Kalantar-Zadeh Kamyar, Kuwae Noriko, Wu Dennis Y, Shantouf Ronney S, Fouque Denis, Anker Stefan D, Block Gladys, Kopple Joel D
Division of Nephrology and Hypertension, Los Angeles Biomedical Institute at Harbor-UCLA Medical Center, Torrance, CA 90509-2910, USA.
Am J Clin Nutr. 2006 Feb;83(2):202-10. doi: 10.1093/ajcn/83.2.202.
In maintenance hemodialysis (MHD) patients, a larger body size is associated with better survival but a worse self-reported quality of life (QoL). It is not clear whether muscle mass or body fat confers the survival advantage.
We hypothesized that both a low baseline body fat percentage and a loss of fat over time were independently associated with higher mortality but with a better QoL score.
In 535 adult MHD patients, body fat was measured directly with the use of near infrared interactance and QoL was measured with a Short Form 36 questionnaire. The patients were followed for < or =30 mo.
Across four 12% increments of body fat at baseline, the reported QoL scores were progressively lower (P < 0.01). After a multivariate adjustment for demographics and surrogates of muscle mass and inflammation (ie, midarm muscle circumference, serum creatinine, and proinflammatory cytokines), 46 patients with body fat of <12% had a death hazard ratio (HR) 4 times that of 199 patients with body fat content between 24% and 36% (HR: 4.01; 95% CI: 1.61, 9.99; P = 0.003). In 411 MHD patients whose body fat was remeasured after 6 mo, a fat loss (< or =-1%) was associated with a death risk 2 times that of patients who gained fat (> or =1%) after a multivariate adjustment (HR: 2.06; 95% CI: 1.05, 4.05; P = 0.04).
A low baseline body fat percentage and fat loss over time are independently associated with higher mortality in MHD patients even after adjustment for demographics and surrogates of muscle mass and inflammation, whereas a tendency toward a worse QoL is reported by MHD patients with a higher body fat percentage. Obesity management in dialysis patients may need reconsideration.
在维持性血液透析（MHD）患者中，体型较大与更好的生存率相关，但自我报告的生活质量（QoL）较差。目前尚不清楚肌肉量或体脂是否赋予了生存优势。
我们假设低基线体脂百分比和随时间的脂肪减少均与较高的死亡率独立相关，但与较好的QoL评分相关。
在535例成年MHD患者中，使用近红外交互作用直接测量体脂，并使用简短健康调查问卷36（Short Form 36 questionnaire）测量QoL。对患者进行了≤30个月的随访。
在基线时体脂每增加12%的四个阶段中，报告的QoL评分逐渐降低（P<0.01）。在对人口统计学以及肌肉量和炎症的替代指标（即上臂中部肌肉周长、血清肌酐和促炎细胞因子）进行多变量调整后，46例体脂<12%的患者的死亡风险比（HR）是199例体脂含量在24%至36%之间的患者的4倍（HR：4.01；95%CI：1.61，9.99；P=0.003）。在411例MHD患者中，6个月后重新测量了体脂，在多变量调整后，脂肪减少（≤-1%）的患者的死亡风险是脂肪增加（≥1%）的患者的2倍（HR：2.06；95%CI：1.05，4.05；P=0.04）。
即使在对人口统计学以及肌肉量和炎症的替代指标进行调整后，低基线体脂百分比和随时间的脂肪减少仍与MHD患者较高的死亡率独立相关，而体脂百分比较高的MHD患者报告有生活质量变差的趋势。透析患者的肥胖管理可能需要重新考虑。
