key: cord-0276146-ck0kk4o4
authors: Rocha, N. O. d.; Bacelo, A. C.; Araujo, A.; Torres, P. R.; Brito, P.; Almeida, C. F.; Fonseca, C. C.; Qintana, M.; Rodrigues, C. C.; Brasil, P. E.
title: ASSOCIATION BETWEEN NUTRITIONAL STATE AND PHASE ANGLE IN SYMPTOMATIC AND ASYMPTOMATIC HTLV-1 INFECTED PATIENTS
date: 2022-03-24
journal: nan
DOI: 10.1101/2022.03.22.22272740
sha: 71ae16f39a9e4a5c6f51e1d51fc87bbdc6411f00
doc_id: 276146
cord_uid: ck0kk4o4

Introduction: The nutritional status of symptomatic and asymptomatic human T-cell lymphotropic virus type 1 (HTLV-1) infected patients is understudied. The phase angle (PA) has been described in the scientific literature as a prognostic indicator of nutritional status, but this has not been sufficiently discussed in the literature. Therefore, neither the impact of the infection nor the disease's progression is sufficiently known regarding the nutritional status, body condition or composition. Objective: To compare the nutritional status of symptomatic and asymptomatic adult individuals infected by HTLV-1, using the PA and anthropometric measures as a prognostic indicator in the HTLV-1 infected population. Methodology: This was an observational, cross-sectional study with symptomatic and asymptomatic HTLV-1 patients followed up at the Neurology outpatient clinic of the Evandro Chagas National Institute of Infectious Diseases (INI-FIOCRUZ), Brazil, from September 2015 to September 2019. Anthropometric measures and indices (body weight, height, body mass index-BMI, mid-upper arm circumference-MUAC, triceps skinfold - TSF, and mid-arm muscle circumference- MUAC), and bioimpedance (phase angle-PA, percentage of lean mass-%LM, and percentage of fat mass-%FM) were checked to assess the nutritional status. Anthropometric variables were classified according to reference values and compared between groups (symptomatic and asymptomatic). Individuals were considered malnourished when at least one of the nutritional assessment results was outside the reference values. PA was correlated with the nutritional status, and groups of symptomatic and asymptomatic were compared to each other. The R-project(R) program version 3.0.2 was used to analyze the data. Differences were considered significant when the p-value was <= 0.05. Results: Ninety-one patients were evaluated, 33 (36.3%) asymptomatic and 58 (63.7%) symptomatic. The majority were female (61.5%) and the median age was 60 (55-58) years. Symptomatic participants, compared to asymptomatic, had a lower proportion of overweight/obesity (51.7% vs 78.8%; p =0.0171), lower BMI (25.47 {+/-} 5.06 kg/m 2 vs 30.08 {+/-} 5.61 kg/m 2 p = <0.001), MUAC (29.56 {+/-} 5.13 cm vs 33.22 {+/-} 4.21 cm; p =0.0011), and %FM (30.75% vs 36.60%; p =0.0064), however, had a higher %LM (68.95% vs 63.40%; p =0.0299). All participants presented PA, however there was no difference between symptomatic (5.74{o} {+/-} 1.18) and asymptomatic (6.21{o} {+/-} 1.16). Conclusion: Overweight and obesity were prevalent, especially among asymptomatic participants. Symptomatic participants had lower BMI, MUAC and %FM. Mid-upper arm circumference was considered a good parameter for monitoring the nutritional status of people with HTLV, mainly in situations where weight measurement is not viable. PA was altered in both groups, therefore, it cannot be used as a disease progression indicator, but it does indicate that HTLV infection alone should be a risk of cellular membrane integrity damage. Studies using PA assessment in HTLV-1 carriers are needed.

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The copyright holder for this this version posted March 24, 2022. ; https://doi.org/10.1101/2022.03.22.22272740 doi: medRxiv preprint AUTHOR'S SUMMARY 91 HTLV is a disease very little explored, and in the scientific field of nutrition it is 92 no different, we found few studies that associate this population and their nutritional 93 status. In academic literature we can find the association of weight, height and BMI, 94 rare studies with bioimpedance assessments. 95 Until this moment, no study has associated nutritional status with the phase 96 angle, which is being used in several infectious diseases as a prognostic indicator of 97 cell membrane integrity. 98 In this study, we note that even though the phase angle values are not 99 significant, they show that, regardless of the symptoms, patients who are infected with patients are symptomatic (3, 5) . 120 Nevertheless, current estimation of HTLV-1's burden is approximately 20 million 121 of infected people worldwide (6) . HTLV can be divided into two types: HTLV-1 and 122 HTLV-2, and HTLV-1 is the most prevalent. HTLV-1 is related to a higher occurrence 123 of adult T-cell leukemia/lymphoma (ATLL) and it is also associated with 124 myelopathy/tropical spastic paraparesis (HAM/TSP). HAM/TSP is a chronic (lifelong) 125 and slow progressive neurological condition (7, 6, 3) . 126 There is a health-disease binomial directly related to conditions that have an 127 impact on nutritional status, which in turn will impact immune status (8, 9) . Additionally, 128 nutritional issues, such as overweight/obesity, underweight, malnutrition and 129 micronutrient deficiency are a significant public health problem in developing countries 130 or in poor populations around the world. These nutrition issues may have important nutritional status in clinical practice. The phase angle (PA), one of BIA's parameters, 135 is related to cell function and integrity and there is evidence pointing to its ability to be 136 a prognostic marker in some health conditions: such as in critically ill patients, in 137 Crohn's disease, oncologic, cirrhotic, HIV patients and various other conditions (12-138 15). 139 Lower PA values represent low reactance (Xc) and high resistance (R), which 140 can be associated with the presence of a health condition or more severe clinical 141 manifestations, cell death, or some change in the selective membrane permeability.

On the other hand, higher values represent high Xc and low R and may be associated 143 with a more significant amount of intact cell membranes, that is, greater body cell mass, 144 and with a good state of health (16). However, the phase angle's reference values and 145 decision thresholds are still debatable and there is no established universal normal 146 range (17).

The present study aimed to compare symptomatic and asymptomatic adults 148 infected with HTLV-1 regarding their PA and nutritional status in order to discuss the 149 potential use of PA as a prognostic marker. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted March 24, 2022. resolution 0.1 ohm and accuracy 0.1 percent; reactance: Range from 0 to 300 ohms, 183 resolution 0.1 oh and accuracy 0.2 percent; phase Angle: range 0 to 20 degrees, 184 resolution 0.1-degree, accuracy 0.2 percent (Xc/R) x180 °/π) by calculating Impedance 185 (Z), the sum of the resistance (R) and Xc arc tangent (Xc/R) x180 °/π).

Before the BIA test, the team instructed participant to: discontinue the use of 187 diuretic drugs for 24 hours, be fasting for 4 to 6 hours, be in alcoholic withdrawal for at 188 least 24 hours, avoiding the consumption of foods rich in caffeine (coffee, dark teas, is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint 

One hundred and ten patients were recruited, 19 were excluded (17%), as they 227 did not meet the inclusion criteria, leaving a total of ninety-one participants with HTLV-228 1 were included, 58 (63.7%) were symptomatic and 33 (36.3%) were asymptomatic. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint and %FM, however, and higher values of %LM (Table 2) . is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint Regarding the anthropometric measures, differences can be observed among 247 the symptomatic and asymptomatic group in some specific strata, such as differences 248 between the AC within the female participants, and differences between the TSF and 249 BMI within the younger females' participants (Table 2) . And even in the AC regardless is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint 

The mean PA is slightly lower in the symptomatic group. Additionally, the same 265 patterns can be observed at most of the strata of sex and age, with a most evident 266 difference between groups of older females. In general, corroborating the BMI 267 interpretation, the asymptomatic group has lower mean %LM values and higher %FM 268 mean values. In the latter case it is more evident in the older male strata and regression 269 (Table 3 and Figure 3 ). is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint When adjusting the effect of HTLV symptoms, for age and sex on PA ( Figure   277 3), it seems the the PA deacreses slighly while age increases, female and symptomatic is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The main findings of this study indicate that: a) BMI, MUAC and %FM were 285 lower in symptomatic than in asymptomatic patients; b) symptomatic group had a lower This relation gains potential attention in this study since it was possible to 301 identify that BMI, MUAC, and the %FM were lower and the lean % LM was higher in 302 symptomatic individuals, who need assistive devices for displacement, than in 303 asymptomatic individuals. Therefore, although there seems to be a mobilization of lean 304 mass, we can suggest that there is also a large mobilization of fat mass. It is noteworthy 305 that the limitation of physical mobility to walk may have contributed to the preservation is the author/funder, who has granted medRxiv a license to display the preprint in is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint Based on the data, it can be concluded that overweight and obesity were 380 predominant. However, the asymptomatic group is more obese than the symptomatic 381 group. The arm's circumference proved to be a good parameter to be used in the is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted March 24, 2022. ; https://doi.org/10.1101/2022.03.22.22272740 doi: medRxiv preprint

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