Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Phase angle and anthropometric indicators of cardiometabolic risk in children and adolescents



The phase angle (PhA) is a measurement obtained from the resistance and reactance found in the bioelectrical impedance examination and is useful in assessing nutritional status and in assessing cardiometabolic diseases. Therefore, the objective was to correlate the phase angle to the anthropometric variables of cardiometabolic risk (CMR) in children and adolescents.


Weight, height, body mass index (BMI), waist circumference (WC) and neck circumference (NC), waist-to-height ratio (WHtR), and PhA of 1231 children and adolescents aged between 5 and 18 years were assessed. PhA was assessed in tertiles and CMR was identified using the anthropometric variables BMI, WC, NC, and WHtR. Linear regression models were used to verify the association between PhA tertiles and CMR anthropometric variables, stratified by sex.


No relationship was found between PhA and CMR variables in children. In adolescents, lower values of NC (β = -0.019, p = 0.005) and BMI (β = -0.025, p = 0.023) were found in boys, WC (β = -0.017, p = 0.020), WHtR (β = -0.017, p = 0.020), NC (β = -0.011, p = 0.027) and BMI (β = -0.026, p = 0.009) in girls when they were in tertile 1 when compared to tertile 3 of the PhA, even after adjusting for age.


The PhA was directly associated with CMR in the assessed adolescents.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Comparison between the anthropometric variables of the cardiometabolic risk and phase angle in tertiles of male adolescents, Fortaleza, 2022.
Fig. 2: Comparison between the anthropometric variables of the cardiometabolic risk and phase angle in tertiles of female adolescents, Fortaleza, 2022.

Similar content being viewed by others

Data availability

We declare that the data analyzed and generated during this study is available to the corresponding author upon reasonable request and as long as it does not violate the privacy of the participants.


  1. Montarroyos ECL, Costa KRL, Fortes RC. Antropometria e sua importância na avaliação do estado nutricional de crianças escolares. Comun ciênc saúde 2013;24:21–6.

    Google Scholar 

  2. De-Mateo-Silleras B, de-la-Cruz-Marcos S, Alonso-Izquierdo L, Camina-Martín MA, Marugán-deMiguelsanz JM, Redondo-del-Río MP. Bioelectrical impedance vector analysis in obese and overweight children. PLoS ONE. 2019;14:e0211148.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Marra M, Sammarco R, De Lorenzo A, Iellamo F, Siervo M, Pietrobelli A, et al. Assessment of Body Composition in Health and Disease Using Bioelectrical Impedance Analysis (BIA) and Dual Energy XRay Absorptiometry (DXA): A Critical Overview. Contrast Media Mol Imaging. 2019;

  4. Norman K, Stobäus 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 

  5. Lukaski HC. Evolution of bioimpedance: a circuitous journey from estimation of physiological function to assessment of body composition and a return to clinical research. Eur J Clin Nutr. 2013;67:S2–9.

    Article  PubMed  Google Scholar 

  6. Barbosa-Silva MCG, Barros AJ, Wang J, Heymsfield SB, Pierson RN Jr. Bioelectrical impedance analysis: population reference values for phase angle by age and sex. Am J Clin Nutr. 2005;82:49–52.

    Article  CAS  PubMed  Google Scholar 

  7. Gonzalez MC, Barbosa-Silva TG, Bielemann RM, Gallagher D, Heymsfield SB. Phase angle and its determinants in healthy subjects: influence of body composition. Am J Clin Nutr. 2016;103:712–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. de Moraes AM, Quinaud RT, Ferreira GOC, Lima AB, Carvalho HM, Guerra-Júnior G. Age-, sex-, and maturity-associated variation in the phase angle after adjusting for size in adolescents. Front Nutr 2022;9:939714.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Więch P, Bazaliński D, Sałacińska I, Binkowska-Bury M, Korczowski B, Mazur A, et al. Decreased bioelectrical impedance phase angle in hospitalized children and adolescents with newly diagnosed type 1 diabetes: a case-control study. J Clin Med 2018;7:516.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Luis DAD, Aller R, Romero E, Dueñas A, Castrillon JLP. Relation of phase angle tertiles with blood adipocytokines levels, insulin resistance and cardiovascular risk factors in obese women patients. Eur Rev Med Pharm Sci. 2010;14:521–6.

    Google Scholar 

  11. Longo GZ, Silva DAS, Gabiatti MP, Martins PC, Hansen F. Phase angle association with metabolic profile in adults: a population-based study. Nutrition. 2021;90:111233.

    Article  CAS  PubMed  Google Scholar 

  12. Miot HA. Tamanho da amostra em estudos clínicos e experimentais. J Vasc Brasileiro. 2011;10:275–8.

    Article  Google Scholar 

  13. BRASIL. Resolução n° 466, de 12 de dezembro de 2012. Dispõe sobre diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos. Diário Oficial [da] República Federativa do Brasil, Brasília, DF, 13 jun. 2013. Available from:

  14. WORLD HEALTH ORGANIZATION (WHO). Growth reference 5-19 years - BMI-for-age (5-19 years) [Internet]. [cited 2022 nov. 05]. Available from:

  15. Cook S, Auinger P, Huang TTK. Growth curves for cardio-metabolic risk factors in children and adolescents. J Pediatr. 2009;155:S6.e15–26.

    Article  PubMed  Google Scholar 

  16. Nafiu OO, Burke C, Lee J, Voepel-Lewis T, Malviya S, Tremper KK. Neck circumference as a screening measure for identifying children with high body mass index. Pediatrics. 2010;126:e306–10.

    Article  PubMed  Google Scholar 

  17. Sociedade Brasileira de Diabetes. Diretrizes da Sociedade Brasileira de Diabetes 2019-20. Brasília: Sociedade Brasileira de Diabetes, 2019. 491 p. ISBN: 978-85-93746-02-4

  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;

  19. Ferreira RC, Oliveira ACM, Bastos EL, Barbosa JHP, Barbosa LB, Vasconcelos SML. Ângulo de fase como indicador prognóstico em pacientes com insuficiência cardíaca congestiva. Rev Bras Nutr Clin. 2015;30:201–5.

    Google Scholar 

  20. Ballarin G, Valerio G, Alicante P, Di Vincenzo O, Scalfi L. Bioelectrical impedance analysis (BIA)- derived phase angle in children and adolescents: a systematic review. Journal of Pediatric Gastroenterology & Nutrition. 2022 Jun 1;Publish Ahead of Print.

  21. 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 

  22. Mattiello R, Amaral MA, Mundstock E, Ziegelmann PK. Valores de referência para o ângulo de fase da bioimpedância elétrica: Revisão sistemática e meta-análise envolvendo mais de 250.000 sujeitos. Clin Nutr. 2020;39:1411–7.

    Article  PubMed  Google Scholar 

  23. Garlini LM, Alves FD, Ceretta LB, Perry IS, Souza GC, Clausell NO. Phase angle and mortality: a systematic review. Eur J Clin Nutr. 2019;73:495–508.

    Article  PubMed  Google Scholar 

  24. Gomez-Arbelaez D, Camacho PA, Cohen DD, Saavedra-Cortes S, Lopez-Lopez C, Lopez-Jaramillo P. Neck circumference as a predictor of metabolic syndrome, insulin resistance and low-grade systemic inflammation in children: the ACFIES study. BMC Pediatrics. 2016;16:1–9.

    Article  Google Scholar 

  25. Eickemberg M, Oliveira CCD, Anna Karla Carneiro R, Sampaio LR. Bioimpedância elétrica e sua aplicação em avaliação nutricional. Rev de Nutrção. 2011;24:883–93.

    Article  Google Scholar 

  26. Mathias-Genovez MG, Oliveira CC, Camelo JS Jr, Del Ciampo LA, Monteiro JP. Bioelectrical impedance of vectorial analysis and phase angle in adolescents. J Am Coll Nutr. 2016;35:262–70.

    Article  CAS  PubMed  Google Scholar 

  27. Schmidt SC, Bosy-Westphal A, Niessner C, Woll A. Representative body composition percentiles from bioelectrical impedance analyses among children and adolescents. The MoMo study. Clin Nutr. 2019;38:2712–20.

    Article  PubMed  Google Scholar 

  28. Buffa R, Floris G, Marini E. Bioelectrical impedance vector in pre- and postmenarcheal females. Nutrition. 2002;18:474–8.

    Article  PubMed  Google Scholar 

  29. Santos LES, Claro ML, Carvalho DS, Oliveira EAR, Silva ARV, Machado ALG, et al. Relação entre maturação sexual e indicadores antropométricos e pressóricos em adolescentes. Ciênc saúde coletiva. 2022;27:3615–26.

    Google Scholar 

  30. Marra M, Caldara A, Montagnese C, De Filippo E, Pasanisi F, Contaldo F, et al. Bioelectrical impedance phase angle in constitutionally lean females, ballet dancers and patients with anorexia nervosa. Eur J Clin Nutr. 2009;63:905–8.

    Article  CAS  PubMed  Google Scholar 

  31. Kyle UG, Earthman CP, Pichard C, Coss-Bu JA. Body composition during growth in children: limitations and perspectives of bioelectrical impedance analysis. Eur J Clin Nutr. 2015;69:1298–305.

  32. Langer RD, Larsen SC, Ward LC, Heitmann BL. Phase angle measured by bioelectrical impedance analysis and the risk of cardiovascular disease among adult Danes. Nutrition. 2021;89:111280.

    Article  PubMed  Google Scholar 

  33. Portugal MRC, Canella DS, Curioni CC, Bezerra FF, Faerstein E, Neves MF, et al. Bioelectrical impedance analysis–derived phase angle is related to risk scores of a first cardiovascular event in adults. Nutrition. 2020;78:110865.

    Article  PubMed  Google Scholar 

  34. Saad MA, Jorge AJ, de Andrade Martins W, Cardoso GP, dos Santos MM, Rosa ML, et al. Phase angle measured by electrical bioimpedance and global cardiovascular risk in older adults. Geriatrics Gerontol Int. 2018;18:732–7.

    Article  Google Scholar 

  35. Guimarães IGC, Silva TA, Jordani MT, Alves L, Luz SAB, Braga CBM. Ângulo de Fase e Estado Nutricional de Crianças em Tratamento Antineoplásico. Rev. Bras. Cancerol. 2021;

  36. Paz ÁS, Martins SS, da Silva BFG, Sena IA, de Oliveira MC, Gonzalez MC. Ângulo de fase como marcador prognóstico para o óbito e desnutrição em gastrectomias por câncer gástrico no Amazonas. Braz J Health Rev 2020;3:7603–13.

    Article  Google Scholar 

  37. Marino LV, Meyer R, Johnson M, Newell C, Johnstone C, Magee A, et al. Bioimpedance spectroscopy measurements of phase angle and height for age are predictive of outcome in children following surgery for congenital heart disease. Clin Nutr. 2018;37:1430–6.

    Article  CAS  PubMed  Google Scholar 

  38. Selberg O, Selberg D. Norms and correlates of bioimpedance phase angle in healthy human subjects, hospitalized patients, and patients with liver cirrhosis. Eur J Appl Physiol. 2002;86:509–16.

    Article  CAS  PubMed  Google Scholar 

  39. Mattiello R, Mundstock E, Ziegelmann PK. Brazilian reference percentiles for bioimpedance phase angle of healthy individuals. Front Nutr. 2022;9:912840.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Nagano M, Suita S, Yamanouchi T. The validity of bioelectrical impedance phase angle for nutritional assessment in children. J Pediatr Surg. 2000;35:1035–9.

    Article  CAS  PubMed  Google Scholar 

  41. Martins PC, de Lima LRA, Berria J, Petroski EL, da Silva AM, Silva DAS. Association between phase angle and isolated and grouped physical fitness indicators in adolescents. Physiol Behav. 2020;217:112825.

    Article  CAS  PubMed  Google Scholar 

  42. Matias CN, Campa F, Nunes CL, Francisco R, Jesus F, Cardoso M, et al. Ângulo de fase é um marcador de quantidade muscular e força em ex-atletas com sobrepeso/obesidade. Int J Environ Res Saúde Pública. 2021;18:6649.

    Google Scholar 

  43. Cumberledge EA, Myers C, Venditti JJ, Dixon CB, Andreacci JL. The effect of the menstrual cycle on body composition determined by contact-electrode bioelectrical impedance analyzers. Int J Exerc Sci. 2018;11:625–32.

    PubMed  PubMed Central  Google Scholar 

  44. Gualdi-Russo E, Toselli S. Influence of various factors on the measurement of multifrequency bioimpedance. Homo. 2002;53:1–16.

    Article  CAS  PubMed  Google Scholar 

Download references


To the study participants, the Fortaleza Municipal Department of Education, the Research Program for the SUS, and the Ceará Foundation to Support Scientific and Technological Development (FUNCAP/SESA/CNPq/MCTI/MS).


This study received financial support from the Research Program for the Brazilian Unified Health System (PPSUS - Agreement No. 900394/2020) of the Ceará Foundation for Support to Scientific and Technological Development (FUNCAP), MCTI, CNPq and SESA.

Author information

Authors and Affiliations



JROR was responsible for the design of the work that led to its submission, acquired the data, drafted the manuscript and played an important role in the interpretation of the results; MDAN responsible for designed the work that led to its submission and played an important role in interpreting the results; MADF acquired the data and participated in the writing of the manuscript; LFNO acquired the data and participated in the writing of the manuscript; ; ABV acquired the data and participated in the writing of the manuscript; GSM acquired the data and participated in the writing of the manuscript ACPD acquired the data; NSLM acquired the data; EVSR participated in the review of the manuscript and final approval; KGSA participated in the review of the manuscript and final approval; CSCM conceived the work leading up to submission, reviewed the manuscript, approved the final version and agreed to be responsible for all aspects of the work to ensure that issues related to the accuracy or completeness of any part of the work are adequately investigated and resolved.

Corresponding author

Correspondence to Carla Soraya Costa Maia.

Ethics declarations

Ethical approval

This study was carried out by the Declaration of Helsinki and approved by the Research Ethics Committee of the State University of Ceará, following all the precepts to preserve the safety and autonomy of those assessed following resolution 466/12 of the National Health Council (protocol number 3.507.172), where to participate the child or adolescent signed an Assent Form and/or their guardian signed an Informed Consent Form.

Competing interests

The authors declare that there is no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ricarte, J.R.O., Nogueira, M.D.d.A., Firmino, M.A.D. et al. Phase angle and anthropometric indicators of cardiometabolic risk in children and adolescents. Eur J Clin Nutr (2024).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI:


Quick links