In a groundbreaking study published in ‘Clinical Nutrition ESPEN’, researchers have identified phase angle (PhA) as a crucial screening tool for malnutrition and sarcopenia in patients with gastric cancer (GC), contributing significantly to the detection and anticipation of postoperative complications following radical gastrectomy. This cross-sectional study establishes a firm foundation for the inclusion of bioelectrical impedance analysis in the clinical evaluation of individuals diagnosed with GC. The findings, presented by a team from The Affiliated People’s Hospital of Jiangsu University, are a remarkable contribution to clinical practices concerning the prognosis and treatment of GC patients.
Malnutrition and Muscle Wasting: A Silent Crisis in Gastric Cancer
Gastric cancer remains a significant global health challenge, with malnutrition and muscle wasting, known as sarcopenia, frequently accompanying this malignancy. Malnutrition not only diminishes the quality of life but also hampers the recovery process, leading to poorer outcomes post-surgery. Hence, the pressing need arises for innovative, reliable means to screen and assess these conditions at the earliest.
DOI: 10.1016/j.clnesp.2023.12.004
The Phase Angle Revelation
Conducted between October 2021 and September 2022, the study encompassed 248 GC patients, out of which 188 underwent radical gastrectomy. Unlike conventional methods, this research employed PhA, determined through bioelectrical impedance analysis (BIA), to gauge cellular health and integrity. Moreover, body composition metrics were extracted from computed tomography (CT) scans at the third lumbar vertebra’s level, charting new territories in diagnostic accuracy.
According to the Global Leadership Initiative on Malnutrition (GLIM) criteria, a staggering 49.2% of participants were found malnourished, while 19.8% displayed sarcopenia based on the criteria of the Asian Working Group for Sarcopenia (AWGS) 2019.
PhA: The Prognostic Indicator
The phase angle is the arctangent of the reactance to resistance ratio, derived from BIA. It symbolizes the cell membrane’s integrity and the body’s overall cellular health. The lower the PhA, the more likely an individual is to suffer from cellular dysfunction and, by extension, overall health impairment.
This study revealed a compelling, one-degree decrease in PhA significantly linked with malnutrition (Odds Ratio [OR] = 8.108) and sarcopenia (OR = 2.903), demonstrating substantial diagnostic accuracy in identifying malnutrition (AUC = 0.797 for males and AUC = 0.816 for females) and sarcopenia (AUC = 0.814 for males and AUC = 0.710 for females). Furthermore, a low PhA and extended operation time surfaced as independent predictors for postoperative complications, cementing PhA’s role as a prognostic tool.
Clinical Implications and Future Directions
These findings are particularly promising, suggesting that PhA can be harnessed as a reliable asset for early intervention strategies, potentially averting the severe consequences of malnutrition and sarcopenia in GC patients. The integration of PhA into routine screenings could lead to tailored treatment modalities, enhancing recovery rates and reducing the risk of postoperative complications.
As GC continues to afflict a vast population worldwide, it’s incumbent upon the medical community to embrace such novel diagnostic techniques. The contribution of PhA to a holistic understanding and management of cancer cachexia could lead not only to improved survival rates but also to a better quality of life for patients grappling with gastric cancer.
Recommendations and the Road Ahead
The global healthcare landscape should consider the broad-scale implementation of BIA to measure PhA in cancer care settings. Continuous research and collaboration are recommended to further refine and elucidate the role of PhA in various cancers. The study’s outcomes hint at a paradigm shift in nutritional screening and reiterated the necessity for multidimensional treatment approaches, especially in patients facing severe conditions like gastric cancer.
Copyright Notice
Copyright © 2023 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.
Author Contributions
Zuo Junbo, Zhou Da, and Zhang Li spearheaded the study, showing extraordinary dedication to advancing the current understanding of malnutrition and sarcopenia in gastric cancer. The team, including Zhou Xiaodong, Gao Xuejin, Zhang JingXin, Ding Xin, Hou Wenji, Wang Chen, Jiang Pengcheng, and Wang Xinying, all played pivotal roles in shaping the research, pooling their extensive experience and expertise for this effort.
Declaration of Competing Interest
The authors declare no conflict of interest related to this work.
References
1. Zhou Da, et al. “Phase angle – A screening tool for malnutrition, sarcopenia, and complications in gastric cancer.” Clin Nutr ESPEN, vol. 59, 2024, pp. 334-342, doi:10.1016/j.clnesp.2023.12.004.
2. Global Leadership Initiative on Malnutrition (GLIM) criteria for the diagnosis of malnutrition: A consensus report from the global clinical nutrition community. (2018).
3. Chen, L.K., et al. “Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment.” Journal of the American Medical Directors Association, vol. 21, no. 3, 2020, pp. 300-307.e2.
4. Norman, K., et al. “The role of bioelectrical impedance analysis for the assessment of fluid status and body composition in the oncologic setting: What clinicians need to know.” Journal of Cachexia, Sarcopenia and Muscle, vol. 11, no. 3, 2020, pp. 725-736.
5. Kyle, U.G., et al. “Bioelectrical impedance analysis – part II: utilization in clinical practice.” Clinical Nutrition, vol. 23, no. 6, 2004, pp. 1430-1453.
Keywords
1. Phase angle gastric cancer
2. BIA malnutrition screening
3. Sarcopenia detection methods
4. Radical gastrectomy complications
5. GLIM AWGS nutritional assessment