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. 2023 Jun 21:10:1142545.
doi: 10.3389/fnut.2023.1142545. eCollection 2023.

Association between phase angle and the nutritional status in pediatric populations: a systematic review

Andrea Franco-Oliva #  1 , Azalia Ávila-Nava #  2 , Estíbaliz Amairani Rodríguez-Aguilar  1 , Ander Trujillo-Mercado  3 , Alda Daniela García-Guzmán  3   4 , Beatriz Adriana Pinzón-Navarro  3   5 , Jimena Fuentes-Servín  1 , Martha Guevara-Cruz  3   6 , Isabel Medina-Vera  1   3
Affiliations

Association between phase angle and the nutritional status in pediatric populations: a systematic review

Andrea Franco-Oliva et al. Front Nutr. .

Abstract

Background and aims: Malnutrition is prevalent in pediatric populations with any disease, and it is also related to changes in body composition. In addition, recent studies have documented relationships between these changes and phase angle (PhA), an important parameter of functional nutritional assessment. PhA could be a new marker of nutritional status. Many studies have generated information about the association between PhA and malnutrition in various pathologies, although the vast majority of this information is from adult populations. In this systematic review, we answered the following question: What is the association between PhA and the nutritional status in pediatric populations?

Methods: We performed a systematic search of the Medline/PubMed and Latin American and Caribbean Health Sciences Literature databases (LILACS) databases for studies published up to October 2022. The inclusion criteria were pediatric subjects, which reported the relationship between PhA and the nutritional status with any objective nutritional indicator, and PhA was measured by electric impedance and reported at 50 kHz. We synthesized data from the studies that reported cutoff analysis of PhA with receiver operating characteristic (ROC) curves, mean PhA values presented by nutritional status strata, and correlations between PhA and nutritional status indicators. We assessed the risk of bias by using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and the Quality Assessment for Diagnostic Accuracy Studies.

Results: Of the 126 studies we identified, 15 met the inclusion criteria. The included studies reported the association between PhA and objective indicators of nutritional status, including weight-for-age z-score (WAZ) <-1 standard deviation (SD) for malnutrition, height-for-age z-score (HAZ) for malnutrition-stunting, body mass index (BMI) for the starvation state, body mass index z-score (BMIz) and BMI for malnutrition, mid-upper arm circumference (MUAC) <11 cm for severe acute malnutrition (SAM), and fat-free mass index z-score (FFMIz) <-2 z-score for moderate malnutrition, among others. The report of these associations between PhA and nutritional status was based on cutoff points generated with ROC curve analysis or comparison of mean PhA values, which were reported stratified by the presence or absence of malnutrition, and correlations between PhA and anthropometric indicators for the evaluation of the nutritional status in the pediatric population. It was difficult to compare the studies due to the heterogeneity of the bioelectrical impedance analysis models used, how PhA was reported (standardized, percentiles, or degrees), and the anthropometric indicators used to diagnose malnutrition.

Conclusion: The early identification of malnutrition is relevant to establish the correct nutritional treatment; PhA appears to be a sensitive indicator of nutritional status and is easy to obtain. Although the results of this review are inadequate to establish PhA cutoff points associated with malnutrition in pediatric populations, in most of the studies, there was an association between PhA and objective indicators of nutritional status.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022362413, identifier: PROSPERO 2022 CRD42022362413.

Keywords: adolescent and youth; children; nutritional status; pediatric population; phase angle.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Study selection flowchart (17).
Figure 2
Figure 2
Phase angle reported in the studies stratified by the presence of undernourishment. PhA, phase angle; BMI, body mass index; FFMIz, fat-free mass index z-score; HAZ, height-for-age z-score; HC, healthy children; m, months; SAM, severe acute malnutrition; y, years.
Figure 3
Figure 3
The prevalence of (A) undernutrition and (B) overnutrition reported in the studies. A, adolescents; AMAz, arm muscle area z-score; BMI, body mass index; C, children; FFMI, fat-free mass index; HAZ, height-for-age z-score; I, infants; SAM, severe acute malnutrition; WHZ, weight-for-height z-score; y, years; %AMC, percentage of arm muscle circumference; %IBW, percentage of ideal body weight.
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Grants and funding

This study was supported by Consejo Nacional de Ciencia y Tecnología (México) grant: CONACYT-FRONTERAS 2019 to IM-V and MG-C (FORDECYT-PRONACES/501225/2020): Instituto Nacional de Pediatría - Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. The monetary sponsorship of publication was financed by the Recurso Fiscal of the E022 program of Instituto Nacional de Pediatría. AF-O received a scholarship from Instituto Danone de México.
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