Erdoğan E, Tutal E, Uyar M E, Bal Z, Demirci B G, Sayın B, Sezer S
Department of Internal Medicine, Baskent University Faculty of Medicine, Ankara, Turkey.
Transplant Proc. 2013;45(10):3485-8. doi: 10.1016/j.transproceed.2013.08.096.
Protein-energy wasting (PEW) is a strong predictive factor for morbidity and mortality in patients who have end-stage renal disease (ESRD). Mini Nutritional Assessment (MNA) is an important and confirmed tool to evaluate PEW that has been recommended by many guidelines. Bioelectrical impedance analysis (BIA) is a noninvasive technique for assessing body composition. The aim of the present study was to analyze the reliability of BIA in malnutrition diagnosis by comparing it with standard MNA in a group of 100 ESRD patients.
One hundred ESRD patients who were medically stable and under dialysis treatment for at least 6 months were enrolled to the study. Monthly assessed serum creatinine, albumin, C-reactive protein (CRP), and lipid profiles from the last 6 months prior to the study were retrospectively collected. A standard Full-MNA and body composition analyses were applied to all patients. Body compositions were analyzed with the BIA technique using the Body Composition Analyzer (Tanita BC-420 MA; Tanita, Tokyo, Japan). Patients were classified into three groups according to MNA scores as PEW (n = 15, score <17), moderate PEW or risk group (n = 49, score 17-23.5), and well-nourished (n = 36, score ≥ 24) patients.
Mean duration of maintenance hemodialysis treatment was significantly shorter in the PEW group compared to both of the other groups described (P = .015). Well-nourished and risk groups had lower CRP and higher albumin levels compared to PEW patients; however, these values were statistically similar in these two groups (P = .018, .01, respectively). According to BIA findings, well-nourished patients had the highest fat ratio, fat mass, muscle mass, visceral fat mass, and fat-free mass compared to both moderate the PEW/risk and the PEW groups (P < .05). Risk group patients also had higher muscle mass, visceral fat mass, and fat-free mass values compared to the PEW group (P < .05). A correlation analysis revealed that MNA scores were positively correlated with albumin (P = .005), creatinine (P = .049), fat mass (P = .045), muscle mass (P = .001), visceral fat ratio (P = .007), and BMI (P = .047) and in negative correlation with CRP (r = -0.357, P = .0001) levels.
We recommend BIA as a complementary diagnostic tool to evaluate nutritional status of ESRD along with MNA, anthropometric measures, and classical biochemical markers.
蛋白质 - 能量消耗（PEW）是终末期肾病（ESRD）患者发病和死亡的一个强有力的预测因素。微型营养评定法（MNA）是评估PEW的一种重要且经证实的工具，已被许多指南推荐。生物电阻抗分析（BIA）是一种评估身体成分的非侵入性技术。本研究的目的是通过将BIA与标准MNA在一组100例ESRD患者中进行比较，分析BIA在营养不良诊断中的可靠性。
100例病情稳定且接受透析治疗至少6个月的ESRD患者被纳入本研究。回顾性收集研究前最后6个月每月评估的血清肌酐、白蛋白、C反应蛋白（CRP）和血脂谱。对所有患者应用标准的全MNA和身体成分分析。使用人体成分分析仪（Tanita BC - 420 MA；日本东京百利达公司）通过BIA技术分析身体成分。根据MNA评分将患者分为三组：PEW组（n = 15，评分<17）、中度PEW或风险组（n = 49，评分17 - 23.5）和营养良好组（n = 36，评分≥24）。
与其他两组相比，PEW组维持性血液透析治疗的平均持续时间显著缩短（P = 0.015）。与PEW患者相比，营养良好组和风险组的CRP水平较低，白蛋白水平较高；然而，这两组的值在统计学上相似（分别为P = 0.018、P = 0.01）。根据BIA结果，与中度PEW/风险组和PEW组相比，营养良好组的脂肪比例、脂肪量、肌肉量、内脏脂肪量和去脂体重最高（P < 0.05）。与PEW组相比，风险组患者的肌肉量、内脏脂肪量和去脂体重值也较高（P < 0.05）。相关性分析显示，MNA评分与白蛋白（P = 0.005）、肌酐（P = 0.049）、脂肪量（P = 0.045）、肌肉量（P = 0.001）、内脏脂肪比例（P = 0.007）和BMI（P = 0.047）呈正相关，与CRP水平呈负相关（r = -0.357，P = 0.0001）。
我们推荐将BIA作为一种辅助诊断工具，与MNA、人体测量指标和经典生化标志物一起用于评估ESRD患者的营养状况。
