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Phase angle during paediatric cancer treatment: Associations with complications and micronutrients in a multicentre
Nubia Maria Oliveira1, Alexis Ross2, David C Wilson3
1Laboratory of Growth and Development, Centre for Investigation in Paediatrics, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil; Children's Health and Exercise Research Centre, Public Health and Sport Sciences, St Luke's Campus, University of Exeter, Exeter, UK.
Insights
Phase angle (PhA) in children undergoing cancer treatment initially declines but shows recovery later. Lower complication burden and certain micronutrients like zinc and selenium are linked to better PhA, suggesting its potential as a prognostic marker.
Area of Science:
- Paediatric oncology
- Bioelectrical impedance analysis
- Body composition analysis
Background:
- Phase angle (PhA) is linked to body composition and cellular health.
- Evidence on PhA in paediatric oncology is limited.
- PhA is a prognostic marker in various diseases.
Purpose of the Study:
- To describe longitudinal changes in PhA during cancer treatment in children and young people (CYP).
- To examine associations between PhA and treatment complications.
- To investigate links between PhA, nutritional status, and micronutrient biomarkers.
Main Methods:
- Prospective cohort studies in Scotland and New Zealand.
- Assessed CYP (<18 years) undergoing cancer treatment at baseline and 3, 6, 9, 12 months.
- Measured PhA using bioelectrical impedance analysis (BIA) and calculated Z-scores (PhA-Z).
- Recorded treatment complications and classified nutritional status.
- Analyzed plasma biomarkers (albumin, vitamins A, E, B12, magnesium, selenium, zinc).
Main Results:
- PhA-Z declined from baseline to 3 and 6 months, with recovery by 12 months.
- Fewer treatment complications (≤7) were associated with higher PhA-Z at 6, 9, and 12 months.
- PhA-Z was not associated with anthropometric nutritional status but positively correlated with albumin, zinc, and selenium.
Conclusions:
- PhA-Z shows an early decline and later recovery during cancer therapy in CYP.
- PhA may indicate treatment-related changes in body composition and physiological status.
- Further validation in larger studies is recommended.
Background & Aims:
Phase angle (PhA), derived from bioelectrical impedance analysis, is consistently associated with fat-free mass and cellular integrity and has been widely studied as a prognostic marker in several diseases; however, evidence in paediatric oncology remains limited. This study aimed to describe longitudinal changes in PhA during cancer treatment in children and young people (CYP) and to examine associations with treatment-related complications, nutritional status, and micronutrient biomarkers.
Methods:
Data were drawn from two prospective cohort studies conducted in Scotland and New Zealand. CYP (<18 years) undergoing cancer treatment were assessed at baseline and at 3, 6, 9, and 12 months. PhA was measured using single-frequency (50 kHz) bioelectrical impedance analysis, and Z-scores (PhA-Z) were calculated. Treatment-related complications were recorded prospectively, and participants were classified into tertiles according to the cumulative number of complications over 12 months (≤3, >3-≤7, and >7). Nutritional status categories (eutrophic, overweight and obese) were defined through body mass index and mid-upper arm circumference. Circulating plasma biomarkers included albumin; vitamins A, E, and B12; magnesium; selenium; and zinc. Mixed-effects models were used to assess longitudinal changes and associations.
Results:
A total of 115 participants were included, with baseline PhA-Z data available for 68. PhA-Z declined from baseline to 3 months (B = -0.82, 95% CI -1.32, -0.32) and to 6 months (B = -0.63, 95% CI -1.17, -0.08). Post hoc analyses indicated recovery at 12 months compared with 3 (p = 0.001, effect size [ES] = 0.63, 95% CI: 0.32 to 0.96) and 6 months (p = 0.019, ES = 0.54, 95% CI: 0.22 to 0.86). Compared with the >7 complications group, participants with ≤3 and >3-≤7 complications showed higher estimated PhA-Z at 6 (B = 2.04; 2.30), 9 (B = 2.79; 2.07), and 12 months (B = 2.20; 1.82) (p < 0.05). Anthropometric nutritional status classifications were not associated with PhA-Z, while albumin, zinc, and selenium were positively associated.
Conclusions:
PhA-Z declined early and recovered later during therapy. Associations with complication burden and selected micronutrients suggest that PhA may be a promising marker of treatment-related alterations in body composition and physiological status, warranting confirmation in larger prospective studies.