Phase angle and extracellular water-to-total body water ratio estimated by bioelectrical impedance analysis are associated with levels of hemoglobin and hematocrit in patients with diabetes

Taiki Hori; Shingen Nakamura; Hiroki Yamagami; Saya Yasui; Minae Hosoki; Tomoyo Hara; Yukari Mitsui; Shiho Masuda; Kiyoe Kurahashi; Sumiko Yoshida; Takeshi Harada; Akio Kuroda; Toshiki Otoda; Tomoyuki Yuasa; Itsuro Endo; Munehide Matsuhisa; Masahiro Abe; Ken-Ichi Aihara

doi:10.1016/j.heliyon.2023.e14724

Phase angle and extracellular water-to-total body water ratio estimated by bioelectrical impedance analysis are associated with levels of hemoglobin and hematocrit in patients with diabetes

Heliyon. 2023 Mar 21;9(4):e14724. doi: 10.1016/j.heliyon.2023.e14724. eCollection 2023 Apr.

Authors

Taiki Hori^{1

2}, Shingen Nakamura^{1

3}, Hiroki Yamagami^{1

2}, Saya Yasui², Minae Hosoki², Tomoyo Hara¹, Yukari Mitsui¹, Shiho Masuda¹, Kiyoe Kurahashi¹, Sumiko Yoshida¹, Takeshi Harada¹, Akio Kuroda⁴, Toshiki Otoda³, Tomoyuki Yuasa³, Itsuro Endo⁵, Munehide Matsuhisa⁴, Masahiro Abe¹, Ken-Ichi Aihara^{2

3}

Affiliations

¹ Department of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima 770-8503, Japan.
² Department of Internal Medicine, Anan Medical Center, 6-1 Kawahara Takarada-cho, Anan Tokushima 774-0045, Japan.
³ Department of Community Medicine and Medical Science, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima 770-8503, Japan.
⁴ Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima 770-8503, Japan.
⁵ Department of Bioregulatory Sciences, Tokushima University Graduate School of Biomedical Sciences, Tokushima Japan, 3-18-15 Kuramoto-cho, Tokushima 770-8503, Japan.

Abstract

Background: Anemia is one of the common complications of diabetes and is associated with mortality. Phase angle (PhA), ratio of extracellular water to total body water (ECW/TBW) and skeletal muscle mass index (SMI) estimated by bioelectrical impedance analysis (BIA) have been used as prognostic indicators for various chronic diseases and frailty. We aimed to clarify the clinical significance of PhA, ECW/TBW and SMI for anemia in patients with diabetes.

Materials and methods: The values of PhA, ECW/TBW and SMI were estimated by a portable BIA device and blood samples were collected in 371 Japanese patients with diabetes. The relationships of PhA, ECW/TBW and SMI with hemoglobin (Hgb) and hematocrit (Hct) were statistically evaluated.

Results: In simple linear regression analysis, PhA and SMI were positively correlated with Hgb and Hct levels in total subjects, male subjects and female subjects. In contrast, ECW/TBW was negatively correlated with Hgb and Hct levels regardless of sex. Multivariate regression analysis showed that both PhA and ECW/TBW but not SMI independently contributed to Hgb and Hct levels after adjustment of clinical confounding factors in both males and females.

Conclusions: PhA and ECW/TBW but not SMI were associated with levels of Hgb and Hct in patients with diabetes. Therefore, aberrant values of PhA and ECW/TBW suggest a risk of anemia in diabetic patients.

Keywords: Bioelectrical impedance analysis; Extracellular water-to-total body water ratio; Hematocrit; Hemoglobin; Phase angle; Skeletal muscle mass index.