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ntroduction
mpedance analysis is based upon relating the measured electrical values of a subject to their physiologic equivalents as
etermined when the subject is the only unknown part of a safe and controlled electrical circuit. The properties of the circuit are
ell-defined and don't change over time. The method is precise, sensitive and specific in its ability to illustrate the changes
herent in the biological subject. Of particular benefit is these changes occur at a level of physiology that precedes those seen
hrough biochemical assays, cell counts, imaging techniques and physical signs. This 'snapshot' of cellular level dynamics and
chitecture provide valuable additional data to clinical practice and medical research. Michaeal Singer ( mgsinger@ipgdx.com )
History
he first electrical impedance measurements of biological variables of the circulation began at New York Post Graduate Hospital
1939 with Dr. Jan Nyboer, Dr. Robert Halsey, Dr. Avrom Barnett and an engineer Mr. Samuel Bagno.
n 1938 Mr. Bagno was awarded U.S Patent No. 2,111,135 titled "APPARATUS AND METHOD FOR DETERMINING
MPEDANCE ANGLES," that discloses an apparatus for measuring the electrical phase displacing properties or impedance angle
f humans, animals, and vital tissues. There is also disclosed a method for measuring the phase angle due to the impedance of an
nimal having properties of varying resistance and capacitance due to changes in muscular tension, comprising the steps of passin
n alternating current through the animal, and measuring the phase during changes of resistance and capacitance.
n 1967 Thomasset was awarded U.S Patent No. 3,316,896 titled "APPARATUS AND METHODS FOR THE MEASURE OF
HE ELECTRICAL IMPEDANCE OF LIVING ORGANISMS," which discloses a method for simultaneously and associatively
etermining the individual impedances of the extracellular contents and the intracellular contents of a living organism, which
onsists in measuring the total impedance of the organism between two selected points at predetermined frequencies.
search of the the US patent office and peer review papers on topics of bioelectrical impedance analysis (BIA) and phase angle
PA) will illustrate how many years this concept has existed. A more recent patent by Michaeal Singer (6,587,715 July 1 2003)
scusses the broad use of resistance, reactance and phase angle as a method for determining illness, progression to death, and
ming of death of biological entities.
hase angle is calculated by finding the ratio of reactance divided by resistance, and taking the arctangent of that ratio. Phase angl
normally expressed in degrees. The energy of all living things comes from cells that consume oxygen and nutrients and expel
arbon dioxide and waste. The quantity and efficiency of cells directly affect phase angle. The outer boundary of the cell is a
asma membrane of phospholipid molecules that are a dielectric to form an electrical capacitor when a radio frequency signal is
troduced to the cells environment. Capacitance is fundamental to any human phase angle measurement, the higher the
apacitance the greater the phase angle. An elite athlete world have a higher phase angle than a sedentary person. It has been well
ocumented that phase angle declines with disease, age and reduce activity level.
urther discussion of Phase Angle and Capacitance can be found in the paper Principles of Bioelectrical Impedance Analysis.
hase angle sensitivity
Fresh fish
hase angle sensitivity can easily be demonstrated by measuring resistance and reactance of a piece of fresh fish in real time. A
uantum II Desk top was configured to sample resistance and reactance each hour for a period of one week. The piece of fish is a
let of Pickerel caught in Lake Erie and is not more than two days from when it was caught.
he initial upward slopes of resistance and reactance at day 0 are a result of the piece of fish stabilizing to 40 degrees Fahrenheit,
hase angle does not change. After day one reactance begins to decline due to the break down of the plasma cell membranes and
duction in intracellular volume. Resistance is the ionic conductor or extracellular volume and remains relatively constant.
n late December of 1992 a male pancreatic cancer patient (age 71, height 69 inches) was admitted to the hospice program of the
niversity of Indiana. A nurse assigned to this patient took BIA measurements each day for the last 127 days of the patients life.
he patient eventually died in early May of 1993.
NHANES III Males and Females
he Third National Health and Nutrition Examination Survey (NHANES III), 1988-94, was conducted on a nationwide probabilit
ample of approximately 33,994 persons 2 months and over. The survey was designed to obtain nationally representative
formation on the health and nutritional status of the population of the United States through interviews and direct physical
xaminations. BIA data was collected on males and females who were 12 years and older.
12 to 19 20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 70 to 79 80 to 89 90 to 99
Age:
n=1379 n=1553 n=1383 n=1155 n=792 n=1055 n=724 n=472 n=32
Resistance: 522 ± 74 487 ± 63 476 ± 65 469 ± 64 470 ± 67 478 ± 71 488 ± 69 502 ± 72 525 ± 86
Reactance: 72 ± 11 74 ± 11 71 ± 11 67 ± 11 63 ± 11 60 ± 11 55 ± 11 50 ± 10 50 ± 11
Phase angle: 8.0 ± 1.0 8.7 ± 0.9 8.5 ± 0.9 8.2 ± 1.0 7.6 ± 0.9 7.1 ± 0.9 6.5 ± 1.0 5.7 ± 0.9 5.4 ± 1.2
12 to 19 20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 70 to 79 80 to 89 90 to 99
Age:
n=1448 n=1511 n=1632 n=1248 n=907 n=1031 n=817 n=477 n=44
Resistance: 622 ± 80 600 ± 83 570 ± 81 569 ± 88 566 ± 87 578 ± 88 576 ± 86 594 ± 83 612 ± 89
Reactance: 81 ± 13 82 ± 13 77 ± 12 75 ± 13 70 ± 12 68 ± 13 62 ± 12 58 ± 12 53 ± 11
Phase angle: 7.5 ± 0.9 7.8 ± 0.8 7.7 ± 0.9 7.6 ± 0.8 7.1 ± 0.9 6.7 ± 0.9 6.2 ± 1.0 5.6 ± 0.9 5.0 ± 0.7
G.M Chertow, et al; Renal Division, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, **Published as "BLUE RIBBON AWARD"
Abstract # T164, A0969, page 1442, journal of the American Society of
Nephrology, September 1996, Volume 7, #9 Link not available
Abstract: We performed a cross-sectional study of BIA (Bioelectrical
impedance analysis, BIA 101-Q, RJL Systems, Clinton Township, MI) in 3009
HD (hemodialysis) patients with follow-up to 12 (median 8) months to evaluate
the relation between impedance and survival. 296 deaths were documented over
the study period; patients were censored at transplantation or if lost to follow-
up. Mean (± SD) age was 60.5 ± 15.5 years, 47% were females, 47% African-
American, and 36% diabetic. Dialysis vintage was 3.8 ± 3.7 years. Mean
reactance (Xc) was 40.9 ± 13.8 ohms; mean resistance (R) was 497.7 ± 99.0
ohms. The mean Xc/R ratio 0.084 ± 0.030; Xc/R was directly correlated with
albumin (r=0.24), pre-albumin (r=0.27), and creatinine (r=0.40), and inversely
correlated with age (r= -0.33) and Quartile's index (r= - 0.15). Xc/R was
significantly higher in men Africa Americans, and non-diabetics (P< 0.0001
compared with women, Caucasians, and diabetics, respectively). To obviate
linearity assumptions, Xc/R was ranked into quintiles, and the relative risks of
death (RR) and 95% confidence intervals (95% CI) within each quintile were
estimated from proportional hazards regression, with and without covariate
adjustment. Survival in patients within the upper three quintiles of Xc/R; The
RR in the two lowest quintiles was 2.7 (95% CI 1.1 to 2.2, P=0.009),
respectively. After adjustment for age, sex, race, diabetes, albumin, creatinine,
and urea reduction ratio, the RR in the lowest quintile was 1.5 (95% CI 1.2 to
2.1, P=0.003). Results were similar when Xc and R were adjusted for body
stature. Conclusion: Xc/R is correlated with biochemical surrogates of
nutritional status in hemodialysis patients, and provides prognostic power even
after adjustment for case mix and laboratory variables. Longer-term follow-up
and longitudinal assessment of Xc/R will be required to determine the optimal
role for BIA in HD patient assessment.