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Health issues and nutrition in the elderly

Phase angle and diabetes in community-dwelling older adults: cross-sectional analysis from the Malaysian elders longitudinal research (MELoR) study



To evaluate the role of PhA in diabetes in a large population of older adults with a high prevalence of diabetes in order to gain new insights on the potential diagnostic and prognostic role of PhA in individuals with diabetes.


Cross-sectional study.


Teaching Hospital.


1085 individuals aged 55 years or over.


Phase Angle was obtained using bioimpedance analysis with the Bodystat QuadScan® 4000. Diabetes mellitus was considered present with fasting hyperglycaemia (serum fasting glucose >6.66 mmol/l), HbA1c > 42 mmol/mol (6.1%), or self-reported Diabetes or the consumption of glucose-lowering agents.


The mean age of the (standard deviation) of the 1,085 participants was 68.11 (7.12) years and 60.7% were women. Among male participants, individuals with PhA within the lowest quartile (PhA ≤4.9) were significantly more likely to have diabetes mellitus [odds Ratio (95% confidence interval, CI), 2.02 (1.17–3.47)] following adjustments for age, body mass index and other comorbidities. The above relationship was attenuated following further adjustment hypoglycaemic medications. Men on oral hypoglycaemic agents had significantly reduced PhA [mean difference (95% CI), −0.44 (−0.67 to −0.22)]. No significant relationship between PhA and diabetes existed among women.


The association between lower PhA (≤4.9) in men aged 55 and over and diabetes which is accounted for by oral hypoglycaemic agents. The mechanisms underlying this relationship remain unclear. This relationship should also be evaluated further to determine the potential of PhA as a prognostic tool for diabetes.

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  1. 1.

    Wan Nazaimoon WM, Md Isa SH, Wan Mohamad WB, Khir AS, Kamaruddin NA, Kamarul IM, et al. Prevalence of diabetes in Malaysia and usefulness of HbA1c as a diagnostic criterion. Diabet Med. 2013;30:825–8.

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Ogurtsova K, da Rocha Fernandes JD, Huang Y, Linnenkamp U, Guariguata L, Cho NH, et al. IDF diabetes atlas: global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pr. 2017;128:40–50.

    CAS  Article  Google Scholar 

  3. 3.

    Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pr. 2014;103:137–49.

    CAS  Article  Google Scholar 

  4. 4.

    Park SW, Goodpaster BH, Strotmeyer ES, Kuller LH, Broudeau R, Kammerer C, et al. Accelerated loss of skeletal muscle strength in older adults with type 2 diabetes. Diabetes Care. 2007;30:1507

    Article  PubMed  Google Scholar 

  5. 5.

    McPherron AC, Guo T, Bond ND, Gavrilova O. Increasing muscle mass to improve metabolism. Adipocyte. 2013;2:92–98.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Gómez JM, et al. Bioelectrical impedance analysis—part I: review of principles and methods. Clin Nutr. 2004;23:1226–43.

    Article  Google Scholar 

  7. 7.

    Wilhelm-Leen ER, Hall YN, Horwitz RI, Chertow GM. Phase angle, frailty and mortality in older adults. J Gen Intern Med. 2014;29:147–54.

    Article  PubMed  Google Scholar 

  8. 8.

    Garlini LM, Alves FD, Ceretta LB, Perry IS, Souza GC, Clausell NO Phase angle and mortality: a systematic review. Eur J Clin Nutr 2018.

  9. 9.

    Norman K, Stobaus N, Pirlich M, Bosy-Westphal A. Bioelectrical phase angle and impedance vector analysis-clinical relevance and applicability of impedance parameters. Clin Nutr. 2012;31:854–61.

    Article  PubMed  Google Scholar 

  10. 10.

    Lukaski HC, Kyle UG, Kondrup J. Assessment of adult malnutrition and prognosis with bioelectrical impedance analysis: phase angle and impedance ratio. Curr Opin Clin Nutr Metab Care. 2017;20:330–9.

    Article  PubMed  Google Scholar 

  11. 11.

    Dittmar M, Reber H, Kahaly GJ. Bioimpedance phase angle indicates catabolism in Type 2 diabetes. Diabet Med. 2015;32:1177–85.

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Jun M-H, Kim S, Ku B, Cho J, Kim K, Yoo H-R, et al. Glucose-independent segmental phase angles from multi-frequency bioimpedance analysis to discriminate diabetes mellitus. Sci Rep. 2018;8:648

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Buffa R, Mereu E, Comandini O, Ibanez M, Marini E. Bioelectrical impedance vector analysis (BIVA) for the assessment of two-compartment body composition. European J Clin Nutrition. 2014;68:1234–1240.

    CAS  Article  Google Scholar 

  14. 14.

    Bosy-Westphal A, Danielzik S, Dörhöfer RP, Later W, Wiese S, Müller MJ. Phase angle from bioelectrical impedance analysis: population reference values by age, sex, and body mass index. JPEN J Parenter Enter Nutr. 2006;30:309–16.

    Article  Google Scholar 

  15. 15.

    Lim LM, McStea M, Chung WW, Nor Azmi N, Abdul Aziz SA, Alwi S, et al. Prevalence, risk factors and health outcomes associated with polypharmacy among urban community-dwelling older adults in multi-ethnic Malaysia. PLoS One. 2017;12:e0173466

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Bonora E, Tuomilehto J. The pros and cons of diagnosing diabetes with A1C. Diabetes Care. 2011;34:S184–S190. Suppl 2

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Buchholz AC, Bartok C, Schoeller DA. The validity of bioelectrical impedance models in clinical populations. Nutr Clin Pract. 2004;19:433–46.

    Article  Google Scholar 

  18. 18.

    Tanaka S, Ando K, Kobayashi K, Seki T, Hamada T, Machino M, et al. Low bioelectrical impedance phase angle is a significant risk factor for frailty. BioMed Res Int. 2019;2019:6283153

    Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Rosas-Carrasco O, Ruiz-Valenzuela RE, López-Teros MT. Phase angle cut-off points and their association with sarcopenia and frailty in adults of 50–64 years old and older adults in Mexico city. Front. Med. 2021.

  20. 20.

    Buscemi S, Blunda G, Maneri R, Verga S. Bioelectrical characteristics of type 1 and type 2 diabetic subjects with reference to body water compartments. Acta Diabetol. 1998;35:220–3.

    CAS  Article  Google Scholar 

  21. 21.

    Rena G, Hardie DG, Pearson ER. The mechanisms of action of metformin. Diabetologia. 2017;60:1577–85.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Migdal A, Yarandi SS, Smiley D, Umpierrez GE. Update on diabetes in the elderly and in nursing home residents. J Am Med Dir Assoc. 2011;12:627–32.

    Article  Google Scholar 

  23. 23.

    Schroeder EB, Bayliss EA, Daugherty SL, Steiner JF. Gender differences in cardiovascular risk factors in incident diabetes. Women’s Health issues: Off Publ Jacobs Inst Women’s Health. 2014;24:e61–8.

    Article  Google Scholar 

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The MELoR study is now the Transforming Cognitive Frailty to Later Life Self-Sufficiency (AGELESS) study, which was funded by the Ministry of Higher Education Malaysia Long Term Research Grant Scheme (LR005–2019) LRGS/1/2019/UM//1/1.

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Conceived and/or designed the work that led to the submission, acquired data, and/or played an important role in interpreting the results.-FI, SBK, MPT, MM. Drafted or revised the manuscript. SM, MPT. Approved the final version. SM, FI, SBK, MPT, MM. Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved SM, FI, SBK, MPT, MM.

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Correspondence to Sumaiyah Mat or Fatimah Ibrahim.

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Mat, S., Tan, M.P., Mohktar, M.S. et al. Phase angle and diabetes in community-dwelling older adults: cross-sectional analysis from the Malaysian elders longitudinal research (MELoR) study. Eur J Clin Nutr (2021).

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