Kamimura Maria Ayako, Avesani Carla Maria, Cendoroglo Miguel, Canziani Maria Eugênia Fernandes, Draibe Sérgio Antônio, Cuppari Lilian
Nutrition Program, Federal University of São Paulo, São Paulo, Brazil.
Nephrol Dial Transplant. 2003 Jan;18(1):101-5. doi: 10.1093/ndt/18.1.101.
Body composition assessment in patients with chronic renal failure is of paramount importance since studies have demonstrated the association of protein-energy malnutrition with an increased morbidity and mortality in this population. However, practical and sensible indicators of body compartments are still needed for clinical purposes. Thus, we aimed to evaluate the simple methods of skinfold thicknesses (SKF) and bioelectrical impedance analysis (BIA), using dual-energy X-ray absorptiometry (DEXA) as a reference method, for the assessment of body fat in patients on long-term haemodialysis therapy.
We studied 30 clinically stable patients (15 men/15 women) undergoing haemodialysis at the Dialysis Unit of the Federal University of São Paulo. Body fat assessment was performed by the SKF, BIA and DEXA methods after a haemodialysis session. Analysis of variance, intra-class correlation coefficient and Bland and Altman plot analysis were used for comparative analysis among the methods.
Body fat estimates by SKF (17.7 +/- 7.8 kg) and BIA (18.6 +/- 9.2 kg) were not significantly different from those obtained by DEXA (18.2 +/- 7.9 kg) considering the whole population. However, the BIA technique worked differently from DEXA when analysed by gender, measuring less fat content in men and higher fat content in women (P < 0.01). No differences were observed for SKF. Strong intra-class correlation coefficients (r) were found between DEXA with SKF (r = 0.94) and BIA (r = 0.91). DEXA showed a relatively good agreement with both SKF [0.47 +/- 2.8 (-5.0 to 6.0) kg] and BIA [-0.39 +/- 3.3 (-6.9 to 6.1) kg] in all patients according to the Bland and Altman plot analysis. However, considering gender, BIA showed greater mean prediction error of 1.93 +/- 2.5 (-3.0 to 6.8) kg for men and -2.71 +/- 2.3 (-7.2 to 1.8) kg for women.
The simple and long established method of SKF was preferable over BIA, which showed gender-specific variability in the assessment of body fat in patients undergoing haemodialysis. However, more comparative and longitudinal studies are needed to evaluate the applicability of these practical methods for monitoring body composition in the routine care of patients with chronic renal failure.
慢性肾衰竭患者的身体成分评估至关重要，因为研究表明蛋白质 - 能量营养不良与该人群发病率和死亡率的增加相关。然而，出于临床目的，仍需要实用且合理的身体组成部分指标。因此，我们旨在以双能X线吸收法（DEXA）作为参考方法，评估皮褶厚度（SKF）和生物电阻抗分析（BIA）这两种简单方法用于长期血液透析治疗患者身体脂肪评估的情况。
我们研究了圣保罗联邦大学透析科的30例临床稳定的血液透析患者（15名男性/15名女性）。在一次血液透析治疗后，采用SKF、BIA和DEXA方法进行身体脂肪评估。采用方差分析、组内相关系数以及Bland和Altman图分析对这些方法进行比较分析。
就总体人群而言，SKF（17.7±7.8 kg）和BIA（18.6±9.2 kg）评估的身体脂肪与DEXA（18.2±7.9 kg）评估的结果无显著差异。然而，按性别分析时，BIA技术与DEXA的结果不同，男性测量的脂肪含量较低，女性测量的脂肪含量较高（P<0.01）。SKF未观察到差异。DEXA与SKF（r = 0.94）和BIA（r = 0.91）之间发现了很强的组内相关系数（r）。根据Bland和Altman图分析，在所有患者中，DEXA与SKF [0.47±2.8（-5.0至6.0）kg]和BIA [-0.39±3.3（-6.9至6.1）kg]均显示出相对较好的一致性。然而，考虑性别因素，BIA对男性的平均预测误差更大，为1.93±2.5（-3.0至6.8）kg，对女性为 -2.71±2.3（-7.2至1.8）kg。
简单且已确立的SKF方法优于BIA，BIA在血液透析患者身体脂肪评估中显示出性别特异性差异。然而，需要更多的比较性和纵向研究来评估这些实用方法在慢性肾衰竭患者常规护理中监测身体成分的适用性。
