Harold Simmons Center for Kidney Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502, USA.
Am J Clin Nutr. 2010 Nov;92(5):1060-70. doi: 10.3945/ajcn.2010.29188. Epub 2010 Sep 15.
Larger body size is associated with greater survival in maintenance hemodialysis (MHD) patients. It is not clear how lean body mass (LBM) and fat mass (FM) compare in their associations with survival across sex in these patients.
We examined the hypothesis that higher FM and LBM are associated with greater survival in MHD patents irrespective of sex.
In 742 MHD patients, including 31% African Americans with a mean (± SD) age of 54 ± 15 y, we categorized men (n = 391) and women (n = 351) separately into 4 quartiles of near-infrared interactance-measured LBM and FM. Cox proportional hazards models estimated death hazard ratios (HRs) (and 95% CIs), and cubic spline models were used to examine associations with mortality over 5 y (2001-2006).
After adjustment for case-mix and inflammatory markers, the highest quartiles of FM and LBM were associated with greater survival in women: HRs of 0.38 (95% CI: 0.20, 0.71) and 0.34 (95% CI: 0.17, 0.67), respectively (reference: first quartile). In men, the highest quartiles of FM and percentage FM (FM%) but not of LBM were associated with greater survival: HRs of 0.51 (95% CI: 0.27, 0.96), 0.45 (95% CI: 0.23, 0.88), and 1.17 (95% CI: 0.60, 2.27), respectively. Cubic spline analyses showed greater survival with higher FM% and higher "FM minus LBM percentiles" in both sexes, whereas a higher LBM was protective in women.
In MHD patients, higher FM in both sexes and higher LBM in women appear to be protective. The survival advantage of FM appears to be superior to that of LBM. Clinical trials to examine the outcomes of interventions that modify body composition in MHD patients are indicated.
更大的体型与维持性血液透析（MHD）患者的生存相关。目前尚不清楚在这些患者中，瘦体重（LBM）和体脂肪量（FM）在与生存相关方面的差异。
我们检验了这样一个假设，即无论性别如何，较高的 FM 和 LBM 与 MHD 患者的更高生存率相关。
在 742 名 MHD 患者中，包括 31%的非裔美国人，平均（±SD）年龄为 54 ± 15 岁，我们将男性（n = 391）和女性（n = 351）分别分为近红外相互作用测量的 LBM 和 FM 的 4 个四分位组。Cox 比例风险模型估计死亡风险比（HR）（和 95%CI），立方样条模型用于检查 5 年（2001-2006 年）死亡率的相关性。
在调整病例组合和炎症标志物后，女性中 FM 和 LBM 的最高四分位数与更高的生存率相关：HR 分别为 0.38（95%CI：0.20，0.71）和 0.34（95%CI：0.17，0.67）（参考：第一四分位数）。在男性中，FM 和 FM%（FM%）的最高四分位数与更高的生存率相关，但 LBM 则不然：HR 分别为 0.51（95%CI：0.27，0.96）、0.45（95%CI：0.23，0.88）和 1.17（95%CI：0.60，2.27）。立方样条分析显示，在两性中，FM%和“FM 减去 LBM 百分位数”越高，生存率越高，而女性中 LBM 较高则具有保护作用。
在 MHD 患者中，两性中的 FM 较高，女性中的 LBM 较高，似乎具有保护作用。FM 的生存优势似乎优于 LBM。需要进行临床试验以检查改变 MHD 患者身体成分的干预措施的结果。
