Currently submitted to: JMIR Formative Research
Date Submitted: May 29, 2026
Open Peer Review Period: Jun 5, 2026 - Jul 31, 2026
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Body composition and phase-angle trajectories in women receiving neoadjuvant chemotherapy or surgery-first treatment for breast cancer (BC-NUTRITION): Protocol and pilot data of a prospective two-cohort study
ABSTRACT
Background:
Breast cancer survivorship requires attention to treatment related changes in body composition, nutrition, and quality of life. Phase angle from bioelectrical impedance analysis reflects cellular health and may identify early nutritional or functional decline.
Objective:
This study examined perioperative body composition and phase angle trajectories in women receiving neoadjuvant chemotherapy versus surgery first treatment and evaluated pilot feasibility.
Methods:
BC-NUTRITION was a prospective two cohort observational pilot study. Women aged 18 to 80 years with primary invasive breast cancer followed either neoadjuvant chemotherapy then surgery or surgery first treatment. Assessments were planned at five points from admission to six months after discharge. Measures included segmental bioelectrical impedance, anthropometry, nutrition screening, patient reported outcomes, biochemistry, surgical variables, and treatment toxicity.
Results:
The pilot dataset included 95 women, 30 in neoadjuvant chemotherapy and 65 in surgery first treatment. Retention to postoperative day 7 was 100 percent, 95 of 95, and all evaluable feasibility metrics met prespecified thresholds. At admission, whole body composition was largely comparable. The neoadjuvant chemotherapy cohort had lower albumin, 40.52 versus 42.58 g per L, p = 0.020, lower lymphocyte count, 1.17 versus 1.79 ×10⁹ per L, p < 0.001, lower Prognostic Nutritional Index, 46.36 versus 51.55, p < 0.001, higher extracellular to total body water ratio, 0.39 versus 0.38, p < 0.001, and lower whole body 50 kHz phase angle, 4.64 degrees versus 5.23 degrees, p < 0.001. During the surgical week, operated side 50 kHz phase angle decreased in both cohorts. The mean decrease was 0.50 degrees after neoadjuvant chemotherapy, 95 percent CI 0.34 to 0.66, p < 0.001, and 0.51 degrees after surgery first treatment, 95 percent CI 0.42 to 0.60, p < 0.001. Whole body phase angle decreased in the surgery first cohort, mean decrease 0.25 degrees, 95 percent CI 0.16 to 0.33, p < 0.001. In the neoadjuvant chemotherapy cohort, the mean change was smaller and not significant, with a 0.11 degree decrease and a 95 percent CI ranging from a 0.25 degree decrease to a 0.03 degree increase, p = 0.112.
Conclusions:
The BC NUTRITION pilot showed strong feasibility and identified phase angle as a promising tissue level signal of perioperative cellular health in breast cancer. These results support the definitive 214 participant study and future phase angle guided nutrition and prehabilitation interventions. Clinical Trial: MR-44-24-028962
Citation
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