Department of Nutrition, S.L Raheja Hospital Fortis associate (Mahim), Mumbai, Maharashtra, India

*Corresponding author:Saseedharan S, Department of Nutrition, S.L Raheja Hospital Fortis associate (Mahim), Mumbai, Maharashtra, India. E-mail Id: docsanjith@rediffmail.com

Article Information:Submission: 03/02/2025; Accepted: 19/03/2025; Published: 22/03/2025

Copyright: © 2025 Saseedharan S, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Nutrition is an important factor to assess the quality of life and functionality in patients receiving chemotherapy. Malnutrition has been observed in patients receiving chemotherapy; hence it is an important factor contributing to recovery. The article explores the growing significance of phase angle in comparison with Body mass Index and Skeletal muscle mass in patients receiving chemotherapy.

Patient with cancer undergo dynamic and longitudinal changes in nutritional status and body composition. In order to measure the body composition, one of the measures used is the Bioelectrical impedance analysis. BIA is an inexpensive, non-invasive and reproducible technique which uses electric current through body to measure impedance. On the other hand, we have phase angle which is a value derived from the BIA and is an indicator of cell membrane health and integrity.[1] Higher PA values may reflect better cell function, higher muscle mass and lower fat mass. [2] The study aimed to analyse the relationship between phase angle with BMI and skeletal muscle mass in patients receiving chemotherapy in one day at a particular health care institution (S.L Raheja Hospital Fortis, Mumbai).

A point prevalence study was conducted on patient with various forms of cancer undergoing chemotherapy. The BMI, skeletal muscle mass and phase angles were measured using our machinery in 30 patients who currently received chemotherapy. The measurements were done in one-day and the data was collected as below.
DLTCL- diffuse lymphocytic T- cell Lyphoma;

The above data shows that Body mass index was variable in each individual with a different form of cancer but all receiving chemotherapy. The phase angle has a correlation with the BMI which is illustrated in the graphs below. Skeletal muscle mass is a key component of fat free mass and metabolic health. The lower the Skeletal muscle mass, indicates sarcopenia which increases the risk of poor health outcomes in the form of premature mortality and increased morbidity [3].

The skeletal muscle mass is calculated using height and weight, which has a normal range of 10-20% in males and 18-28% in females. It is important to note that we are measuring the skeletal muscle mass in patients with cancer which may vary.

A multiple linear regression was conducted to assess the predictors of phase angle in patients undergoing chemotherapy. The model included height, weight, skeletal muscle mass (SMM), skeletal muscle index (SMI), and fat percentage as predictors.
• The overall model was not statistically significant (F (5,24) =1.74, p=0.165), explaining 11% of the variance in phase angle (Adjusted R2=0.11).

• Significant predictors:
o Weight: A significant negative relationship was found between weight and phase angle (β=−2.34, p=0.017), indicating that higher weight was associated with lower phase angle.
o Skeletal Muscle Mass (SMM): A significant positive relationship was observed between SMM and phase angle (β=2.22, p=0.015), suggesting that greater muscle mass was associated with higher phase angle.
o Fat Percentage: A significant positive relationship was found between fat percentage and phase angle (β=1.58, p=0.020), indicating that higher fat percentage was associated with a better phase angle.
• Non-significant predictors:
o Height (p=0.645) and Skeletal Muscle Index (SMI) (p=0.738) did not show significant relationships with phase angle.

These findings suggest that SMM and fat percentage play important roles in determining phase angle in chemotherapy patients, while weight appears to have an opposing effect. However, the model’s overall explanatory power remains modest, indicating that other factors likely influence phase angle.

• Skeletal Muscle Mass (SMM)
The significant positive relationship between SMM and phase angle highlights the importance of maintaining or increasing muscle mass in cancer patients undergoing chemotherapy. SMM is a key determinant of cellular health, which phase angle reflects, suggesting that interventions to preserve muscle mass could improve overall health outcomes. It is important to note here that the above is seen in the regression analysis as explained above.

The negative association between weight and phase angle suggests that simply increasing weight, especially if it involves non-muscle mass (e.g., fat), does not necessarily improve cellular health. This implies that clinicians should focus on muscle preservation rather than just weight gain during chemotherapy.

The significant positive relationship with phase angle implies that body fat, although often viewed negatively, may play a role in maintaining cellular integrity in cancer patients. This finding requires further investigation to understand how fat distribution and quality impact phase angle.

The overall model only explains a small portion of the variance in phase angle (11%), suggesting that other factors, such as disease severity, inflammation, or hydration status, might also influence phase angle. Future studies with larger sample sizes and more comprehensive data could provide a clearer picture of the factors contributing to phase angle in cancer patients.

o SMM is highly correlated with other body composition parameters, such as weight and skeletal muscle index (SMI). When these variables are included in the regression model, SMM’s unique contribution to phase angle becomes more apparent after controlling for shared variance.
o In simple correlation, SMM’s effect on phase angle might be masked by other variables influencing both SMM and phase angle. However, in regression, when those confounding factors are controlled, the independent impact of SMM emerges.

o Even if SMM alone does not show a strong correlation with phase angle, its combined effect along with other predictors in the regression model could still be meaningful.
o Essentially, regression helps isolate the independent role of SMM in predicting phase angle, which may not be evident when looking at simple correlations.

o With a small sample size, correlation estimates can be unstable, leading to non-significant results. Regression analysis, by incorporating multiple variables, may still detect an effect that was not apparent in the correlation matrix.

Values are r (p); BMI: Body mass index; SMM: Skeletal muscle mass; SMI: Skeletal muscle index
Phase angle specific correlation
Phase Angle-Specific Correlation Analysis:
1. Phase Angle and Height:
o Correlation: r=0.04, p=0.832
o There is no significant relationship between height and phase angle.
2. Phase Angle and Weight:
o Correlation: r=−0.017, p=0.929
o There is no significant relationship between weight and phase angle.
3. Phase Angle and BMI:
o Correlation: r=−0.006, p=0.974
o There is no significant relationship between BMI and phase angle.
4. Phase Angle and Skeletal Muscle Mass (SMM):
o Correlation: r=0.039, p=0.836

o There is no significant relationship between SMM and phase angle.
5. Phase Angle and Skeletal Muscle Index (SMI):
o Correlation: r=−0.049, p=0.798
o There is no significant relationship between SMI and phase angle.
6. Phase Angle and Fat Percentage:
o Correlation: r=0.077, p=0.686
o There is no significant relationship between fat percentage and phase angle.

No significant correlations were observed between phase angle and any of the anthropometric or body composition variables, including height, weight, BMI, SMM, SMI, and fat percentage.
o Correlation measures only the direct pairwise relationship between two variables without accounting for other factors.

Regression, on the other hand, evaluates the relationship between the dependent variable (phase angle) and multiple predictors simultaneously, adjusting for the influence of other variables.

Although simple correlation analysis did not indicate a significant relationship between SMM and phase angle, multiple regression analysis identified SMM as a significant predictor. This discrepancy can be attributed to the fact that correlation measures only the direct relationship between two variables, while regression accounts for multiple predictors simultaneously, adjusting for shared variance. In this study, the high correlation of SMM with other anthropometric variables, particularly weight and skeletal muscle index, may have masked its direct effect on phase angle in the correlation analysis. However, when included in the regression model, SMM’s independent contribution became evident. These findings underscore the importance of multivariable approaches in evaluating body composition predictors of phase angle.

A total of 30 patients were analysed, of which 33% were females. Skeletal Muscle Mass (SMM) is the strongest predictor of phase angle, highlighting its role in maintaining cellular health and integrity. BMI and Weight show weak relationships with phase angle, suggesting that weight alone is not a good indicator of phase angle, and the

muscle mass component (SMM) likely plays a more significant role. Fat Percentage and SMI do not show significant correlations with phase angle, suggesting that these variables may not be as important in determining phase angle in this specific sample.

This study can aid in providing us with an insight in increasing nutrition in order to increase the skeletal muscle mass in cancer patients. With this insight, the phase angle measurements would be higher which would correlate with the cell membrane health, hydration and nutrition status in order to guide us towards their recovery and reduce morbidity [4]. Moreover, it is reported there is a statistically weakly positive correlation was found between body mass index and phase angle values (p<0.05) seen in study [5]. Statistically moderate positive correlation was found between body muscle and phase angle values (p<0.05). In addition, as mentioned in many sources, the phase angle can be an indicator of the integrity and functional adequacy of the cells, especially in diseases with catabolism effect. In order to increase phase angle, one can include a balanced diet which includes mediterranean diet benefiting in preventing cardiovascular diseases, promoting longevity and supporting health aging.[6] The nutrition must target a protein rich and high protein intake in forms of enteral and parenteral nutrition.[7-9]