir Immune Defic Syndr Hum Retrovirol 9, 20–25.CrossRefGoogle ScholarPubMed
Ottery, F (1996) Supportive nutritional management of the patient with pancreatic cancer. Oncology (Huntingt) 10, 26–32.Google ScholarPubMed
Pencharz, PB & Azcue, M (1996) Use of bioelectrical impedance analysis measurements in the clinical management of malnutrition. Am J Clin Nutr 64, 485S–488S.CrossRefGoogle ScholarPubMed
Pupim, LB, Kent, P & Ikizler, TA (1999) Bioelectrical impedance analysis in dialysis patients. Miner Electrolyte Metab 25, 400–406.CrossRefGoogle ScholarPubMed
Rocha Lima, CM & Centeno, B (2002) Update on pancreatic cancer. Curr Opin Oncol 14, 424–430.CrossRefGoogle ScholarPubMed
Sarhill, N, Mahmoud, FA, Christie, R & Tahir, A (2003) Assessment of nutritional status and fluid deficits in advanced cancer. Am J Hosp Palliat Care 20, 465–473.CrossRefGoogle ScholarPubMed
Schwenk, A, Beisenherz, A, Romer, K, Kremer, G, Salzberger, B & Elia, M (2000) Phase angle from bioelectrical impedance analysis remains an independent predictive marker in HIV-infected patients in the era of highly active antiretroviral treatment. Am J Clin Nutr 72, 496–501.CrossRefGoogle ScholarPubMed
Schwenk, A, Ward, LC, Elia, M & Scott, GM (1998) Bioelectrical impedance analysis predicts outcome in patients with suspected bacteremia. Infection 26, 277–282.CrossRefGoogle ScholarPubMed
Selberg, O & Selberg, D (2002) Norms and correlates of bioimpedance phase angle in healthy human subjects, hospitalized patients, and patients with liver cirrhosis. Eur J Appl Physiol 86, 509–516.CrossRefGoogle ScholarPubMed
Simons, JP, Schols, AM, Westerterp, KR, ten Velde, GP & Wouters, EF (1995) The use of bioelectrical impedance analysis to predict total body water in patients with cancer cachexia. Am J Clin Nutr 61, 741–745.CrossRefGoogle ScholarPubMed
Talluri, T, Lietdke, RJ, Evangelisti, A, Talluri, J & Maggia, G (1999) Fat-free mass qualitative assessment with bioelectric impedance analysis (BIA). Ann NY Acad Sci 873, 94–98.CrossRefGoogle ScholarPubMed
Toso, S, Piccoli, A, Gusella, M, Menon, D, Bononi, A, Crepaldi, G & Ferrazzi, E (2000) Altered tissue electric properties in lung cancer patients as detected by bioelectric impedance vector analysis. Nutrition 16, 120–124.CrossRefGoogle ScholarPubMed
Waitzberg, DL & Correia, MI (2003) Nutritional assessment in the hospitalized patient. Curr Opin Clin Nutr Metab Care 6, 531–538.CrossRefGoogle ScholarPubMed
Zarowitz, BJ & Pilla, AM (1989) Bioelectrical impedance in clinical practice. DICP 23, 548–555.CrossRefGoogle ScholarPubMed