Phase Angle and Extracellular Water‐to‐Total Body Water Ratio Measured by Bioelectrical Impedance Analysis Are Associated with Anemia and Hemoglobin Levels in Women with Type 2 Diabetes: A Cross‐Sectional Study

ABSTRACT Background and Aims Anemia is common in women with diabetes, increasing disability and mortality risks. Bioelectrical impedance analysis (BIA) measures phase angle (PhA), reflecting cellular integrity and muscle quality, and the extracellular water to total body water ratio (ECW/TBW), indicating fluid balance and inflammation. Both are associated with malnutrition and chronic inflammation, key factors in anemia. This study explored their association with anemia in diabetic women. Methods The current study is a cross‐sectional study that was done in Phase II of the Mashhad stroke and heart atherosclerotic disorder (MASHAD) study (2018–2020). We evaluated 1381 women with diabetes, aged 35–65. PhA and ECW/TBW were assessed using BIA (InBody S10 Biospace). To assess the relationships between PhA, ECW/TBW and anemia, multiple logistic regression was performed. Linear regression was used to evaluate the associations of PhA and ECW/TBW with hemoglobin (Hb) and hematocrit (Hct) levels. Results In the fully adjusted logistic models, a higher PhA and lower ECW/TBW were associated with a lower risk of anemia (OR: 0.55; 95% CI: 0.33, 0.94 and OR: 1.86; 95% CI: 1.08, 3.19, respectively). Furthermore, in linear regression analysis, PhA exhibited a positive correlation with Hb ( β = 0.20; p < 0.001) and Hct levels ( β = 0.34; p = 0.03). ECW/TBW was negatively correlated with Hb ( β = −16.96; p < 0.001) and showed a non‐significant negative correlation with Hct ( β = −19.39; p = 0.09). Conclusions PhA is associated with lower odds of anemia and higher Hb and Hct levels in women with diabetes, while a higher ECW/TBW is linked to an increased risk of anemia and lower Hb levels. These findings underscore the novel clinical relevance of PhA and ECW/TBW in identifying anemia risk in diabetic women, highlighting their potential as associative markers for early detection and intervention.