The phase angle and chronic obstructive pulmonary disease: a systematic review_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

HOU Shuanglong ¹ , WEI Jiaxin ¹ , ZHAO Xin ² ,  WANG Gang ^1,3

1. Graduate Department of Xi'an Physical Education University, Xi'an, Shannxi 710068, P. R. China;
2. Department of Rehabilitation Medicine, The Second Affiliated Hospital of the Air Force Military Medical University, Xi'an, Shannxi 710032, P. R. China;
3. School of Sports and Health Sciences, Xi'an Physical Education University, Xi'an, Shannxi 710068, P. R. China;

Corresponding?author：

WANG Gang, Email: wanggang778@126.com

Keywords：

Chronic obstructive pulmonary disease; phase angle; disease severity; function; prognosis

DOI：

10.7507/1671-6205.202312004

Video：

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Objective To systematic investigate whether phase angle of bioelectrical impedance is associated with the functionality, severity, and prognosis of individuals afflicted with chronic obstructive pulmonary disease (COPD). Methods Relevant literature from the PubMed, Embase, Web of Science, Scopus, CNKI, and WanFang databases was retrieved, and literature screening and data extraction in accordance with standardized methods were conducted. Literature quality was assessed by utilizing Mixed Methods Appraisal Tool. Subsequently, data pertaining to the results was extracted for summarization and induction, and descriptive analyzed through qualitative synthesis. Results A total of 11 studies, encompassing 2189 subjects, were included in this review, and the overall quality of the literature was deemed relatively high. Of these studies, three examined the correlation between phase angle and the severity of COPD, eight studies examined the correlation between phase angle and pulmonary and physical function in COPD, and seven studies reported the association between phase angle and adverse outcomes such as hospitalization time, nutritional risk, acute exacerbation and mortality in COPD. The collective findings suggestted that reduced levels of phase angle are linked to severe illness, diminished function, and unfavorable prognosis among individuals with COPD. Phase angle emerged as an independent predictor of lung function, physical exercise endurance, acute exacerbation and mortality in COPD patients. Conclusion The phase angle level of COPD patients is associated with their disease severity, function, and prognosis, and is an potential available indicator for clinical management of COPD patients.

Citation： HOU Shuanglong, WEI Jiaxin, ZHAO Xin, WANG Gang. The phase angle and chronic obstructive pulmonary disease: a systematic review. Chinese Journal of Respiratory and Critical Care Medicine, 2024, 23(5): 312-320. doi: 10.7507/1671-6205.202312004 Copy

1.	Christenson SA, Smith BM, Bafadhel M, et al. Chronic obstructive pulmonary disease. Lancet, 2022, 399(10342): 2227-2242.
2.	World Health Organization. The Top 10 Causes of Death. https://www.who.int/news-room //fact-sheets/detail/the-top-10-causes-of-death.
3.	Zhu B, Wang Y, Ming J, et al. Disease burden of COPD in China: a systematic review. Int J Chron Obstruct Pulmon Dis, 2018, 13(2): 1353-1364.
4.	Wang X, Liang Q, Li Z, et al. Body composition and COPD: a new perspective. Int J Chron Obstruct Pulmon Dis, 2023, 18(2): 79-97.
5.	Deng M, Lu Y, Zhang Q, et al. Global prevalence of malnutrition in patients with chronic obstructive pulmonary disease: Systemic review and meta-analysis. Clin Nutr, 2023, 42(6): 848-858.
6.	李坤營, 馬利軍, 齊詠. 慢性阻塞性肺疾病合并營養不良患者骨骼肌損耗機制的研究進展. 中國呼吸與危重監護雜志, 2013, 12(3): 313-315.
7.	De Benedetto F, Marinari S, De Blasio F. Phase angle in assessment and monitoring treatment of individuals with respiratory disease. Rev Endocr Metab Disord, 2023, 24(3): 491-502.
8.	Bellido D, García-García C, Talluri A, et al. Future lines of research on phase angle: Strengths and limitations. Rev Endocr Metab Disord, 2023, 24(3): 563-583.
9.	Viertel M, Bock C, Reich M, et al. Performance of CT-based low skeletal muscle index, low mean muscle attenuation, and bioelectric impedance derived low phase angle in the detection of an increased risk of nutrition related mortality. Clin Nutr, 2019, 38(5): 2375-2380.
10.	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.
11.	De Almeida C, Penna PM, Pereira SS, et al. Relationship between phase angle and objective and subjective indicators of nutritional status in cancer patients: a systematic review. Nutr Cancer, 2021, 73(11): 2201-2210.
12.	De Borba EL, Ceolin J, Ziegelmann PK, et al. Phase angle of bioimpedance at 50 kHz is associated with cardiovascular diseases: systematic review and meta-analysis. Eur J Clin Nutr, 2022, 76(10): 1366-1373.
13.	Norman K, Herpich C, Müller-Werdan U. Role of phase angle in older adults with focus on the geriatric syndromes sarcopenia and frailty. Rev Endocr Metab Disord, 2023, 24(3): 429-437.
14.	Jiang N, Zhang J, Cheng S, et al. The role of standardized phase angle in the assessment of nutritional status and clinical outcomes in cancer patients: a systematic review of the literature. Nutrients, 2022, 15(1): 50-67.
15.	Praget-Bracamontes S, González-Arellanes R, Aguilar-Salinas CA, et al. Phase angle as a potential screening tool in adults with metabolic diseases in clinical practice: a systematic review. Int J Environ Res Public Health, 2023, 20(2): 1608-1619.
16.	Maddocks M, Kon SS, Jones SE, et al. Bioelectrical impedance phase angle relates to function, disease severity and prognosis in stable chronic obstructive pulmonary disease. Clin Nutr, 2015, 34(6): 1245-1250.
17.	De Blasio F, Santaniello MG, De Blasio F, et al. Raw BIA variables are predictors of muscle strength in patients with chronic obstructive pulmonary disease. Eur J Clin Nutr, 2017, 71(11): 1336-1340. DOI: 10.1038/ ejcn.2017.147.
18.	De Blasio F, Di Gregorio A, De Blasio F, et al. Malnutrition and sarcopenia assessment in patients with chronic obstructive pulmonary disease according to international diagnostic criteria, and evaluation of raw BIA variables. Respir Med, 2018, 134(3): 1-5.
19.	De Blasio F, Scalfi L, Di Gregorio A, et al. Raw bioelectrical impedance analysis variables are independent predictors of early all-cause mortality in patients with COPD. Chest, 2019, 155(6): 1148-1157.
20.	程玉婷, 徐蕾, 姜金霞, 等. 慢性阻塞性肺疾病急性加重期患者相位角與營養狀況及住院時間的相關性研究. 中國臨床醫生雜志, 2021, 49(10): 1177-1180.
21.	Orea-Tejeda A, Gómez-Martínez M, González-Islas D. The impact of hydration status and fluid distribution on pulmonary function in COPD patients. Sci Rep, 2022, 12(1): 1216-1223.
22.	Martínez-Luna N, Orea-Tejeda A, González-Islas D, et al. Association between body composition, sarcopenia and pulmonary function in chronic obstructive pulmonary disease. BMC Pulm Med, 2022, 22(1): 106-114.
23.	張瑩. 相位角水平對老年慢性阻塞性肺疾病病人預后評估的作用研究. 護理研究, 2022, 36(8): 1410-1414.
24.	Gómez-Martínez M, Rodríguez-García W, González-Islas D, et al. Impact of body composition and sarcopenia on mortality in chronic obstructive pulmonary disease patients. J Clin Med, 2023, 12(4): 1321-1332.
25.	Cuttitta G, Ferraro M, Cibella F, et al. Relationship among body composition, adipocytokines, and irisin on exercise capacity and quality of life in COPD: a pilot study. Biomolecules, 2022, 13(1): 48-66.
26.	周翠銀, 郭云, 王星欣, 等. 不同相位角水平對老年慢性阻塞性肺疾病患者預后的評估價值. 臨床與病理雜志, 2023, 43(2): 265-272.
27.	Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med, 2009, 6(7): e1000100.
28.	廖星, 胡瑞學, 李博, 等. 混合方法研究評價工具的介紹— MMAT. 中國全科醫學, 2021, 24(31): 4015-4020.
29.	Kyle UG, Genton L, Pichard C. Low phase angle determined by bioelectrical impedance analysis is associated with malnutrition and nutritional risk at hospital admission. Clinical Nutrition, 2013, 32(2): 294-299.
30.	Zhang Z, Wan Z, Zhu Y, et al. Prevalence of malnutrition comparing NRS2002, MUST, and PG-SGA with the GLIM criteria in adults with cancer: A multi-center study. Nutrition, 2021, 83: 111072.
31.	Stolz D, Mkorombindo T, Schumann DM, et al. Towards the elimination of chronic obstructive pulmonary disease: a Lancet Commission. Lancet, 2022, 400(10356): 921-972.
32.	石滿杰, 胡瑞宇, 李冰, 等. 腸道菌群失衡在常見呼吸系統疾病中的研究進展. 中國呼吸與危重監護雜志, 2022, 21(3): 215-220.
33.	楊海珍, 胡克. 牙周疾病對慢性阻塞性肺疾病預后的影響. 中國呼吸與危重監護雜志, 2023, 22(8): 605-608.
34.	Bagdonas E, Raudoniute J, Bruzauskaite I, et al. Novel aspects of pathogenesis and regeneration mechanisms in COPD. Int J Chron Obstruct Pulmon Dis, 2015, 10(3): 995-1013.
35.	Singh D, Agusti A, Anzueto A, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: the GOLD science committee report 2019. Eur Respir J, 2019, 53(5): 1900164.
36.	Celli BR, Cote CG, Lareau SC, et al. Predictors of Survival in COPD: more than just the FEV₁. Respir Med, 2008, 102(suppl 1): S27-35.
37.	Mattiello R, Amaral MA, Mundstock E, et al. 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.
38.	Mantero M, Rogliani P, Di Pasquale M, et al. Acute exacerbations of COPD: risk factors for failure and relapse. Int J Chron Obstruct Pulmon Dis, 2017, 12(9): 2687-2693.

1. Christenson SA, Smith BM, Bafadhel M, et al. Chronic obstructive pulmonary disease. Lancet, 2022, 399(10342): 2227-2242.
2. World Health Organization. The Top 10 Causes of Death. https://www.who.int/news-room //fact-sheets/detail/the-top-10-causes-of-death.
3. Zhu B, Wang Y, Ming J, et al. Disease burden of COPD in China: a systematic review. Int J Chron Obstruct Pulmon Dis, 2018, 13(2): 1353-1364.
4. Wang X, Liang Q, Li Z, et al. Body composition and COPD: a new perspective. Int J Chron Obstruct Pulmon Dis, 2023, 18(2): 79-97.
5. Deng M, Lu Y, Zhang Q, et al. Global prevalence of malnutrition in patients with chronic obstructive pulmonary disease: Systemic review and meta-analysis. Clin Nutr, 2023, 42(6): 848-858.
6. 李坤營, 馬利軍, 齊詠. 慢性阻塞性肺疾病合并營養不良患者骨骼肌損耗機制的研究進展. 中國呼吸與危重監護雜志, 2013, 12(3): 313-315.
7. De Benedetto F, Marinari S, De Blasio F. Phase angle in assessment and monitoring treatment of individuals with respiratory disease. Rev Endocr Metab Disord, 2023, 24(3): 491-502.
8. Bellido D, García-García C, Talluri A, et al. Future lines of research on phase angle: Strengths and limitations. Rev Endocr Metab Disord, 2023, 24(3): 563-583.
9. Viertel M, Bock C, Reich M, et al. Performance of CT-based low skeletal muscle index, low mean muscle attenuation, and bioelectric impedance derived low phase angle in the detection of an increased risk of nutrition related mortality. Clin Nutr, 2019, 38(5): 2375-2380.
10. 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.
11. De Almeida C, Penna PM, Pereira SS, et al. Relationship between phase angle and objective and subjective indicators of nutritional status in cancer patients: a systematic review. Nutr Cancer, 2021, 73(11): 2201-2210.
12. De Borba EL, Ceolin J, Ziegelmann PK, et al. Phase angle of bioimpedance at 50 kHz is associated with cardiovascular diseases: systematic review and meta-analysis. Eur J Clin Nutr, 2022, 76(10): 1366-1373.
13. Norman K, Herpich C, Müller-Werdan U. Role of phase angle in older adults with focus on the geriatric syndromes sarcopenia and frailty. Rev Endocr Metab Disord, 2023, 24(3): 429-437.
14. Jiang N, Zhang J, Cheng S, et al. The role of standardized phase angle in the assessment of nutritional status and clinical outcomes in cancer patients: a systematic review of the literature. Nutrients, 2022, 15(1): 50-67.
15. Praget-Bracamontes S, González-Arellanes R, Aguilar-Salinas CA, et al. Phase angle as a potential screening tool in adults with metabolic diseases in clinical practice: a systematic review. Int J Environ Res Public Health, 2023, 20(2): 1608-1619.
16. Maddocks M, Kon SS, Jones SE, et al. Bioelectrical impedance phase angle relates to function, disease severity and prognosis in stable chronic obstructive pulmonary disease. Clin Nutr, 2015, 34(6): 1245-1250.
17. De Blasio F, Santaniello MG, De Blasio F, et al. Raw BIA variables are predictors of muscle strength in patients with chronic obstructive pulmonary disease. Eur J Clin Nutr, 2017, 71(11): 1336-1340. DOI: 10.1038/ ejcn.2017.147.
18. De Blasio F, Di Gregorio A, De Blasio F, et al. Malnutrition and sarcopenia assessment in patients with chronic obstructive pulmonary disease according to international diagnostic criteria, and evaluation of raw BIA variables. Respir Med, 2018, 134(3): 1-5.
19. De Blasio F, Scalfi L, Di Gregorio A, et al. Raw bioelectrical impedance analysis variables are independent predictors of early all-cause mortality in patients with COPD. Chest, 2019, 155(6): 1148-1157.
20. 程玉婷, 徐蕾, 姜金霞, 等. 慢性阻塞性肺疾病急性加重期患者相位角與營養狀況及住院時間的相關性研究. 中國臨床醫生雜志, 2021, 49(10): 1177-1180.
21. Orea-Tejeda A, Gómez-Martínez M, González-Islas D. The impact of hydration status and fluid distribution on pulmonary function in COPD patients. Sci Rep, 2022, 12(1): 1216-1223.
22. Martínez-Luna N, Orea-Tejeda A, González-Islas D, et al. Association between body composition, sarcopenia and pulmonary function in chronic obstructive pulmonary disease. BMC Pulm Med, 2022, 22(1): 106-114.
23. 張瑩. 相位角水平對老年慢性阻塞性肺疾病病人預后評估的作用研究. 護理研究, 2022, 36(8): 1410-1414.
24. Gómez-Martínez M, Rodríguez-García W, González-Islas D, et al. Impact of body composition and sarcopenia on mortality in chronic obstructive pulmonary disease patients. J Clin Med, 2023, 12(4): 1321-1332.
25. Cuttitta G, Ferraro M, Cibella F, et al. Relationship among body composition, adipocytokines, and irisin on exercise capacity and quality of life in COPD: a pilot study. Biomolecules, 2022, 13(1): 48-66.
26. 周翠銀, 郭云, 王星欣, 等. 不同相位角水平對老年慢性阻塞性肺疾病患者預后的評估價值. 臨床與病理雜志, 2023, 43(2): 265-272.
27. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med, 2009, 6(7): e1000100.
28. 廖星, 胡瑞學, 李博, 等. 混合方法研究評價工具的介紹— MMAT. 中國全科醫學, 2021, 24(31): 4015-4020.
29. Kyle UG, Genton L, Pichard C. Low phase angle determined by bioelectrical impedance analysis is associated with malnutrition and nutritional risk at hospital admission. Clinical Nutrition, 2013, 32(2): 294-299.
30. Zhang Z, Wan Z, Zhu Y, et al. Prevalence of malnutrition comparing NRS2002, MUST, and PG-SGA with the GLIM criteria in adults with cancer: A multi-center study. Nutrition, 2021, 83: 111072.
31. Stolz D, Mkorombindo T, Schumann DM, et al. Towards the elimination of chronic obstructive pulmonary disease: a Lancet Commission. Lancet, 2022, 400(10356): 921-972.
32. 石滿杰, 胡瑞宇, 李冰, 等. 腸道菌群失衡在常見呼吸系統疾病中的研究進展. 中國呼吸與危重監護雜志, 2022, 21(3): 215-220.
33. 楊海珍, 胡克. 牙周疾病對慢性阻塞性肺疾病預后的影響. 中國呼吸與危重監護雜志, 2023, 22(8): 605-608.
34. Bagdonas E, Raudoniute J, Bruzauskaite I, et al. Novel aspects of pathogenesis and regeneration mechanisms in COPD. Int J Chron Obstruct Pulmon Dis, 2015, 10(3): 995-1013.
35. Singh D, Agusti A, Anzueto A, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: the GOLD science committee report 2019. Eur Respir J, 2019, 53(5): 1900164.
36. Celli BR, Cote CG, Lareau SC, et al. Predictors of Survival in COPD: more than just the FEV₁. Respir Med, 2008, 102(suppl 1): S27-35.
37. Mattiello R, Amaral MA, Mundstock E, et al. 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.
38. Mantero M, Rogliani P, Di Pasquale M, et al. Acute exacerbations of COPD: risk factors for failure and relapse. Int J Chron Obstruct Pulmon Dis, 2017, 12(9): 2687-2693.

Chinese Journal of Respiratory and Critical Care Medicine

The phase angle and chronic obstructive pulmonary disease: a systematic review

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