Assessing nutritional and hydration status in patients with a diabetic foot ulcer: Agreement between hand-to-hand and hand-to-foot bioimpedance methods

Abstract

Objectives

Malnutrition is prevalent among people with a diabetic foot ulcer (DFU) and is associated with impaired wound healing and increased amputation risk. Assessing fat-free mass (FFM) is crucial for diagnosing malnutrition. However, hand-to-foot (HF) bioelectrical impedance analysis (BIA) measurements are often not feasible due to amputations or ulcerated feet. This study evaluates the agreement between hand-to-hand (HH) and HF BIA measurements in assessing body composition, hydration, and nutritional status in patients with DFU.

Methods

In this cross-sectional study, 164 patients with DFU underwent HF and HH BIA measurements to assess body composition. Malnutrition was diagnosed using the GLIM criteria. Agreement between methods was analyzed using one-sample t-tests, Bland–Altman plots, intra-class correlation, and Cohen’s d. Over- or underestimation was defined as deviation >10% from HF values.

Results

Statistically significant but small differences were observed between HF and HH measurements for resistance (P < 0.001), reactance (P = 0.036), and phase angle (P < 0.001). Strong agreement was found for body composition and hydration metrics. Malnutrition was diagnosed in 32.3% of patients, with HH showing 88.7% accuracy in identifying malnourished individuals, similar to HF (89%).

Conclusions

HH BIA is a reliable alternative for assessing body composition and nutritional status in patients with DFUs. Although statistically significant differences were found in resistance, reactance, and phase angle, the derived body composition and hydration indices showed strong consistency between methods (ICC > 0.75). The small systematic biases observed were clinically negligible, supporting the use of HH BIA when HF measurements are unfeasible.