Department of Nephrology, Baskent University, Ankara, Turkey.
J Ren Nutr. 2012 Sep;22(5):490-8. doi: 10.1053/j.jrn.2011.09.001. Epub 2011 Dec 6.
Atherosclerosis (AS) and malnutrition are 2 major causes of morbidity and mortality in hemodialysis (HD) patients. A high body fat percentage (BFP) may be paradoxically associated with improved survival in chronic HD patients. We aimed to establish BFP profile of the HD patients by using bioimpedance analysis, body mass index (BMI), and waist/hip ratio (WHR) to find out their association with inflammation and AS.
In total, 125 HD patients (64 male, 51% mean age of 49.7 ± 12.3 years) were included in the study. Malnutrition-inflammation score (MIS) has been used and supported with biochemical parameters: C-reactive protein, serum iron, total iron binding capacity, ferritin, complete blood count, serum albumin, total cholesterol, low- and high-density lipoproteins, and triglyceride. The patients were divided into 3 groups according to their BFP that were defined by bioimpedance analysis. We also compared these groups according to BMI percentiles. Independent variables affecting BMI and MIS were identified by logistic regression analysis.
AS was correlated with high BFP for our female HD patients, but not for the males. BFP, BMI, and WHR were significantly higher for females. Older age (P = .02), BMI (P < .01), WHR (P < .01), total leukocyte count (P = .02), serum iron (P < .01), and total iron-binding capacity (P = .02) were found significantly correlated with higher BFP for female HD patients, whereas only BMI (P < .01) and serum creatinine levels (P = .04) were significant for male patients. In logistic regression analysis, independent factors affecting cardiovascular disease (CVD) were gender, BFP, MIS, and lymphocyte/leukocyte ratio. Independent factors affecting MIS were gender, BFP, CVD, serum albumin level, and serum C-reactive protein.
BFP and male gender may be contributing factors for CVD; however, female HD patients with high BFP had higher risk of CVD than male counterparts. Further studies are needed to evaluate the pathophysiology of this discrepancy between genders.
动脉粥样硬化（AS）和营养不良是血液透析（HD）患者发病率和死亡率的两个主要原因。高体脂肪百分比（BFP）可能与慢性 HD 患者的生存改善呈矛盾相关。我们旨在通过生物阻抗分析、体重指数（BMI）和腰臀比（WHR）来建立 HD 患者的 BFP 特征，以发现其与炎症和 AS 的关系。
本研究共纳入 125 名 HD 患者（64 名男性，51%的平均年龄为 49.7±12.3 岁）。使用营养不良-炎症评分（MIS）并结合生化参数：C 反应蛋白、血清铁、总铁结合能力、铁蛋白、全血细胞计数、血清白蛋白、总胆固醇、低和高密度脂蛋白、和甘油三酯。根据生物阻抗分析定义的 BFP 将患者分为 3 组。我们还根据 BMI 百分位数对这些组进行了比较。通过逻辑回归分析确定影响 BMI 和 MIS 的独立变量。
AS 与我们女性 HD 患者的高 BFP 相关，但与男性无关。女性的 BFP、BMI 和 WHR 显著更高。年龄较大（P=0.02）、BMI（P<0.01）、WHR（P<0.01）、总白细胞计数（P=0.02）、血清铁（P<0.01）和总铁结合能力（P=0.02）与女性 HD 患者的高 BFP 显著相关，而只有 BMI（P<0.01）和血清肌酐水平（P=0.04）对男性患者有显著影响。在逻辑回归分析中，影响心血管疾病（CVD）的独立因素是性别、BFP、MIS 和淋巴细胞/白细胞比。影响 MIS 的独立因素是性别、BFP、CVD、血清白蛋白水平和血清 C 反应蛋白。
BFP 和男性性别可能是 CVD 的促成因素；然而，高 BFP 的女性 HD 患者患 CVD 的风险高于男性。需要进一步研究来评估这种性别差异的病理生理学。
