Body composition assessment via bioelectrical impedance analysis in ICU patients receiving enteral nutrition at Hanoi Medical University Hospital
Main Article Content
Abstract
A cross-sectional study was conducted to evaluate the body composition of ICU patients on the 8th day of enteral nutrition using Bioelectrical Impedance Analysis (BIA). Data from 36 critically ill patients revealed an average phase angle of 4.2 ± 1.2, with mean intracellular water at 16.8 ± 2.9 L, average protein content, lean soft tissue, and fat-free mass were 7.3 ± 1.2 kg, 35.8 ± 6.1 kg, and 37.9 ± 6.4 kg, respectively. While males typically exhibited higher muscle mass, lean mass, and fluid volumes, females demonstrated a higher mean phase angle (p > 0.05). The findings suggest that achieving energy and protein targets per ESPEN guidelines by the 8th day is insufficient to counteract muscle wasting driven by complex catabolism in the critically ill. Therefore, monitoring BIA indices is vital to individualize nutritional support and optimize clinical management.
Article Details
Keywords
Body composition, bioelectrical impedance analysis (BIA), 8th day, ICU patients, enteral nutrition
References
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11. Karina Marques Vermeulen, Leilane Lilian Araújo Leal, Mariana Câmara Martins Bezerra Furtado, et al. Phase Angle and Onodera’s Prognostic Nutritional Index in critically ill patients. Nutr Hosp. 2016 Nov 29; 33(6): 1268-1275. doi: 10.20960/nh.770.
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14. Sheean PM, Peterson SJ, Gurka DP, et al. Nutrition assessment: the reproducibility of Subjective Global Assessment in patients requiring mechanical ventilation. Eur J Clin Nutr. 2010; 64(11): 1358-1364. doi:10.1038/ejcn.2010.154.
15. Mendes R, Policarpo S, Fortuna P, et al. Nutritional risk assessment and cultural validation of the modified NUTRIC score in critically ill patients-A multicenter prospective cohort study. J Crit Care. 2017; 37: 249. doi:10.1016/j.jcrc.2016.09.007.
16. Khalid I, Doshi P, DiGiovine B. Early enteral nutrition and outcomes of critically ill patients treated with vasopressors and mechanical ventilation. Am J Crit Care. 2010; 19(3): 261-268. doi:10.4037/ajcc2010197.
17. Cahill NE, Dhaliwal R, Day AG, et al. Nutrition therapy in the critical care setting: what is “best achievable” practice? An international multicenter observational study. Crit Care Med. 2010; 38(2): 395-401. doi:10.1097/CCM.0b013e3181c0263d.
18. Singer P, Blaser AR, Berger MM, et al. ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit. Clin Nutr. 2023; 42(9): 1671-1689. doi:10.1016/j.clnu.2023.07.011.
19. Lee ZY, Yap CSL, Hasan MS, et al. The effect of higher versus lower protein delivery in critically ill patients: a systematic review and meta-analysis of randomized controlled trials. Crit Care. 2021; 25: 260. doi:10.1186/s13054-021-03693-4.
2. Puthucheary ZA, Rawal J, McPhail M, et al. Acute skeletal muscle wasting in critical illness. JAMA. 2013; 310(15): 1591-1600. doi:10.1001/jama.2013.278481.
3. Ranim Kaddoura, Alison Shanks, Marianne Chapman, et al. Relationship between nutritional status on admission to the intensive care unit and clinical outcomes. Nutrition & Dietetics - Journal of Dietitians Australia. 2021; 78(2): 28-134. https://onlinelibrary.wiley.com/doi/abs/10.1111/1747-0080.12637.
4. Nguyễn Thị Trang, Phạm Văn Phú, Nghiêm Nguyệt Thu, và cs. Tình trạng dinh dưỡng của người bệnh cao tuổi và một số yếu tố liên quan tại khoa hồi sức tích cực Bệnh viện Lão khoa Trung ương năm 2017 - 2018. Tạp chí Dinh dưỡng và Thực phẩm. 2018; 4(5): 9-16. Accessed September 28, 2025.
5. Artinian V, Krayem H, DiGiovine B. Effects of early enteral feeding on the outcome of critically ill mechanically ventilated medical patients. Chest. 2006; 129(4): 960-967. doi:10.1378/chest.129.4.960.
6. Hsu CC, Sun CY, Tsai CY, et al. Metabolism of Proteins and Amino Acids in Critical Illness: From Physiological Alterations to Relevant Clinical Practice. Journal of Multidisciplinary Healthcare. 2021; 14: 1107-1117. doi:10.2147/JMDH.S306350.
7. Singer P, Blaser AR, Berger MM, et al. ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit. Clinical Nutrition. 2023; 42(9): 1671-1689. doi:10.1016/j.clnu.2023.07.011.
8. Nishikawa H, Yoh K, Enomoto H, et al. Extracellular Water to Total Body Water Ratio in Viral Liver Diseases: A Study Using Bioimpedance Analysis. Nutrients. 2018; 10(8): 1072. doi:10.3390/nu10081072.
9. McManus ML, Churchwell KB, Strange K. Regulation of cell volume in health and disease. N Engl J Med. 1995; 333(19): 1260-1266. doi:10.1056/NEJM199511093331906.
10. Mayerhöfer T, Shaw AD, Wiedermann CJ, et al. Fluids in the ICU: which is the right one? Nephrol Dial Transplant. 2022; 38(7): 1603-1612. doi:10.1093/ndt/gfac279.
11. Karina Marques Vermeulen, Leilane Lilian Araújo Leal, Mariana Câmara Martins Bezerra Furtado, et al. Phase Angle and Onodera’s Prognostic Nutritional Index in critically ill patients. Nutr Hosp. 2016 Nov 29; 33(6): 1268-1275. doi: 10.20960/nh.770.
12. Kyle UG, Soundar EP, Genton L, et al. Can phase angle determined by bioelectrical impedance analysis assess nutritional risk? A comparison between healthy and hospitalized subjects. Clin Nutr. 2012; 31(6): 875-881. doi:10.1016/j.clnu.2012.04.002.
13. Chakravarty C, Hazarika B, Goswami L, et al. Prevalence of malnutrition in a tertiary care hospital in India. Indian J Crit Care Med. 2013; 17(3): 170-173. doi:10.4103/0972-5229.117058.
14. Sheean PM, Peterson SJ, Gurka DP, et al. Nutrition assessment: the reproducibility of Subjective Global Assessment in patients requiring mechanical ventilation. Eur J Clin Nutr. 2010; 64(11): 1358-1364. doi:10.1038/ejcn.2010.154.
15. Mendes R, Policarpo S, Fortuna P, et al. Nutritional risk assessment and cultural validation of the modified NUTRIC score in critically ill patients-A multicenter prospective cohort study. J Crit Care. 2017; 37: 249. doi:10.1016/j.jcrc.2016.09.007.
16. Khalid I, Doshi P, DiGiovine B. Early enteral nutrition and outcomes of critically ill patients treated with vasopressors and mechanical ventilation. Am J Crit Care. 2010; 19(3): 261-268. doi:10.4037/ajcc2010197.
17. Cahill NE, Dhaliwal R, Day AG, et al. Nutrition therapy in the critical care setting: what is “best achievable” practice? An international multicenter observational study. Crit Care Med. 2010; 38(2): 395-401. doi:10.1097/CCM.0b013e3181c0263d.
18. Singer P, Blaser AR, Berger MM, et al. ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit. Clin Nutr. 2023; 42(9): 1671-1689. doi:10.1016/j.clnu.2023.07.011.
19. Lee ZY, Yap CSL, Hasan MS, et al. The effect of higher versus lower protein delivery in critically ill patients: a systematic review and meta-analysis of randomized controlled trials. Crit Care. 2021; 25: 260. doi:10.1186/s13054-021-03693-4.