ABCD of Health Assessment: How Phase Angle Impacts Nutritional Status

Anthropometry is the science of obtaining systematic measurements of the human body. The anthropometry history dates back to the 19th century, and it was previously used to determine how human nature and structure changes through their evolutionary process. Nowadays, anthropometric measurements are a part of body composition assessment and analysis. Regardless of the new discoveries to evaluated our health status there is one that remains the ABCD health assessment and it provides us with a wide array of information. However, the combination between the new and the classics can impact our evaluation and enable us to give a better treatment plan.

Nutritional assessment has a holistic approach, and it is composed of 4 different elements.

ABCD Health Assessment

Anthropometric measurements and body composition: This element encompasses the measurement of height, weight, calculations of body mass index (BMI), waist-to-hip ratio, and the determination of the body composition. Body composition describes the distribution of the different compartments in our body, such as fat mass, skeletal muscle mass, total body water, and lean mass (total body water, skeletal muscle mass, and bone). 

Biomarkers and laboratory findings: Laboratory findings are a great tool to assess the patient’s current health. There are two main types of biomarkers: those that measure the macronutrient status, such as proteins, carbohydrates, and lipids. The other type is those biomarkers that measure the micronutrients such as vitamins, minerals, and phytonutrients.

Some common examples are: 

Protein:  makers like total protein, albumin, prealbumin and globulin.

Fats: Lipid profile composed of markers such as total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein, triglycerides, lipid particle number, and size, as well as TG/HDL ratio.

Carbohydrates: biomarkers like fasting blood glucose, fasting insulin, HgA1c, HOMA-IR score, and glucose oral tolerance test are a few biochemical markers that measure carbohydrate function.

Minerals:  zinc, selenium, magnesium, phosphorus, iron, copper, calcium, and iodine are measured in urine or serum. 

Vitamins: Vitamin A, D, E, K, C, and B are part of the biochemical markers. They can be found in serum or urine.

Clinical indicators:  a clinical examination should include a complete physical exam. We can correlate the information with our physical characteristics, biochemical markers, body composition analysis, and dietetic history to determine nutrient deficits or detect metabolic conditions.

The physician can know additional information about the clinical evaluation from the assessment of taste or smell senses. Also, evaluation of the mouth, teeth, gums, and tongue provides a broader insight. Any abnormalities can be associated with hypothyroidism, candida overgrowth, pellagra, liver disease, sensitivity to foods, and impaired glucose tolerance.

Diet, nutrition, and lifestyle:  a patient’s dietary patterns are dictated by their ability to eat, chew and swallow. Also, the economic income can modify a patient’s dietary intake. Furthermore, exercise, work schedule, how many meals per day our patient has can determine their propensity to develop a disease.

Nutritional Screenings

The nutritional screenings determine a patient’s nutritional risk, and these are applied to hospitalized patients. Also, these assessment tools are quick methods that can rapidly detect nutritional risk in a larger population (such as in hospitals). Consequently, these assessment tools can detect undernutrition or risk of developing malnutrition, ensuring a rapid response from the dietetic professionals, preventing undesired weight loss in patients at risk. Most of these screenings consider BMI, how much weight has the patient lost, and in what period, acute disease, 

An in-depth ABCD evaluation should always follow these nutritional assessment tools.

Common nutritional screenings:

• A subjective global assessment.
• Mini-nutritional assessment.
• NRS-2002.
• MUST (Malnutrition Universal Screening Tool).

How phase angle associates with health assessment

A novel measurement with critical clinical applications and growing research literature is the Phase Angle. Almost all anthropometric measurements correlate with inflammation and disease, such as excessive fat mass or low skeletal muscle mass. However, Phase Angle can describe the overall health status of the patient. The phase angle is proportional to body cell mass. Therefore it reflects cellular nutrition status.

In previous studies, the phase angle showed a significant correlation with frailty and sarcopenia in the elderly population. The studies that reported this association assure that the loss of cell mass and the skeletal muscle mass reduction are the main factors that impact the phase angle measurement. The authors conclude that the phase angle and handgrip strength test have the exact detection capacity for frailty.

In patients with anorexia nervosa, the phase angle resulted in a better prediction tool when compared with BMI. The main objective of this study was to determine the phase angle’s usefulness to predict malnutrition. The authors concluded that phase angle predictability relied on its capacity to detect the body cell mass and the cells’ health status. 

These findings suggest that phase angle is a great tool to determine the nutritional status of specific populations. However, its clinical applications need to be studied in-depth to pinpoint its exact function. Besides, the ABCD assessment is a complete evaluation, and a single marker can never supplant the human clinical eye. The correlation of the phase angle and the nutritional screenings, followed by an ABCD assessment, is the best way to ensure our patient’s proper evaluation. – Ana Paola Rodríguez Arciniega, MS

References:

Ma?ecka-Massalska, Teresa et al. “Application of phase angle for evaluation of the nutrition status of patients with anorexia nervosa.”  Psychiatria polska vol. 51,6 (2017): 1121-1131. doi:10.12740/PP/67500

Tanaka, Satoshi et al. “Low Bioelectrical Impedance Phase Angle Is a Significant Risk Factor for Frailty.” BioMed research international vol. 2019 6283153. 10 Jun. 2019, doi:10.1155/2019/6283153

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