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A doen?a arterial coronariana (DAC) ? um importante problema de sa?de p?blica por ser uma das principais causas de morbimortalidade. ? necess?rio, portanto, ferramentas que avaliem a sa?de celular de pacientes com DAC e que auxiliem no monitoramento dos processos inflamat?rios a fim de identificar precocemente indiv?duos com risco para eventos agudos e complica??es cardiovasculares futuras. Evid?ncias apontam o ?ngulo de fase (PhA) como um indicador de inflama??o em diversas situa??es de sa?de, no entanto, na doen?a coronariana n?o foi investigado. OBJETIVO: Investigar a associa??o do ?ngulo de fase com o estado inflamat?rio em pacientes com doen?a arterial coronariana cr?nica. M?TODOS: A tese ? composta por dois manuscritos: uma revis?o sistem?tica e um estudo original. Revis?o sistem?tica: Foram realizadas buscas nas bases de dados MEDLINE, EMBASE, Cochrane, Scielo, LILACS, CINAHL, Scopus e Web of Science. A sele??o foi realizada independentemente por dois revisores conforme os crit?rios de elegibilidade, assim como a an?lise do risco de vi?s e da qualidade dos estudos inclu?dos. Os resultados foram sintetizados e descritos na revis?o. Como n?o foram encontrados estudos em pacientes com DAC, exploramos artigos em pacientes com doen?as cardiometab?licas e indiv?duos sem doen?as cr?nicas. Estudo original: A amostra foi composta por pacientes com doen?a arterial coronariana cr?nica, atendidos no Ambulat?rio de Hipercolesterolemia do Servi?o de Cardiologia do Hospital S?o Lucas da PUCRS. O ?ngulo de fase foi avaliado atrav?s do equipamento Biospace, modelo Inbody S10, da Ottoboni. Os marcadores inflamat?rios avaliados foram: Prote?na c-reativa ultrassens?vel (PCR-us), interleucina-6 (IL-6), interleucina-10 (IL-10) e fator de necrose tumoral alfa (TNF-?). Foi inclu?do um grupo controle com indiv?duos sem DAC para an?lise comparativa. Na an?lise estat?stica, a correla??o do PhA e vari?veis preditoras foi verificado com os coeficientes de correla??o de Pearson e de Spearman. Para a identificar se os marcadores inflamat?rios influenciaram no ?ngulo de fase foi utilizada a regress?o linear. RESULTADOS: Revis?o sistem?tica: Foram identificados 755 artigos na pesquisa, e inclu?dos 11 artigos, totalizando 50.787 participantes. Os marcadores inflamat?rios investigados nos estudos foram: PCR, TNF-?, IL-6 e IL-33. Nos indiv?duos com doen?a cardiometab?lica, o ?ngulo de fase se associou negativamente com PCR, TNF-? e IL-6 em 71,4%, 50% e 100% dos estudos, respectivamente. Em indiv?duos sem doen?a cr?nica, foi observada uma associa??o negativa do PhA com PCR, TNF-? e IL-6 em 75%, 100% e 100% dos estudos, respectivamente. Estudo original: 82 indiv?duos participaram do estudo, sendo 60 do grupo DAC e 22 do grupo controle. A m?dia geral do ?ngulo de fase foi de 5,8?0,8?, n?o diferindo entre os grupos (p=0,933). Apenas a IL-6 foi significativamente superior entre os pacientes com DAC (p=0,002). O PhA n?o se correlacionou com nenhum dos marcadores inflamat?rios avaliados (p>0,05). CONCLUS?O: Os resultados da revis?o sistem?tica sugerem uma associa??o negativa do PhA com marcadores inflamat?rios PCR, IL-6 TNF-? em indiv?duo com doen?as cardiometab?licas e sem doen?a cr?nica. No entanto, no estudo original n?o foi encontrada associa??o do PhA com o estado inflamat?rio em pacientes com DAC cr?nica, necessitando mais estudos em pacientes sem tratamento pr?vio ou em fase inst?vel da doen?a. Coronary artery disease (CAD) is an important public health problem as it is one of the main causes of morbidity and mortality. It is therefore necessary to have tools that assess the cellular health of patients with CAD and that assist in the monitoring of inflammatory processes in order to early identify individuals at risk for acute events and future cardiovascular complications. Evidence points to the phase angle (PhA) as an indicator of inflammation in several health situations, however, in coronary disease it has not been investigated. OBJECTIVE: To investigate the association of phase angle with inflammatory status in patients with chronic coronary artery disease. METHODS: The thesis consists of two manuscripts: a systematic review and an original study. Systematic review: Searches were carried out in MEDLINE, EMBASE, Cochrane, Scielo, LILACS, CINAHL, Scopus and Web of Science databases. The selection was performed independently by two reviewers according to the eligibility criteria, as well as the analysis of the risk of bias and the quality of the included studies. The results were synthesized and described in the review. As no studies were found in patients with CAD, we explored articles in patients with cardiometabolic diseases and individuals without chronic diseases. Original study: The sample consisted of patients with chronic coronary artery disease, treated at the Hypercholesterolemia Outpatient Clinic of the Cardiology Service of Hospital S?o Lucas, PUCRS. The phase angle was evaluated using the Biospace equipment, model Inbody S10, from Ottoboni. The inflammatory markers evaluated were: Ultrasensitive c-reactive protein (hs-CRP), interleukin-6 (IL-6), interleukin-10 (IL-10) and tumor necrosis factor alpha (TNF-?). A control group with individuals without CAD was included for comparative analysis. In the statistical analysis, correlation of PhA and predictor variables was verified with Pearson's and Spearman's correlation coefficients. To identify whether the inflammatory markers influenced the phase angle, linear regression was used. RESULTS: Systematic review: 755 articles were identified in the research, and 11 articles were included, totaling 50,787 participants. The inflammatory markers investigated in the studies were: CRP, TNF-?, IL-6 and IL-33. In subjects with cardiometabolic disease, phase angle was negatively associated with CRP, TNF-? and IL-6 in 71.4%, 50% and 100% of the studies, respectively. In individuals without chronic disease, a negative association of PhA with CRP, TNF-? and IL-6 was observed in 75%, 100% and 100% of the studies, respectively. Original study: 82 individuals participated in the study, 60 from the CAD group and 22 from the control group. The general mean of the phase angle was 5.8?0.8?, not differing between the groups (p=0,933). Only IL-6 was significantly higher among CAD patients (p=0,002). PhA did not correlate with any of the inflammatory markers evaluated (p>0,05). CONCLUSION: The results of the systematic review suggest a negative association of PhA with inflammatory markers CRP, IL-6 TNF-? in individuals with cardiometabolic diseases and without chronic disease. However, in the original study, no association was found between PhA and inflammatory status in patients with chronic CAD, requiring further studies in patients with no previous treatment or in an unstable phase of the disease. Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES

Relationship between bioelectrical impedance phase angle and upper and lower limb muscle strength in athletes from several sports: a systematic review with meta-analysis

Introdução: A Insuficiência Cardíaca (IC) é considerada uma síndrome clínica na qual o coração apresenta capacidade reduzida de bombear sangue suficiente a fim de suprir as exigências metabólicas dos tecidos. A sarcopenia, que apresenta uma perda muscular mais acelerada e acentuada em pacientes com IC, agrava o prognóstico da doença. A relação entre o ângulo de fase (AF), mensurado pela bioimpedância elétrica (BIA), e o prognóstico de algumas doenças pode ser compreendida também pelo cenário de desnutrição prolongada e inflamação, resultando em morte celular. A avaliação do nível de integridade celular por meio do AF oferece uma abordagem de um método prático, cuja associação com a sarcopenia ainda não foi esclarecida nessa população específica. Objetivos: Avaliar a associação de valores de AF com a sarcopenia e seus componentes, assim como estabelecer o ponto de corte do AF para predizer desfechos, como internação hospitalar e mortalidade, em pacientes idosos com IC. Metodologia: Estudo de coorte com pacientes ambulatoriais com IC atendidos no Hospital de Clínicas de Porto Alegre (HCPA). O AF foi mensurado através de BIA e o diagnóstico de sarcopenia seguiu os critérios do European Working Group on Sarcopenia in Older People. Foi realizada avaliação antropométrica, bioimpedância elétrica (AF e composição corporal) e capacidade funcional, além de analisados os marcadores inflamatórios: Proteína C-reativa ultrasenssível (PCR-US), Interleucina-6 (IL-6) e Fator de necrose tumoral alfa (TNF-α). O ponto de corte para AF foi determinado pela Curva Característica de Operação do Receptor (ROC). O tempo de seguimento para avaliar internação hospitalar e mortalidade foi de três anos. Resultados: Foram incluídos 106 pacientes com IC, sendo a maioria do sexo masculino, brancos e com idade média de 69±7,0 anos, predominando pacientes com fração de ejeção do ventrículo esquerdo reduzida (FEVE) (70,8%) e classes funcionais da NYHA I e II (82,1%). Provável sarcopenia foi encontrada em 36,8%, sarcopenia em 23,6% e sarcopenia grave em 4,4% dos pacientes. Sarcopênicos apresentavam maior média de idade comparativamente a não sarcopênicos (73±8,1 e 67,8± 6,1 anos; p=0,001), associação com FEVE reduzida (p=0,027) e índice de massa corporal (IMC) ≤ 24,9 kg/m² (p

Introduction. Possibilities of three-frequency broadband electrical bioimpedanceometry of the nasal and paranasal regions were investigated.Research methodology and equipment. The studies were performed experimentally non-invasively using a three-frequency wideband bioimpedance system TOR-M-1, adapted to the conditions and requirements of rhinological studies. The TOR-M-1 system provides the measurement of the module Z and the phase angle φ of the impedance of the human body sections at three frequencies of 20 kHz, 100 kHz and 500 kHz with programmatic calculation of active R, reactive X components of the impedance at these frequencies. Non-invasive impedance parameters were measured using a tetrapolar technique using paired stainless steel active electrodes connected to the human body in the area between the cheek and the hand.Results and Discussion. It is established that the values ​​of the module, phase angle, active and reactive components of the impedance at these frequencies are individually individual for a particular person and change dynamically in the presence of rhinological diseases. The most characteristic features that characterize the normal and abnormal conditions of the nasal and paranasal tissues, are concentrated in the frequency dependences of the phase angle.Conclusions. Cole diagrams for groups of patients with certain phase-to-angle ratios at three frequencies show the possibility of determining different functional states of patients: the normal state, the presence of residual phenomena of rhinological diseases, while the subjective person feels normal and active disease. The results of impedance frequency parameters dynamics during respiratory disease are presented., Исследованы возможности тричастотнои широкополосной электрической биоимпедансометрии носовых и околоносовых областей с точки зрения оценки состояния и динамики ринологического осложнений по частотным зависимостям параметров полного сопротивления (импеданса) этих областей. Исследования выполнены экспериментально неинвазивно с использованием системы тричастотнои широкополосной биоимпедансометрии ТОР-М-1, адаптированной для условий и требований ринологического исследований. Система ТОР-М-1 обеспечивает измерение модуля Z и фазового угла φ импеданса участков тела человека на трех разнесенных частотах 20 кГц, 100 кГц и 500 кГц с программным расчетом активной R, реактивной Х составляющих импеданса на этих частотах. Неинвазивное измерение параметров импеданса осуществляли с тетраполярная методике с использованием парных «активных» электродов из нержавеющей стали, подключенных к телу человека по методике правая щека-левая рука и левая щека-правая рука добровольца. Установлено, что значение модуля, фазового угла, активной и реактивной составляющих импеданса на этих частотах является личностно индивидуальными для конкретного лица-добровольца и динамично изменяются при наличии и течения ринологического осложнений. Наиболее характерные признаки, характеризующие нормальный и аномальный состояния носового и околоносовых сред, сосредоточены в частотных зависимостях фазового угла. На примерах построения диаграмм Коула для групп пациентов с определенными соотношениями фазовых углов на указанных частотах показана возможность определения нормального состояния пациентов (без ринологического осложнений), наличия остаточных явлений ринологических осложнений, в то время как человек субъективно чувствует нормальное состояние, и состояния заболевания. Также приведены результаты исследований, характеризующие динамику частотных параметров импеданса при наличии респираторного заболевания., Досліджено можливості тричастотної широкосмугової електричної біоімпедансометрії носових і навколоносових областей з точки зору оцінки стану і динаміки ринологічних ускладнень за частотними залежностями параметрів повного електричного опору (імпедансу) цих областей. Дослідження виконані експериментально неінвазивно з використанням системи тричастотної широкосмугової біоімпедансометрії ТОР-М-1, адаптованої для умов і вимог ринологічних досліджень. Система ТОР-М-1 забезпечує вимірювання модуля Z і фазового кута φ імпедансу ділянок тіла людини на трьох рознесених частотах 20 кГц, 100 кГц і 500 кГц з програмним розрахунком активної R, реактивної Х складових імпедансу на цих частотах. Неінвазивне вимірювання параметрів імпедансу здійснювали за тетраполярною методикою з використанням парних «активних» електродів із нержавіючої сталі, під’єднаних до тіла людини за методикою права щока-ліва рука та ліва щока-права рука добровольця. Встановлено, що значення модуля, фазового кута, активної і реактивної складових імпедансу на цих частотах є особистісно індивідуальними для конкретної особи-добровольця і динамічно змінюються у разі наявності і перебігу ринологічних ускладнень. Найбільш характерні ознаки, які характеризують нормальний і аномальний стани носового і навколоносового середовищ, зосереджені у частотних залежностях фазового кута. На прикладах будови діаграм Коула для груп пацієнтів з певними співвідношеннями фазових кутів на зазначених частотах показана можливість визначення нормального стану пацієнтів (без ринологічних ускладнень), наявності залишкових явищ ринологічних ускладнень, в той час як людина суб’єктивно відчуває нормальний стан, та стану захворювання. Також наведені результати досліджень, які характеризують динаміку частотних параметрів імпедансу у разі наявності респіраторного захворювання.

Electrical Bioimpedance Spectroscopy (EIS) is a technique used to assess passive electrical properties of biological materials. EIS detects physiological and pathological conditions in animal tissues. Recently, the introduction of broadband excitation signals has reduced the measuring time for application techniques such as Electrical Bioimpedance Myography. Therefore, this work is aimed at proposing a prototype by using discrete interval binary sequences (DIBS), which is based on a system that holds a current source, impedance acquisition system, microcontroller and graphical user interface. Measurements between 5 &Omega, to 5 k&Omega, had impedance acquisition and phase angle errors of aproximately 2% and were lower than 3 degrees, respectively. Based on a proposed circuit, bioimpedance of the chest muscle (Pectoralis Major) was measured during isotonic exercise (push-up). As a result, our analyses have detected tiredness and fatigue. We have explored and proposed new parameters which assess such conditions, as both the maximum magnitude and tiredness coefficient. These parameters decrease exponentially with consecutive push-ups and were convergent in the majority of the sixteen days of measurement.

Background: This study analyzed the phase-angle (PA) values of hospitalized HVI-infected patients by comparing them with those reported for a healthy population and investigated their relation with nutritional parameters. Methods: This is a cross-sectional study including 101 hospitalized patients diagnosed with HIV infection and evaluated by bioimpedance, anthropometry and biochemical tests. The phase angle values, weight loss percentage (%WL), body mass index (BMI), arm muscle circumference (AMC), tricipital skinfold (TSF), body fat percentage (%BF) and albumin were considered. In order to compare with values for the healthy population, the PA z-score of the patients under study was calculated. Spearman's correlation and the multiple linear regression model were used to identify nutritional parameters associated with the PA z-score. Results: The patients showed a mean PA z-score of -2.6 ± 1.5, and only 6.6% of them with a positive value. The PA z-score values correlated with %WL (r = -0.51; p < 0.0001), albumin (r = 0.49; p < 0.0001), BMI (r = 0.58; p < 0.0001), AMC (r = 0.41; p < 0.0001), TSF (r = 0.47; p < 0.001) and %BF (r = 0.48, p < 0.0001). In multiple analysis %WL (p = 0.008), albumin (p = 0.01), AMC (p < 0.0001) and %BF (p = 0.0003) remained associated with the score. Conclusions: Low PA z-score values were observed, suggesting a worse clinical prognosis for the patients. The inclusion of the PA z-score as a nutritional indicator during care provision to HIV-infected patients is recommended. Antecedentes: Este estudio analizaba los valores del ángulo de fase (AF) de pacientes hospitalizados e infectados por el VIH al compararlos con los notificados para un población sana e investigaba su relación con los parámetros nutricionales. Métodos: Se trataba de un estudio transversal que incluyó a 101 pacientes hospitalizados diagnosticados de infección por el VIH y en los que se evaluó la bioimpedancia, la antropometría y parámetros bioquímicos. Se consideraron los valores del ángulo de fase, el porcentaje de pérdida de peso (%PP), el índice de masa corporal (IMC), la circunferencia muscular del brazo (CMB), el pliegue tricipital (PT), el porcentaje de grasa corporal (%GC) y la albúmina. Para compararlos con los de una población sana, se calcularon las puntuaciones z del AF de los pacientes estudiados. Se emplearon la correlación de Spearman y el modelo de regresión linear múltiple para identificar los parámetros nutricionales asociados con la puntuación z del AF. Resultados: Los pacientes mostraron una puntuación z del AF de -2,6 ± 1,5, el 23,7% de ellos tenían un valor superior a -1,65 y sólo el 6,6% un valor positivo. Los valores de las puntuaciones z del AF se correlacionaron con el %PP (r = -0,51; p < 0,0001), la albúmina (r = 0,49; p < 0,0001), el IMC (r = 0,58; p < 0,0001), la CMB (r = 0,41; p < 0,0001), el PT (r = 0,47; p < 0,001) y el %GC (r = 0,48, p < 0,0001). En el análisis múltiple, el %PP (p = 0,008), la albúmina (p = 0,01), la CMB (p < 0,0001) y el %GC (p = 0,0003) seguían asociándose con la puntuación z. Conclusiones: Obtuvimos unos valores bajos de puntuación z del AF, lo que sugiere un peor pronóstico clínico en los pacientes. Recomendamos la inclusión de la puntuación z del AF como un indicador nutricional durante la provisión de la atención sanitaria a los pacientes infectados por el VIH.

Made available in DSpace on 2013-08-12T19:10:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-05-01 Made available in DSpace on 2013-09-30T18:35:51Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-05-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:48:09Z No. of bitstreams: 0 Made available in DSpace on 2014-05-20T13:48:09Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-05-01 Background: This study analyzed the phase-angle (PA) values of hospitalized HVI-infected patients by comparing them with those reported for a healthy population and investigated their relation with nutritional parameters.Methods: This is a cross-sectional study including 101 hospitalized patients diagnosed with HIV infection and evaluated by bioimpedance, anthropometry and biochemical tests. The phase angle values, weight loss percentage (%WL), body mass index (BMI), arm muscle circumference (AMC), tricipital skinfold (TSF), body fat percentage (%BF) and albumin were considered. In order to compare with values for the healthy population, the PA z-score of the patients under study was calculated. Spearman's correlation and the multiple linear regression model were used to identify nutritional parameters associated with the PA z-score.Results: The patients showed a mean PA z-score of -2.6 +/- 1.5, and only 6.6% of them with a positive value. The PA z-score values correlated with %WL (r = -0.51; p < 0.0001), albumin (r = 0.49; p < 0.0001), BMI (r = 0.58; p < 0.0001), AMC (r = 0.41; p < 0.0001), TSF (r = 0.47; p < 0.001) and %BF (r = 0.48, p < 0.0001). In multiple analysis %WL (p = 0.008), albumin (p = 0.01), AMC (p < 0.0001) and %BF (p = 0.0003) remained associated with the score.Conclusions: Low PA z-score values were observed, suggesting a worse clinical prognosis for the patients. The inclusion of the PA z-score as a nutritional indicator during care provision to HIV-infected patients is recommended. (Nutr Hosp. 2012;27:771-774) DOI:10.3305/nh.2012.27.3.5684 São Paulo State Univ, Botucatu Sch Med, UNESP, São Paulo, Brazil São Paulo State Univ, Inst Biosci, UNESP, São Paulo, Brazil São Paulo State Univ, Botucatu Sch Med, UNESP, São Paulo, Brazil São Paulo State Univ, Inst Biosci, UNESP, São Paulo, Brazil