Association of Phase Angle Determined by Bioelectrical Impedance Analysis with Cardiovascular Risk Factors: A Systematic Review and Meta-analysis of Observational Studies

Abstract Context The phase angle (PhA) of bioimpedance is a noninvasive parameter that has been reported to reflect the health and integrity of cells. Data on how PhA is related to cardiovascular risk factors are controversial. Objective This systematic review and meta-analysis aims to explore the association between PhA and cardiovascular risk factors in participants over 18 years old. Data Sources A systematic search was conducted in PubMed, Scopus, and Web of Science (2000–2024) to identify studies reporting the relationship between PhA and cardiovascular risk factors, including lipid profile, glycemic control, blood pressure, central obesity, and serum uric acid. Data Extraction Meta-analysis was performed using a random-effects model due to high heterogeneity (I2 statistic). Subgroup analyses by gender and health status, as well as meta-regressions, were conducted to explore heterogeneity. Publication bias was assessed using funnel plots and Egger’s test. Of 812 identified studies, 27 met the inclusion criteria. Data Analysis There were varied associations between PhA and key health markers. For lipid profiles, a significant negative correlation was observed with total cholesterol (r = -0.10, P = .02) in individuals with chronic conditions. With regard to glycemic control, PhA showed a significant negative correlation with fasting blood glucose (r = -0.18, P < .001) and homeostatic model assessment for insulin resistance (HOMA-IR) (r = -0.17, P = .02) in men. Diastolic blood pressure was positively correlated with PhA in the males and healthy subgroups (P < .05), while a significant negative correlation with systolic blood pressure was identified in unhealthy individuals (r = -0.10, P < .001). No significant correlations were found between PhA and other cardiovascular risk factors (P > .05). Conclusion This meta-analysis identified the potential of PhA as a noninvasive tool for cardiovascular risk assessment; however, the inconsistent findings necessitate further research considering other potential confounders as well as recruiting larger samples in other populations. Systematic Review Registration PROSPERO registration no. CRD42024597723.