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Phase angle as an index of physiological status: validating bioelectrical assessments of hydration and cell mass in health and disease

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Abstract

Bioelectrical impedance (BI) is a practical method to assess body composition in health and disease. This method relies on the passive conduction of an applied, safe, low-level alternating current through water and electrolytes in the body. Using a phase-sensitive device, BI yields measurements of impedance (Z) and its components, resistance (R) and reactance (Xc), that are related geometrically as phase angle (PhA). In vitro studies provide empirical evidence relating BI measurements to physiological variables. Cooking raw food samples results in greater decreases in PhA, predominantly Xc, with smaller reductions R indicating destruction of cell membrane integrity with simultaneous movement of fluid from intracellular to extracellular space. Infusion of saline into a cell-free model shows a proportional decrease in R with increases in volume. Saline infusion in a composite model of cells disproportionately decreases Xc and PhA, compared to R, demonstrating greater relative expansion of extracellular water (ECW) with a lesser relative increase in total fluid volume. Surgical patients treated with fluid infusion and diuresis demonstrate changes in Xc predominantly indicating relative changes in ECW with lesser variations in R indicating fluctuations in total fluid volume. Proteomics studies disclose strong independent associations of PhA with protein markers of fluid overload and protein proliferation. Interpretations of PhA measurements for body cell mass should be examined in the context of hydration status.

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Abbreviations

arctan:

arctangent.

BIA:

bioelectrical impedance analysis.

C:

capacitor.

CAP:

capacitance.

CM :

membrane capacitance.

d:

day.

ECF:

extracellular fluid.

ECW:

extracellular water.

E/I:

ratio of extracellular to intracellular water.

f:

frequency.

ICF:

intracellular fluid.

ICW:

intracellular water.

I/O:

fluid input to output balance.

PhA:

phase angle.

r:

correlation coefficient.

R:

resistance or resistor.

R2 :

coefficient of determination.

TBW:

total body water.

Z:

impedance.

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Authors and Affiliations

  1. Department of Kinesiology and Public Health Education, University of North Dakota Grand Forks, North Dakota 58202 and Antonio Talluri PixelCanDo, Florence, Italy

    Henry C. Lukaski

  2. PixelCanDo, Florence, Italy

    Antonio Talluri

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  1. Henry C. Lukaski
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Correspondence to Henry C. Lukaski.

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Lukaski, H.C., Talluri, A. Phase angle as an index of physiological status: validating bioelectrical assessments of hydration and cell mass in health and disease. Rev Endocr Metab Disord 24, 371–379 (2023). https://doi.org/10.1007/s11154-022-09764-3

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