Bioelectrical Impedance Phase Angle: Utility in clinical practice

Pablo Gustavo de Oliveira, Amanda Senna Pereira dos Santos, Elza Daniel de Mello


The choice of the best nutrition assessment method in hospitalized patients remains a challenge. The aim of this study
was to review the use of phase angle (PA) in clinical practice. PA is a parameter obtained from bioelectrical
impedance analysis, being a derived measure from the relationship between resistance and reactance. Because PA is
dependent on body cell mass (BCM) and cell membrane functions, it has been considered a prognostic marker in
several clinical conditions. BCM reflects the cellular components responsible for energy transfer and biochemical
activity and is considered an excellent reference for expressing the rates of physiological processes, such as energy
expenditure and proteolysis. Low PA values suggest cell death or decreased cell integrity, whereas higher PA values
suggest a large amount of intact cell membranes, with a consequently better prognosis. The literature lacks studies
determining PA reference values, which has prevented its use in routine clinical practice. Reference values are
therefore necessary to properly evaluate possible deviations from the population mean.


Phase angle; Malnutrition; Nutrition assessment

Full Text:



Garcia RWD, Leandro-Merhi VA, Pereira AM. Estado

nutricional e sua evolução em pacientes internados em clinica

médica. Rev Bras Nutr Clín 2004;19:59- 63

Nursal TZ, Noyan T, Atalay BG, Köz N, Karakaly H. Simple

two-part tool for screening of malnutrition. Nutrition


Pennié JB. State of malnutrition in Cuban hospitals. Nutrition


Barbosa-Silva MC, Barros AJ, Post CL, Waitzberg DL,

Heymsfield SB: Can bioelectrical impedance analysis identify

malnutrition in preoperative nutrition assessment? Nutrition

, 19:422-426.

Pirlich M, Schütz T, Kemps M, Luhman N, Minko N, Lübke HJ,

et al. Social risk factors for hospital malnutrition. Nutrition


Ottery FD.; Definition of standardized nutritional assessment

and interventional pathways in oncology. Nutrition

;12:S15-S19 In: Barbosa-Silva MCG, Barros AJD.

Avaliação nutricional subjetiva: Parte 2 - Revisão de suas

adaptações e utilizações nas diversas especialidades clínicas.

Arq Gastroenterol 2002; V. 39 No.4. Disponível em: Acesso em: 01/9/ 2010.

Bauer J, Capra S, Ferguson M: Use of the scored Patient-

Generated Subjective Global Assessment (PG-SGA) as a

nutrition assessment tool in patients with cancer. Eur J Clin Nutr

, 56:779-785.

Kuzu MA, Terzioglu H, Genc V, Erkek AB, Ozban M, Sonyürek

P, et al. Preoperative nutritional risk assessment in predicting

postoperative outcome in patients undergoing major surgery.

World J Surg 2006;30(3):378-90.

Barbosa-Silva MC, Barros AJ. Bioelectric impedance and

individual characteristics as prognostic factors for postoperative

complications. Clin Nutr 2005;24(5):830-8.

Putwatana P, Reodecha P, Sirapo-ngam Y, Lertsithichai P,

Sumboonnanonda K. Nutrition screening tools and the

prediction of postoperative infectious and wound complications:

comparison of methods in presence of risk adjustment. Nutrition


Selberg, O.; Selberg, D. Norms and correlates of bioimpedance

phase angle in healthy human subjects, hospitalized patients, and

patients with liver cirrhosis. European Journal of Applied

Physiology, v. 86, n. 6, p. 509-516, Apr. 2002.

Barbosa-Silva, M. C.; Barros, A. J.; Wang, J.; Heymsfield, S. B.;

Pierson Jr, R. N. Bioelectrical impedance analysis: population

reference values for phase angle by age and sex. American

Journal of Clinical Nutrition, v. 82, p. 49- 52, 2005.

Elia M (1993) The bioimpedance ''craze''. Eur J Clin Nutr

:825– 827

Baumgartner RN, Chumlea WC, Roche AF. Bioelectric

impedance phase angle and body composition. Am J Clin Nutr

;48:16 –23.

Toso SPA, Gusella M, Menon D, Bononi A, Crepaldi G, et al.

Altered tissue electric properties in lung cancer patients as

detected by bioelectric impedance vector analysis. Nutrition.

; 16(2):120-4.

Piccoli A, Nescolarde LD, Rosell J. Análisis convencional y

vectorial de bioimpedância en la práctica clínica. Nefrologia


Mattar JÁ. Application of total body bioimpedance to the

critically ill patient. Brazilian Group for Bioimpedance Study.

New Horiz. 1996;4(4):493-503.

Gupta D, Lis CG, Dahlk SL, Vashi PG, Grutsh JF, Lammersfeld

CA. Bioelectrical impedance phase angle as a prognostic

indicator in advanced pancreatic cancer. Br J Nutr.


Scwenk A, Beisenherz A, Romer K, Kremer G, Salzberger B,

Elia M. Phase angle from bioelectrical impedance analysis

remains an independent predictive marker in HIV-infected

patients in the era of highly active antiretroviral treatment. Am J

Clin Nutr. 2000;72(2):496-501.

Coppini LZ, Bottoni A, Silva MLT, Waitzberg DL. Aplicação da

análise da impedância bioelétrica na avaliação nutricional. Rev

Bras Nutr Clin 1998; 132:819.

Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia

M,Gómez JM, et al. Bioelectrical impedance analysis-part I:

review of principles and methods. Clin Nutr 2004;23(5):1226-

De Lorenzo A, Barra FPA, Sasso GF, Battistini NC, Deureberg P.

Body impedance measurements during dialysis. Eur J Clin Nutr

; 45:321-5, in: Kamimura MA, Draibe SA, Sigulem DM,

Cuppari Lilin. Métodos de avaliação da composição corporal em

paciente submetidos à hemodiálise. Ver.Nutr., Campinas,


Gupta D, Lammersfeld CA, Burrows JL, Dahlk SL, Vashi PG,

Grutsch JF, et al. Bioelectrical impedance phase angle in clinical

practice: implications for prognosis in advanced colorectal

cancer. Am J Clin Nutr 2004;80(6):1634-8.

Saijuddin S, Kerry J, Hasmot A, Alain BL, Abu A, Mahbubur

Rashid, et al. Bioelectrical Impedance among Rural Bangladeshi

Women during Pregnancy and in the Postpartum Period. J

HEALTH POPUL NUTR 2011 Jun;29(3):236-244.

Mushnick R, Fein PA, Mittman N, Goel N, Chattopadhyay J,

Avram MM. Relationship of bioelectrical impedance parameters

to nutrition and survival in peritoneal dialysis patients. Kidney

Int Suppl 2003;(87):S53-6.

Nagano M, Suita S, Yamanouchi T. The validity of bioelectrical

impedance phase angle for nutritional assessment in children. J

Pediatr Surg 2000;35(7):1035-9.

Cômodo A, et al. Utilização da bioimpedância para avaliação da

massa corpórea. Associação Médica Brasileira e Conselho

Federal de Medicina. Projeto diretrizes, Conteúdo disponível


Utilizacao.pdf. Acesso em 22 de fevereiro de 2012.



  • There are currently no refbacks.

Comments on this article

View all comments