Phase Angle as an Indicator of Nutritional Status: A cross-sectional Study on the Iranian Population

Phase Angle as an Indicator of Nutritional Status: A cross-sectional Study on the Iranian Population | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Phase Angle as an Indicator of Nutritional Status: A cross-sectional Study on the Iranian Population Fatemeh Samadinian, Niloofar Eshaghian, Mohammad Javad Tarrahi, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6758040/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 31 Aug, 2025 Read the published version in Journal of Health, Population and Nutrition → Version 1 posted 11 You are reading this latest preprint version Abstract Background Phase angle (PhA), derived from bioelectrical impedance analysis, serves as an indicator of cellular health, membrane integrity, and hydration status. Despite its potential utility, the relationship between PhA and nutritional and lifestyle factors has not been extensively studied in Iranian populations. This study aimed to investigate these associations in Iranian adults. Methods This case-control study included 239 university employees (85 men and 154 women) with a mean age of 43.32 years. Anthropometric indices and blood pressure were measured. PhA was measured by the Body Composition Analyzer Mc780 MA device. Dietary intakes were assessed by using a validated 86-item food frequency questionnaire (FFQ). Physical activity was evaluated by the short form of the International Physical Activity Questionnaire (IPAQ). Results Significant positive correlations were observed between PhA and several anthropometric and body composition indices, including weight, body mass index (BMI), waist circumference (WC), hip circumference (HC), fat-free mass (FFM), muscle mass, bone mass, and visceral fat. PhA showed significant associations with dietary intake variables. Conclusions This study highlights significant associations between PhA and body composition and dietary factors in Iranian adults, with notable sex-based differences. These findings suggest that PhA may be a valuable marker for assessing nutritional and cellular health. Phase angle Nutritional Status Anthropometry Adult University employees Background Malnutrition is a significant concern contributing to both acute and chronic diseases, which has significant consequences on the survival, quality of life, clinical status, and socio-economic conditions of people in the community, especially patients hospitalized ( 1 , 2 ). Accurate assessment of nutritional status across different age groups and genders holds crucial importance. However, in many cases, measuring weight and body mass index are generally used as the criteria for evaluating the nutritional status in adults, which do have not the necessary precision to predict their health status ( 2 , 3 ). Bioelectrical impedance analysis (BIA) is an indirect and non-invasively method of assessing body composition (measures body fat and fat-free mass), and is a safe, inexpensive, and easy-to-use approach, compared to other methods. Phase angle (PA), as a BIA parameter, is an indicator of cell membrane health and integrity as well as hydration and nutritional status, reflecting relative contributions of fluid (resistance), and cell membranes (reactance) of the body ( 4 – 6 ). Bosy-Westphal et al in 2006, reported that the main determinants of PA in healthy German adults were gender and age. In children and adolescents, the main determinants of PA were age and BMI ( 7 ). The results of a cross-sectional study by Gonzalez et al. on healthy adults showed that the most important determinants of PA in men and women were height, fat-free mass and age, and age had the greatest effect on PA ( 6 ). Overall, PA has been considered a marker of nutritional status and clinical conditions such as inflammation, oxidative stress ( 8 ), liver cirrhosis ( 9 ), heart failure ( 10 ), patients with COVID-19 ( 11 ), cancer ( 12 ), and other diseases ( 1 , 13 ). PA is emerging as a global health indicator encompassing the overall well-being of the body. Several studies show that there is a significant correlation between phase angle and overall survival, so patients with low phase angle may have cell membrane deterioration as well as poorer overall survival ( 1 , 12 ). A low PA indicates decreased cellular integrity, poor muscle function, catabolism and cell death, while, a high PA indicates a state of healthy whole-body condition, better nutritional status and high integrity and health of the cell membrane ( 1 , 8 , 11 , 12 , 14 ). People’s phase angles vary greatly, and there is currently no standardization for population groups. The standard range of the phase angle depends on various factors such as gender, age, race, body height, measuring position, and of course the measuring device ( 2 , 6 , 7 ). However, no study has been conducted to determine PA specific to healthy Asian populations, including Iran. Considering that the anthropometric standards in different regions of the world differ from each other despite the presence of different races and ethnic diversity, the current study aims to determine the PA in a sample of the Iranian population, while exploring its relationship with various factors, including age, gender, BMI, food intake, physical activity and blood pressure. Methods Study design and population : This study was done cross-sectionally on 258 healthy employees of Isfahan University of Medical Sciences in the age range of 18–60 years who were selected by an easy non-random sampling method. The study’s protocol was reviewed and approved by the Medical Ethics Committee at the Isfahan University of the Medical Sciences, Iran (ethics registration number: IR.MUI.RESEARCH.REC.1399.052). The participants included 18-60-year-old healthy people who are working at the Isfahan University of Medical Sciences campus, Isfahan, Iran, in 2022. Participants under 18 or over 60 years old, pregnant or lactating women, and people with a history of metabolic diseases such as diabetes, malignant diseases, liver or kidney diseases, and hypertension were excluded. In addition, people who have a history of adherence to a specific diet (vegetarian, ketogenic, very low-calorie, and athlete diets) or use of special medicine therapy were excluded from the study. All eligible participants were informed about the purpose and method of the study and written informed consent was obtained from them. The study included a visit for anthropometric measures, PhA determinations, and a semi-quantitative food frequency questionnaire (FFQ). Demographic data and medical history of participants, including drug use and disease were collected through a questionnaire. The unwillingness of participants to cooperate was considered in different stages of the project. Furthermore, those participants who left more than 40 food items blank on the 86-item food frequency questionnaire (FFQ) as well as those with reported energy intake outside the range of 800–4200 kcal/d. After all these exclusions, 239 participants remained for the current analysis. Anthropometric Measurements and phase angle : The weight with light clothes and body composition of the participants were evaluated by portable TANITA M780 (Tanita, Japan.). Height was measured in a standing position, looking straight ahead, arms at sides, and shoulders relaxed with no shoes on with 0.1 cm precision by Seca 763 scale (Hamburg, Germany). Body mass index (BMI) was calculated by dividing the weight (kg) by the square of height (m2). Waist circumference (WC) was measured at the narrowest area of the waist and maximum level of the hip, over light clothing, using a flexible tape measure, without any pressure to the body surface and was recorded to the nearest 0.1 cm. Waist-Height Ratio (WHtR) was calculated by dividing the waist in meters by height in meters. Body composition, including fat mass, fat-free mass, muscle mass, bone mass, visceral fat and PhA were measured by the Body Composition Analyzer Mc 780 MA device. Blood pressure was measured twice using a standard mercury sphygmomanometer on the left arm in a seated position after a 15-minute rest. Before measuring the blood pressure, they were asked about the consumption of tea, coffee and physical activity. The mean of the two measured systolic and diastolic blood pressure was reported. To reduce measurement error, all measurements were performed by a trained dietitian. Assessment of dietary intakes and physical activity The usual dietary consumption of the participants over the past year was collected using a validated semi-quantitative 86-item food frequency questionnaire (FFQ)( 15 , 16 ). The participants were asked to specify the frequency of their consumption of each item according to the food servings in the last year. Depending on the type of food consumption, the frequency of consumption daily, weekly, or monthly was asked, and it was completed by a trained nutritionist. Then the reported portion size was converted to grams per day using household measures, and the nutrients and energy content were extracted by NUTRITIONIST 4 (First Data Bank, San Bruno, CA). Participants filled in a validated form of the 7-item Physical Activity Questionnaire-Short Form (IPAQ-S)( 17 ). Data were converted to metabolic equivalent hours/week. Statistical analysis SPSS software version 23 (IBM, Chicago, IL) was used for analyses. Quantitative data are presented as mean ± standard deviation (SD), while qualitative data are presented as frequency (percentage). The Shapiro-Wilk test was used to assess normality. Independent Sample T-test, and Chi-square test were utilized for analyzing variables. P-values < 0.05 (two-sided) were considered as statistically significant. Results This study included 239 adults (85 male and 154 female). The mean age for men and women was 45.0 ± 7.4 years and 42.4 ± 9.3 years respectively. Men had significantly higher PhA values (6.2 ± 0.6°) than women (5.3 ± 0.6°, p < 0.001). The characteristics of the study participants are shown in Table 1 . The men had greater weight, height, BMI, FFM, muscle mass, visceral fat, basal metabolic rate (BMR) and PA values than women (p < 0.001 for all). Table 1 Anthropometric measurements and body composition characteristics of the study participants by Sex Characteristics Men (n = 85) Women (n = 154) P-value Age (year) 45.0 ± 7.4 42.4 ± 9.3 0.034 Biological age (year) 47.5 ± 10.6 43.6 ± 12.7 0.014 Weight (kg) 80.7 ± 11.9 65.4 ± 9.6 0.0001˂ Height (cm) 172.1 ± 7.4 159.8 ± 6.3 0.0001˂ BMI (kg/m 2 ) 27.5 ± 3.9 25.6 ± 4.0 0.0001˂ Fat mass (kg) 22.0 ± 6.7 22.4 ± 6.2 0.0001˂ Fat free mass (kg) 60.6 ± 6.8 43.0 ± 4.4 0.0001˂ Muscle mass (kg) 57.5 ± 6.5 40.8 ± 4.2 0.0001˂ WC (cm) 99.7 ± 9.2 88.6 ± 10.4 0.0001˂ HC (cm) 104.6 ± 5.9 102.9 ± 8.0 0.096 Phase angle (°) 6.2 ± 06 5.3 ± 0.6 0.0001˂ Phase angle status < 5.6 ≥ 5.6 12 (14.1) 73 (85.9) 105 (68.6) 48 (31.4) 0.0001˂ BMR (kcal) 1754.9 ± 285.6 1300.1 ± 156.1 0.0001˂ Bone mass (kg) 3.0 ± 0.3 2.4 ± 0.2 0.029 Visceral fat Level 10.0 ± 3.1 5.8 ± 2.6 0.0001˂ Physical activity level (MET) Low Moderate Intense 20 (23.5) 64 (75.3) 1 (1.2) 42 (27.3) 111 (72.1) 1 (0.6) 0.736 SBP (mmHg) 118.5 ± 10.2 112.6 ± 11.2 0.007 DBP (mmHg) 77.5 ± 8.2 74.5 ± 7.8 0.052 • Data presented as Mean ± SD or Number (Percent). • Abbreviations: BMI, Body mass index; WC, Waist circumference; HC, Hip circumference; BMR, Basal metabolic rate; MET: Metabolic Equivalent SBP, Systolic Blood Pressure; DBP, Diastolic blood pressure; • P-values calculated by Independent Sample T-test, and Chi-square test. No significant sex-based differences were observed in the physical activity level and diastolic blood pressure although systolic blood pressure was slightly higher in men ( p = 0.007 ). Table 2 shows the energy and macronutrient intake of participants. Compared with women, men had a greater intake of energy, carbohydrate and protein (p < 0.001). There was no significant difference in fat intake between men and women ( p = 0.127 ). Pearson correlation values between the PA and body composition and anthropometric variables are presented in Table 3 . A positive correlation was observed between PhA and weight, BMI, WC, HC, FFM, muscle mass, bone mass, and visceral mass ( p < 0.001 ). Conversely, PhA correlated negatively with fat mass ( p = 0.624 ). Dietary intake also showed significant positive correlations with PhA for energy, protein, and carbohydrate intake ( p < 0.001 ), while fat intake did not show a significant correlation ( p = 0.086 ) ( Table 4 ). Table 2 Dietary intakes of study participants by Sex Male (n = 85) Female (n = 153) P-value Energy (Kcal) 3646.6 ± 1747.7 2538.4 ± 829.4 ˂0.0001 Protein (gr) 113.4 ± 53.3 82.9 ± 34.4 ˂0.0001 Carbohydrate (gr) 602.0 ± 345.9 372.2 ± 133.7 ˂0.0001 Total fat (gr) 97.2 ± 44.8 88.3 ± 41.2 0.127 • Data presented as Mean ± SD Table 3 Correlation between the phase angle and all anthropometric, body-composition and Physical activity of study participants r P-value Weight, kg 0.238 ˂0.0001 BMI, kg/m 2 0.405 ˂0.0001 Waist Circumference (cm) 0.421 ˂0.0001 Hip Circumference (cm) 0.190 0.004 BMR (Kcal) 0.566 ˂0.0001 Fat Mass (kg) − 0.032 0.624 Visceral Fat (kg) 0.407 ˂0.0001 Fat Free Mass (kg) 0.582 ˂0.0001 Muscle Mass (kg) 0.581 ˂0.0001 Bone Mass (kg) 0.563 ˂0.0001 Physical activity 0.007 0.911 • P-values calculated by Pearson's correlation. • Abbreviations: BMI, Body Mass Index; BMR, Basal Metabolic Rate. Table 4 Correlation between the phase angle and dietary intakes r P-value Energy (Kcal) 0.245 ˂0.0001 Protein (gr) 0.225 ˂0.0001 Carbohydrate (gr) 0.264 ˂0.0001 Total fat (gr) 0.112 0.086 • P-values calculated by Pearson's correlation. Discussion Our findings show a significant difference in PhA values between men and women, with men exhibiting higher mean PhA (6.2 ± 0.6°) compared to women (5.3 ± 0.6°). These results align with previous studies indicating that PhA is influenced by body composition, particularly the proportion of fat-free mass and muscle mass. Men typically have a higher FFM and lower fat mass than women, higher values in men may indicate greater cellular health and metabolic activity, as muscle tissue is more metabolically active than adipose tissue ( 6 , 18 ). The strongest correlations were observed between PhA and measures of lean body mass, including FFM, muscle mass, and bone mass. These findings are in agreement with studies that have emphasized the role of lean mass in determining PhA. FFM and muscle mass are the primary contributors to reactance, which is directly proportional to PhA ( 3 , 18 , 19 ). Conversely, the negative correlation between PhA and fat mass observed in other studies was less pronounced in our findings, potentially due to the relatively homogenous fat mass distribution across the study sample ( 6 , 20 , 21 ). Interestingly, physical activity levels, assessed via the short form of the International Physical Activity Questionnaire, did not significantly differ between men and women and showed limited association with PhA. Mundstock et al in a systematic review and meta-analysis found that physical activity has a positive effect on phase angle ( 22 ). There was also a study revealing that a higher physical activity was positively associated with higher PhA among Korean adults ( 23 ). A similar finding was reported by Streb et al, that physical activity did not correlate with the PhA ( 24 ). While physical activity is known to influence body composition, the lack of significant correlation may stem from the subjective nature of self-reported activity levels or the relatively small variance in physical activity within the study population. These findings emphasize the complexity of the relationship between physical activity and PhA and suggest that other factors, such as genetic influences, nutritional status, or specific training adaptations, might play a more substantial role ( 6 , 22 ). The findings highlight the need for future research utilizing objective activity measurements and more heterogeneous samples to better understand the relationship between physical activity and PhA. The positive correlation between PhA and dietary intake of energy, carbohydrates, and protein in this study underscores the influence of nutrition on cellular and body composition health. Previous studies have shown that protein intake is associated with higher PhA values due to improved muscle synthesis and cellular repair mechanisms ( 25 – 27 ). However, the association between phase angle and dietary intake has been poorly explored. Unterberger et al reported no relationship between PhA and protein intake in older individuals ( 28 ). Interestingly, in our study fat intake did not show a significant relationship with PhA, suggesting that macronutrients like protein and carbohydrates, which directly support lean mass, have a more pronounced impact on PhA than dietary fats. Previous researches underscore the significant influence of race on phase angle and suggests that each population requires its reference values for PhA, despite similar patterns of variation by sex and age observed globally ( 6 , 12 , 29 ). This evidence supports the notion that each population should adopt tailored risk cutoff points derived from its unique reference PA values while ensuring the use of a standardized PA measurement. The focus of our study on the Iranian population is particularly noteworthy, as it addresses a significant gap in the existing literature. Most PhA research has predominantly involved Western and Asian populations, leaving Middle Eastern groups underrepresented. By contributing data from this region, the study not only enriches the global understanding of PhA variability but also provides a foundation for establishing specific reference values for Middle Eastern populations. This step is crucial for advancing precision in nutritional and clinical assessments within this demographic. The present study has several strengths. This was the first study to determine PA in a sample of the Iranian population by comprehensively assessing anthropometric, dietary, and body composition variables with sex-specific analyses, increasing the generalizability of the findings. In addition, the use of a validated FFQ and a reliable bioelectrical impedance analysis. Importantly, the results emphasize the potential of phase angle as a valuable biomarker for assessing health status in community-dwelling adults. Nevertheless, this study has some limitations. The cross-sectional design limits the ability to establish causality; emphasizing the need for prospective studies to validate these findings. Additionally, the reliance on self-reported physical activity data introduces the potential for recall and reporting biases, which may have impacted the results. Furthermore, the absence of micronutrient intake analysis is a notable limitation, as micronutrient status could influence PhA values, warranting further investigation in future research. Prospective studies are recommended to address these issues. Conclusion This study demonstrates significant sex-based differences in PhA and its association with body composition and dietary intake in an Iranian adult population. These findings underscore the potential of PhA as a valuable tool for assessing nutritional and cellular health. Its strong association with FFM and dietary intake highlights its potential utility in monitoring interventions aimed at improving body composition and overall health. However, further research is needed to validate these associations in diverse populations and to explore the longitudinal implications of PhA in health and disease. Additionally, exploring the relationships between PhA and other health indicators, such as inflammatory markers and metabolic health, could further elucidate its role in assessing overall well-being. Abbreviations PhA: Phase angle, FFQ: Food Frequency Questionnaire, IPAQ: International Physical Activity Questionnaire, BMI: Body Mass Index, WC: Waist Circumference, HC: Hip Circumference, FFM: Fat-Free Mass. BIA: Bioelectrical Impedance Analysis. Declarations Ethics approval and consent to participate: The study procedure was performed according to the declaration of Helsinki and the STROBE checklist. All participants provided informed written consent and the study protocol was approved by the Ethics Committee of Isfahan University of Medical Sciences (IR.ARI.MUI.REC.1399.052). Consent for publication: Not applicable Availability of data and materials: The datasets generated and/or analyzed during the current study are not publicly available as per the rules and regulations of the Isfahan University of Medical Science but are available upon reasonable request from the corresponding author. Competing interests: The authors declare no competing interests. Funding: The financial support for all parts of the study comes from the Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran (no. 198333). Authors' contributions : FS, NE, MJT, RA, MA, and FSH contributed to the conception, design, data collection, data interpretation, manuscript drafting and approval of the final version of the manuscript, and agreed on all aspects of the work. Acknowledgements: We wish to thank all staff of Isfahan University of Medical Sciences who kindly participated in our study. References Rinaldi S, Gilliland J, O'Connor C, Chesworth B, Madill J. 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Cite Share Download PDF Status: Published Journal Publication published 31 Aug, 2025 Read the published version in Journal of Health, Population and Nutrition → Version 1 posted Editorial decision: Revision requested 02 Jul, 2025 Reviews received at journal 18 Jun, 2025 Reviews received at journal 17 Jun, 2025 Reviewers agreed at journal 17 Jun, 2025 Reviews received at journal 13 Jun, 2025 Reviewers agreed at journal 13 Jun, 2025 Reviewers agreed at journal 12 Jun, 2025 Reviewers invited by journal 12 Jun, 2025 Editor assigned by journal 29 May, 2025 Submission checks completed at journal 29 May, 2025 First submitted to journal 27 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6758040","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":471417588,"identity":"01ba9f41-1c8a-4d70-be06-50d76a8296c5","order_by":0,"name":"Fatemeh Samadinian","email":"","orcid":"","institution":"Isfahan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Fatemeh","middleName":"","lastName":"Samadinian","suffix":""},{"id":471417589,"identity":"db928ea9-e94a-4c05-8244-3294c5df9aa2","order_by":1,"name":"Niloofar Eshaghian","email":"","orcid":"","institution":"Isfahan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Niloofar","middleName":"","lastName":"Eshaghian","suffix":""},{"id":471417590,"identity":"eb3444b7-b5c5-4828-a14b-f0d1a79b1be9","order_by":2,"name":"Mohammad Javad Tarrahi","email":"","orcid":"","institution":"Isfahan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mohammad","middleName":"Javad","lastName":"Tarrahi","suffix":""},{"id":471417592,"identity":"087154b8-df9e-4bb1-b805-0da31debde0d","order_by":3,"name":"Reza Amani","email":"","orcid":"","institution":"Isfahan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Reza","middleName":"","lastName":"Amani","suffix":""},{"id":471417595,"identity":"68c47f7c-341c-4c90-8833-c4b16ad245e7","order_by":4,"name":"Mojtaba Akbari","email":"","orcid":"","institution":"Isfahan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mojtaba","middleName":"","lastName":"Akbari","suffix":""},{"id":471417596,"identity":"3e24a191-3b09-4fc7-9d7d-00a5f1402e7a","order_by":5,"name":"Fatemeh Shirani","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1ElEQVRIiWNgGAWjYDACCcYGEMnAxsB8gAHMJkELWwKxWuAsHgPitMjPbm778HOHBQOf9JlvEj932MgxsB8+ugGfFoM7B5tn9p4BOowvd5tk75k0YwaetLQbeLVIJDYz8LYBtfDwbpPgbTuc2CDBY4ZXi/yMxGbGv2AtPM8k/xKjheFGYjMzxBYeNmmibDEAaZEFa2EztpZtSzNmI+QX+RnpjxnfttUxyPcwP7z5ts1Gjp/98DH8DoOC+gYGBhZwHLERoxwGmD+QonoUjIJRMApGDgAAuC5AZY55xGoAAAAASUVORK5CYII=","orcid":"","institution":"Isfahan University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Fatemeh","middleName":"","lastName":"Shirani","suffix":""}],"badges":[],"createdAt":"2025-05-27 09:53:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6758040/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6758040/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s41043-025-01060-5","type":"published","date":"2025-08-31T15:58:21+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":90345441,"identity":"b4b9e8f0-327f-4c66-b8ce-520776c91ada","added_by":"auto","created_at":"2025-09-01 16:10:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":630878,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6758040/v1/7b694ec1-56a2-4055-9381-04d40dada000.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Phase Angle as an Indicator of Nutritional Status: A cross-sectional Study on the Iranian Population","fulltext":[{"header":"Background","content":"\u003cp\u003eMalnutrition is a significant concern contributing to both acute and chronic diseases, which has significant consequences on the survival, quality of life, clinical status, and socio-economic conditions of people in the community, especially patients hospitalized (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Accurate assessment of nutritional status across different age groups and genders holds crucial importance. However, in many cases, measuring weight and body mass index are generally used as the criteria for evaluating the nutritional status in adults, which do have not the necessary precision to predict their health status (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBioelectrical impedance analysis (BIA) is an indirect and non-invasively method of assessing body composition (measures body fat and fat-free mass), and is a safe, inexpensive, and easy-to-use approach, compared to other methods. Phase angle (PA), as a BIA parameter, is an indicator of cell membrane health and integrity as well as hydration and nutritional status, reflecting relative contributions of fluid (resistance), and cell membranes (reactance) of the body (\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Bosy-Westphal et al in 2006, reported that the main determinants of PA in healthy German adults were gender and age. In children and adolescents, the main determinants of PA were age and BMI (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The results of a cross-sectional study by Gonzalez et al. on healthy adults showed that the most important determinants of PA in men and women were height, fat-free mass and age, and age had the greatest effect on PA (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOverall, PA has been considered a marker of nutritional status and clinical conditions such as inflammation, oxidative stress (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), liver cirrhosis (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), heart failure (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), patients with COVID-19 (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), cancer (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), and other diseases (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). PA is emerging as a global health indicator encompassing the overall well-being of the body. Several studies show that there is a significant correlation between phase angle and overall survival, so patients with low phase angle may have cell membrane deterioration as well as poorer overall survival (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). A low PA indicates decreased cellular integrity, poor muscle function, catabolism and cell death, while, a high PA indicates a state of healthy whole-body condition, better nutritional status and high integrity and health of the cell membrane (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). People\u0026rsquo;s phase angles vary greatly, and there is currently no standardization for population groups. The standard range of the phase angle depends on various factors such as gender, age, race, body height, measuring position, and of course the measuring device (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). However, no study has been conducted to determine PA specific to healthy Asian populations, including Iran. Considering that the anthropometric standards in different regions of the world differ from each other despite the presence of different races and ethnic diversity, the current study aims to determine the PA in a sample of the Iranian population, while exploring its relationship with various factors, including age, gender, BMI, food intake, physical activity and blood pressure.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e \u003cb\u003eStudy design and population\u003c/b\u003e: This study was done cross-sectionally on 258 healthy employees of Isfahan University of Medical Sciences in the age range of 18\u0026ndash;60 years who were selected by an easy non-random sampling method. The study\u0026rsquo;s protocol was reviewed and approved by the Medical Ethics Committee at the Isfahan University of the Medical Sciences, Iran (ethics registration number: IR.MUI.RESEARCH.REC.1399.052).\u003c/p\u003e \u003cp\u003eThe participants included 18-60-year-old healthy people who are working at the Isfahan University of Medical Sciences campus, Isfahan, Iran, in 2022. Participants under 18 or over 60 years old, pregnant or lactating women, and people with a history of metabolic diseases such as diabetes, malignant diseases, liver or kidney diseases, and hypertension were excluded. In addition, people who have a history of adherence to a specific diet (vegetarian, ketogenic, very low-calorie, and athlete diets) or use of special medicine therapy were excluded from the study. All eligible participants were informed about the purpose and method of the study and written informed consent was obtained from them. The study included a visit for anthropometric measures, PhA determinations, and a semi-quantitative food frequency questionnaire (FFQ). Demographic data and medical history of participants, including drug use and disease were collected through a questionnaire. The unwillingness of participants to cooperate was considered in different stages of the project. Furthermore, those participants who left more than 40 food items blank on the 86-item food frequency questionnaire (FFQ) as well as those with reported energy intake outside the range of 800\u0026ndash;4200 kcal/d. After all these exclusions, 239 participants remained for the current analysis.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e\u003cb\u003eAnthropometric Measurements and phase angle\u003c/b\u003e:\u003c/h2\u003e \u003cp\u003eThe weight with light clothes and body composition of the participants were evaluated by portable TANITA M780 (Tanita, Japan.). Height was measured in a standing position, looking straight ahead, arms at sides, and shoulders relaxed with no shoes on with 0.1 cm precision by Seca 763 scale (Hamburg, Germany). Body mass index (BMI) was calculated by dividing the weight (kg) by the square of height (m2). Waist circumference (WC) was measured at the narrowest area of the waist and maximum level of the hip, over light clothing, using a flexible tape measure, without any pressure to the body surface and was recorded to the nearest 0.1 cm. Waist-Height Ratio (WHtR) was calculated by dividing the waist in meters by height in meters. Body composition, including fat mass, fat-free mass, muscle mass, bone mass, visceral fat and PhA were measured by the Body Composition Analyzer Mc 780 MA device.\u003c/p\u003e \u003cp\u003eBlood pressure was measured twice using a standard mercury sphygmomanometer on the left arm in a seated position after a 15-minute rest. Before measuring the blood pressure, they were asked about the consumption of tea, coffee and physical activity. The mean of the two measured systolic and diastolic blood pressure was reported. To reduce measurement error, all measurements were performed by a trained dietitian.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eAssessment of dietary intakes and physical activity\u003c/strong\u003e \u003cp\u003eThe usual dietary consumption of the participants over the past year was collected using a validated semi-quantitative 86-item food frequency questionnaire (FFQ)(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). The participants were asked to specify the frequency of their consumption of each item according to the food servings in the last year. Depending on the type of food consumption, the frequency of consumption daily, weekly, or monthly was asked, and it was completed by a trained nutritionist. Then the reported portion size was converted to grams per day using household measures, and the nutrients and energy content were extracted by NUTRITIONIST 4 (First Data Bank, San Bruno, CA). Participants filled in a validated form of the 7-item Physical Activity Questionnaire-Short Form (IPAQ-S)(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Data were converted to metabolic equivalent hours/week.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStatistical analysis\u003c/strong\u003e \u003cp\u003eSPSS software version 23 (IBM, Chicago, IL) was used for analyses. Quantitative data are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD), while qualitative data are presented as frequency (percentage). The Shapiro-Wilk test was used to assess normality. Independent Sample T-test, and Chi-square test were utilized for analyzing variables. P-values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 (two-sided) were considered as statistically significant.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThis study included 239 adults (85 male and 154 female). The mean age for men and women was 45.0\u0026thinsp;\u0026plusmn;\u0026thinsp;7.4 years and 42.4\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3 years respectively. Men had significantly higher PhA values (6.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u0026deg;) than women (5.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u0026deg;, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The characteristics of the study participants are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The men had greater weight, height, BMI, FFM, muscle mass, visceral fat, basal metabolic rate (BMR) and PA values than women (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for all).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAnthropometric measurements and body composition characteristics of the study participants by Sex\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMen (n\u0026thinsp;=\u0026thinsp;85)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen (n\u0026thinsp;=\u0026thinsp;154)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45.0\u0026thinsp;\u0026plusmn;\u0026thinsp;7.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.4\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBiological age (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47.5\u0026thinsp;\u0026plusmn;\u0026thinsp;10.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.6\u0026thinsp;\u0026plusmn;\u0026thinsp;12.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80.7\u0026thinsp;\u0026plusmn;\u0026thinsp;11.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.4\u0026thinsp;\u0026plusmn;\u0026thinsp;9.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0001˂\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e172.1\u0026thinsp;\u0026plusmn;\u0026thinsp;7.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e159.8\u0026thinsp;\u0026plusmn;\u0026thinsp;6.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0001˂\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0001˂\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFat mass (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.0\u0026thinsp;\u0026plusmn;\u0026thinsp;6.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.4\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0001˂\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFat free mass (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60.6\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0001˂\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuscle mass (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0001˂\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWC (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99.7\u0026thinsp;\u0026plusmn;\u0026thinsp;9.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88.6\u0026thinsp;\u0026plusmn;\u0026thinsp;10.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0001˂\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHC (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e102.9\u0026thinsp;\u0026plusmn;\u0026thinsp;8.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.096\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhase angle (\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.2\u0026thinsp;\u0026plusmn;\u0026thinsp;06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0001˂\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhase angle status\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5.6\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;5.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (14.1)\u003c/p\u003e \u003cp\u003e73 (85.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e105 (68.6)\u003c/p\u003e \u003cp\u003e48 (31.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0001˂\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMR (kcal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1754.9\u0026thinsp;\u0026plusmn;\u0026thinsp;285.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1300.1\u0026thinsp;\u0026plusmn;\u0026thinsp;156.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0001˂\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBone mass (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVisceral fat Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0001˂\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical activity level (MET)\u003c/p\u003e \u003cp\u003eLow Moderate Intense\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (23.5)\u003c/p\u003e \u003cp\u003e64 (75.3)\u003c/p\u003e \u003cp\u003e1 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (27.3)\u003c/p\u003e \u003cp\u003e111 (72.1)\u003c/p\u003e \u003cp\u003e1 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.736\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSBP (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e118.5\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e112.6\u0026thinsp;\u0026plusmn;\u0026thinsp;11.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDBP (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74.5\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u0026bull; Data presented as Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or Number (Percent).\u003c/p\u003e \u003cp\u003e\u0026bull; Abbreviations: BMI, Body mass index; WC, Waist circumference; HC, Hip circumference; BMR, Basal metabolic rate; MET: Metabolic Equivalent\u0026nbsp;\u0026nbsp; SBP, Systolic Blood Pressure; DBP, Diastolic blood pressure;\u003c/p\u003e \u003cp\u003e\u0026bull; P-values calculated by Independent Sample T-test, and Chi-square test.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eNo significant sex-based differences were observed in the physical activity level and diastolic blood pressure although systolic blood pressure was slightly higher in men (\u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.007\u003c/em\u003e). Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the energy and macronutrient intake of participants. Compared with women, men had a greater intake of energy, carbohydrate and protein (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). There was no significant difference in fat intake between men and women (\u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.127\u003c/em\u003e). Pearson correlation values between the PA and body composition and anthropometric variables are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. A positive correlation was observed between PhA and weight, BMI, WC, HC, FFM, muscle mass, bone mass, and visceral mass (\u003cem\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e). Conversely, PhA correlated negatively with fat mass (\u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.624\u003c/em\u003e). Dietary intake also showed significant positive correlations with PhA for energy, protein, and carbohydrate intake (\u003cem\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e), while fat intake did not show a significant correlation (\u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.086\u003c/em\u003e) \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDietary intakes of study participants by Sex\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale (n\u0026thinsp;=\u0026thinsp;85)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale (n\u0026thinsp;=\u0026thinsp;153)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnergy (Kcal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3646.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1747.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2538.4\u0026thinsp;\u0026plusmn;\u0026thinsp;829.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e˂0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProtein (gr)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e113.4\u0026thinsp;\u0026plusmn;\u0026thinsp;53.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82.9\u0026thinsp;\u0026plusmn;\u0026thinsp;34.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e˂0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCarbohydrate (gr)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e602.0\u0026thinsp;\u0026plusmn;\u0026thinsp;345.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e372.2\u0026thinsp;\u0026plusmn;\u0026thinsp;133.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e˂0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal fat (gr)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97.2\u0026thinsp;\u0026plusmn;\u0026thinsp;44.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88.3\u0026thinsp;\u0026plusmn;\u0026thinsp;41.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.127\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u0026bull; Data presented as Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation between the phase angle and all anthropometric, body-composition and Physical activity of study participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight, kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.238\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e˂0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.405\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e˂0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWaist Circumference (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.421\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e˂0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHip Circumference (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMR (Kcal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.566\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e˂0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFat Mass (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.624\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVisceral Fat (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.407\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e˂0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFat Free Mass (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.582\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e˂0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuscle Mass (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.581\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e˂0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBone Mass (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.563\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e˂0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.911\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u0026bull; P-values calculated by Pearson's correlation.\u003c/p\u003e \u003cp\u003e\u0026bull; Abbreviations: BMI, Body Mass Index; BMR, Basal Metabolic Rate.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation between the phase angle and dietary intakes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnergy (Kcal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e˂0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProtein (gr)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e˂0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCarbohydrate (gr)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e˂0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal fat (gr)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.086\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u0026bull; P-values calculated by Pearson's correlation.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur findings show a significant difference in PhA values between men and women, with men exhibiting higher mean PhA (6.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u0026deg;) compared to women (5.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u0026deg;). These results align with previous studies indicating that PhA is influenced by body composition, particularly the proportion of fat-free mass and muscle mass. Men typically have a higher FFM and lower fat mass than women, higher values in men may indicate greater cellular health and metabolic activity, as muscle tissue is more metabolically active than adipose tissue (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The strongest correlations were observed between PhA and measures of lean body mass, including FFM, muscle mass, and bone mass. These findings are in agreement with studies that have emphasized the role of lean mass in determining PhA. FFM and muscle mass are the primary contributors to reactance, which is directly proportional to PhA (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Conversely, the negative correlation between PhA and fat mass observed in other studies was less pronounced in our findings, potentially due to the relatively homogenous fat mass distribution across the study sample (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eInterestingly, physical activity levels, assessed via the short form of the International Physical Activity Questionnaire, did not significantly differ between men and women and showed limited association with PhA. Mundstock et al in a systematic review and meta-analysis found that physical activity has a positive effect on phase angle (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). There was also a study revealing that a higher physical activity was positively associated with higher PhA among Korean adults (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). A similar finding was reported by Streb et al, that physical activity did not correlate with the PhA (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). While physical activity is known to influence body composition, the lack of significant correlation may stem from the subjective nature of self-reported activity levels or the relatively small variance in physical activity within the study population. These findings emphasize the complexity of the relationship between physical activity and PhA and suggest that other factors, such as genetic influences, nutritional status, or specific training adaptations, might play a more substantial role (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). The findings highlight the need for future research utilizing objective activity measurements and more heterogeneous samples to better understand the relationship between physical activity and PhA.\u003c/p\u003e \u003cp\u003eThe positive correlation between PhA and dietary intake of energy, carbohydrates, and protein in this study underscores the influence of nutrition on cellular and body composition health. Previous studies have shown that protein intake is associated with higher PhA values due to improved muscle synthesis and cellular repair mechanisms (\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). However, the association between phase angle and dietary intake has been poorly explored. Unterberger et al reported no relationship between PhA and protein intake in older individuals (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Interestingly, in our study fat intake did not show a significant relationship with PhA, suggesting that macronutrients like protein and carbohydrates, which directly support lean mass, have a more pronounced impact on PhA than dietary fats.\u003c/p\u003e \u003cp\u003ePrevious researches underscore the significant influence of race on phase angle and suggests that each population requires its reference values for PhA, despite similar patterns of variation by sex and age observed globally (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). This evidence supports the notion that each population should adopt tailored risk cutoff points derived from its unique reference PA values while ensuring the use of a standardized PA measurement. The focus of our study on the Iranian population is particularly noteworthy, as it addresses a significant gap in the existing literature. Most PhA research has predominantly involved Western and Asian populations, leaving Middle Eastern groups underrepresented. By contributing data from this region, the study not only enriches the global understanding of PhA variability but also provides a foundation for establishing specific reference values for Middle Eastern populations. This step is crucial for advancing precision in nutritional and clinical assessments within this demographic.\u003c/p\u003e \u003cp\u003eThe present study has several strengths. This was the first study to determine PA in a sample of the Iranian population by comprehensively assessing anthropometric, dietary, and body composition variables with sex-specific analyses, increasing the generalizability of the findings. In addition, the use of a validated FFQ and a reliable bioelectrical impedance analysis. Importantly, the results emphasize the potential of phase angle as a valuable biomarker for assessing health status in community-dwelling adults. Nevertheless, this study has some limitations. The cross-sectional design limits the ability to establish causality; emphasizing the need for prospective studies to validate these findings. Additionally, the reliance on self-reported physical activity data introduces the potential for recall and reporting biases, which may have impacted the results. Furthermore, the absence of micronutrient intake analysis is a notable limitation, as micronutrient status could influence PhA values, warranting further investigation in future research.\u003c/p\u003e \u003cp\u003eProspective studies are recommended to address these issues.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrates significant sex-based differences in PhA and its association with body composition and dietary intake in an Iranian adult population. These findings underscore the potential of PhA as a valuable tool for assessing nutritional and cellular health. Its strong association with FFM and dietary intake highlights its potential utility in monitoring interventions aimed at improving body composition and overall health. However, further research is needed to validate these associations in diverse populations and to explore the longitudinal implications of PhA in health and disease. Additionally, exploring the relationships between PhA and other health indicators, such as inflammatory markers and metabolic health, could further elucidate its role in assessing overall well-being.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePhA: Phase angle, FFQ: Food Frequency Questionnaire, IPAQ: International Physical Activity Questionnaire, BMI: Body Mass Index, WC: Waist Circumference, HC: Hip Circumference, FFM: Fat-Free Mass. BIA: Bioelectrical Impedance Analysis.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e The study procedure was performed according to the declaration of Helsinki and the STROBE checklist. All participants provided informed written consent and the study protocol was approved by the Ethics Committee of Isfahan University of Medical Sciences (IR.ARI.MUI.REC.1399.052).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe datasets generated and/or analyzed during the current study are not publicly available as per the rules and regulations of the Isfahan University of Medical Science but are available upon reasonable request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe financial support for all parts of the study comes from the Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran (no.\u0026nbsp;198333).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e: FS, NE, MJT, RA, MA, and FSH contributed to the conception, design, data collection, data interpretation, manuscript drafting\u0026nbsp;and\u0026nbsp;approval of the final version of the manuscript, and agreed\u0026nbsp;on\u0026nbsp;all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e We wish to thank all staff of Isfahan University of Medical Sciences who kindly participated in our study.\u0026nbsp;\u003c/p\u003e\n\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRinaldi S, Gilliland J, O\u0026apos;Connor C, Chesworth B, Madill J. 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Clinical Nutrition. 2019;38(4):1504-10.\u003c/li\u003e\n\u003cli\u003eYang J, Yu J, Kim J, Park E. Association between Physical Activity and Phase Angle Obtained via Bioelectrical Impedance Analysis in South Korean Adults Stratified by Sex. Nutrients. 2024;16(13).\u003c/li\u003e\n\u003cli\u003eStreb AR, Hansen F, Gabiatti MP, Tozetto WR, Del Duca GF. Phase angle associated with different indicators of health-related physical fitness in adults with obesity. Physiology \u0026amp; Behavior. 2020;225:113104.\u003c/li\u003e\n\u003cli\u003eBučan Nenadić D, Radić J, Kolak E, Vučković M, Novak I, Selak M, et al. Phase angle association with dietary habits and metabolic syndrome in diabetic hypertensive patients: A cross-sectional study. Nutrients. 2022;14(23):5058.\u003c/li\u003e\n\u003cli\u003eMajerr M, Kozjek NR, Knap B. Association of dietary protein intake with phase angle in peritoneal dialysis patients in Slovenia. Clinical Nutrition ESPEN. 2023;58:663.\u003c/li\u003e\n\u003cli\u003eRezazadegan M, Shirani M, Samadanian F, Akbari M, Shirani F. Association between dietary inflammatory index and phase angle in university employees: a cross-sectional study. Scientific Reports. 2024;14(1):21664.\u003c/li\u003e\n\u003cli\u003eUnterberger S, Aschauer R, Z\u0026ouml;hrer PA, Draxler A, Aschauer M, Kager B, et al. Association of bioelectrical impedance phase angle with physical performance and nutrient intake of older adults. Nutrients. 2023;15(6):1458.\u003c/li\u003e\n\u003cli\u003eBarbosa-Silva MC, 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(1):49-52.\u003c/li\u003e\n\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-health-population-and-nutrition","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"johp","sideBox":"Learn more about [Journal of Health, Population and Nutrition](http://jhpn.biomedcentral.com/)","snPcode":"41043","submissionUrl":"https://submission.nature.com/new-submission/41043/3","title":"Journal of Health, Population and Nutrition","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Phase angle, Nutritional Status, Anthropometry, Adult, University employees","lastPublishedDoi":"10.21203/rs.3.rs-6758040/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6758040/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePhase angle (PhA), derived from bioelectrical impedance analysis, serves as an indicator of cellular health, membrane integrity, and hydration status. Despite its potential utility, the relationship between PhA and nutritional and lifestyle factors has not been extensively studied in Iranian populations. This study aimed to investigate these associations in Iranian adults.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis case-control study included 239 university employees (85 men and 154 women) with a mean age of 43.32 years. Anthropometric indices and blood pressure were measured. PhA was measured by the Body Composition Analyzer Mc780 MA device. Dietary intakes were assessed by using a validated 86-item food frequency questionnaire (FFQ). Physical activity was evaluated by the short form of the International Physical Activity Questionnaire (IPAQ).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eSignificant positive correlations were observed between PhA and several anthropometric and body composition indices, including weight, body mass index (BMI), waist circumference (WC), hip circumference (HC), fat-free mass (FFM), muscle mass, bone mass, and visceral fat. PhA showed significant associations with dietary intake variables.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis study highlights significant associations between PhA and body composition and dietary factors in Iranian adults, with notable sex-based differences. These findings suggest that PhA may be a valuable marker for assessing nutritional and cellular health.\u003c/p\u003e","manuscriptTitle":"Phase Angle as an Indicator of Nutritional Status: A cross-sectional Study on the Iranian Population","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-16 12:07:51","doi":"10.21203/rs.3.rs-6758040/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-02T05:39:47+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-18T21:08:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-17T09:59:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"132708085728751942116868434327216894329","date":"2025-06-17T09:05:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-13T11:50:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"130913981213382847149644132665628994287","date":"2025-06-13T10:53:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"188697913672023374336104394440797260425","date":"2025-06-12T13:57:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-12T13:21:23+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-29T15:08:52+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-29T15:03:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Health, Population and Nutrition","date":"2025-05-27T09:44:54+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-health-population-and-nutrition","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"johp","sideBox":"Learn more about [Journal of Health, Population and Nutrition](http://jhpn.biomedcentral.com/)","snPcode":"41043","submissionUrl":"https://submission.nature.com/new-submission/41043/3","title":"Journal of Health, Population and Nutrition","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b9d8eb0c-6031-4baa-81e4-6a248d3c951c","owner":[],"postedDate":"June 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-09-01T16:08:28+00:00","versionOfRecord":{"articleIdentity":"rs-6758040","link":"https://doi.org/10.1186/s41043-025-01060-5","journal":{"identity":"journal-of-health-population-and-nutrition","isVorOnly":false,"title":"Journal of Health, Population and Nutrition"},"publishedOn":"2025-08-31 15:58:21","publishedOnDateReadable":"August 31st, 2025"},"versionCreatedAt":"2025-06-16 12:07:51","video":"","vorDoi":"10.1186/s41043-025-01060-5","vorDoiUrl":"https://doi.org/10.1186/s41043-025-01060-5","workflowStages":[]},"version":"v1","identity":"rs-6758040","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6758040","identity":"rs-6758040","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}