Impact of Percent Body Fat on All-Cause Mortality among Adequate Dialysis Patients with and without Insulin Resistance: A Multi-Center Prospective Cohort Study

Duong, Tuyen Van; Wong, Te-Chih; Chen, Hsi Hsien; Chen, Tso Hsiao; Hsu, Yung Ho; Peng, Sheng; Kuo, Ko Lin; Liu, Hsiang Chung; Lin, En Tzu; Yang, Shwu Huey

doi:10.3390/nu11061304

Cited by 3 publications

(6 citation statements)

References 54 publications

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“…Marcelli et al investigated an international European cohort of 37,345 hemodialysis patients (age 62.7 ± 15.2 years) and found that low fat tissue index (<10th percentile), determined with BIA, was associated with significantly increased mortality compared to the reference fat tissue index between the 10th and 90th percentile (HR 1.19; 95% CI 1.08-1.31; p < 0.001) [78]. Moreover, Caetano et al [79] and Duong et al [80] reported that low fat mass determined using BIA was significantly associated with higher risk of mortality in hemodialysis patients. Based on these results, it is suggested that greater fat mass is associated with better survival in hemodialysis patients in contrast to the general population.…”

Section: Fat Mass and Mortalitymentioning

confidence: 97%

Significance of Adipose Tissue Maintenance in Patients Undergoing Hemodialysis

Okuno

2021

Nutrients

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In the general population, obesity is known to be associated with adverse outcomes, including mortality. In contrast, high body mass index (BMI) may provide a survival advantage for hemodialysis patients, which is known as the obesity paradox. Although BMI is the most commonly used measure for the assessment of obesity, it does not distinguish between fat and lean mass. Fat mass is considered to serve as an energy reserve against a catabolic condition, while the capacity to survive starvation is also thought to be dependent on its amount. Thus, fat mass is used as a nutritional marker. For example, improvement of nutritional status by nutritional intervention or initiation of hemodialysis is associated with an increase in fat mass. Several studies have shown that higher levels of fat mass were associated with better survival in hemodialysis patients. Based on body distribution, fat mass is classified into subcutaneous and visceral fat. Visceral fat is metabolically more active and associated with metabolic abnormalities and inflammation, and it is thus considered to be a risk factor for cardiovascular disease and mortality. On the other hand, subcutaneous fat has not been consistently linked to adverse phenomena and may reflect nutritional status as a type of energy storage. Visceral and subcutaneous adipose tissues have different metabolic and inflammatory characteristics and may have opposing influences on various outcomes, including mortality. Results showing an association between increased subcutaneous fat and better survival, along with other conditions, such as cancer or cirrhosis, in hemodialysis patients have been reported. This evidence suggests that fat mass distribution (i.e., visceral fat and subcutaneous fat) plays a more important role for these beneficial effects in hemodialysis patients.

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Section: Fat Mass and Mortalitymentioning

confidence: 97%

Significance of Adipose Tissue Maintenance in Patients Undergoing Hemodialysis

Okuno

2021

Nutrients

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“…In our sample, men, NDD, and KTx patients had higher prevalence of obesity and lower prevalence of low muscle mass and sarcopenia. In addition, adiposity was a protective factor for low muscle mass diagnosis, as in the obesity paradox in CKD, which is not well understood [ 6 , 9 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, sarcopenia was associated with increased mortality regardless of estimated glomerular filtration rate, but excess adiposity modified this association only among persons with CKD [ 6 ]. Also, insulin derangements were shown to modify the relationship between adiposity and mortality, as body fat showed a protective effect on survival only in HD patients with insulin resistance [ 12 ]. The studies evidence that interfering factors could play a role in the obesity paradox, but it is yet unclear whether increased muscle mass or increased body fat confers the survival advantage.…”

Section: Discussionmentioning

confidence: 99%

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Bed-side measures for diagnosis of low muscle mass, sarcopenia, obesity, and sarcopenic obesity in patients with chronic kidney disease under non-dialysis-dependent, dialysis dependent and kidney transplant therapy

et al. 2020

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Muscle depletion and sarcopenic obesity are related to a higher morbimortality risk in chronic kidney disease (CKD). We evaluated bed-side measures/indexes associated with low muscle mass, sarcopenia, obesity, and sarcopenic obesity in CKD and proposed cutoffs for each parameter. Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People revised consensus applying dual energy X-ray absorptiometry (DXA) and hand grip strength (HGS), and obesity according to the International Society for Clinical Densitometry. Anthropometric parameters including calf (CC) and waist (WC) circumferences and WC/height (WC/H); bioelectrical impedance data including appendicular fat free mass (AFFM) and fat mass index (FMI) were assessed. ROC analysis and area under the curve (AUC) were applied for performance analyses. AFFM and CC presented the best performances for low muscle mass diagnosis–AFFM AUC for women was 0.96 and for men, 0.94, and CC AUC for women was 0.89 and for men, 0.85. FMI and WC/H were the best parameters for obesity diagnosis–FMI AUC for women was 0.99 and for men, 0.96, and WC/H AUC for women was 0.94 and for men, 0.95. The cutoffs (sensibility and specificity, respectively) for women were AFFM≤15.87 (90%; 96%), CC≤35.5 (76%; 94%), FMI>12.58 (100%; 93%), and WC/H>0.66 (91%; 84%); and for men, AFFM≤21.43 (98%; 84%), CC≤37 (88%; 69%), FMI>8.82 (93%; 88%), and WC/H>0.60 (95%; 80%). Sensibility and specificity for sarcopenia diagnosis were for AFFM+HGS in women 85% and 99% and in men, 100% and 99%; for CC+HGS in women 85% and 99% and in men, 100% and 100%; and for sarcopenic obesity were for FMI+AFFM in women 75% and 97% and in men, 75% and 95%. The tested bed-side measures/indexes presented excellent performance.

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“…In addition to muscle depletion, obesity is also common among CKD patients [10,11]. Obesity has a controversial role in survival rates and clinical prognosis in CKD patients [6,9,12]. Currently, body mass index (BMI) is the most widely used obesity measure, but the index is an imperfect measure of adiposity [10].…”

Section: Introductionmentioning

confidence: 99%

Aplicação de métodos de imagem, bioelétricos, antropométricos e funcionais para avaliação de composição corporal e estado nutricional na doença renal crônica

Bellafronte¹

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women 75% and 97% and in men, 75% and 95%. The prevalence of sarcopenia in total sample was 7% (FNIH) and 5% (EWGSOP2). Low muscle mass was present in 39% (FNIH) and 36% (EWGSOP2). Dynapenia affected 10% of the participants (FNIH and EWGSOP2). Sarcopenic patients presented lower body adiposity by EWGSOP2 criteria and higher adiposity by FNIH. The impact of fatigue on daily activities was significantly different in HD patients and in individuals classified as presenting low HGS and sarcopenia. Prevalence of muscle depletion evaluated by FFMI, AFFMI and HGS varied from 11 to 50%, higher for low muscle mass. Prevalence of obesity evaluated by BMI, FMI, %FM and WC varied from 26 to 62%, higher for WC and %FM. Prevalence of sarcopenic obesity varied from 2 to 23%. Women were more affected by sarcopenic obesity. Muscle depletion and sarcopenic obesity where more prevalent among HD and obesity among NDD and KTx patients. The agreement was poor among muscle mass and strength criteria; substantial between FMI, BMI, and %FM and fair among WC and the others; for sarcopenic obesity, varied from almost perfect to poor. Conclusions: For body composition evaluation in patients with CKD, BIS applied using the whole body protocol in normal hydration patients with CKD is as reliable as DXA. However, BIS must be used with caution in overhydration patients with ECW/ICW ≥ 0.7250. The newly developed equations are indicated for greater precision. AFFM by BIS alone and in addition to HGS, FMI by BIS alone and in addition to AFFM, with the proposed cut-offs, are recommended as altenative tools for diagnosis of low muscle mass, sarcopenia, obesity and sarcopenic obesity, respectively. These alternative measurements need external validation before routine use in clinical practice. Our results suggest that in adult CKD patients, sarcopenia and low muscle mass prevalence varies according to the diagnostic criteria and are common conditions. Body adiposity association with sarcopenia depends on the criteria used to define this syndrome with FNIH criteria detecting higher adiposity in individuals with sarcopenia.Fatigue pictogram could be applied for screening patients at risk of decreased functional capacity. In addition, significant differences were found among low muscle mass vs low muscle strength and high total body fat vs high visceral fat diagnostic criteria that are added in sarcopenic obesity diagnosis.

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Impact of Percent Body Fat on All-Cause Mortality among Adequate Dialysis Patients with and without Insulin Resistance: A Multi-Center Prospective Cohort Study

Cited by 3 publications

References 54 publications

Significance of Adipose Tissue Maintenance in Patients Undergoing Hemodialysis

Significance of Adipose Tissue Maintenance in Patients Undergoing Hemodialysis

Bed-side measures for diagnosis of low muscle mass, sarcopenia, obesity, and sarcopenic obesity in patients with chronic kidney disease under non-dialysis-dependent, dialysis dependent and kidney transplant therapy

Aplicação de métodos de imagem, bioelétricos, antropométricos e funcionais para avaliação de composição corporal e estado nutricional na doença renal crônica

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