接受血液透析患者老年营养风险指数、骨密度、身体成分和握力之间的关系。

Associations among Geriatric Nutrition Risk Index, bone mineral density, body composition and handgrip strength in patients receiving hemodialysis.

机构信息

Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

Department of Radiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Radiology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.

出版信息

Nutrition. 2019 Sep;65:6-12. doi: 10.1016/j.nut.2019.02.013. Epub 2019 Feb 26.

DOI:10.1016/j.nut.2019.02.013

PMID:31029923

Abstract

OBJECTIVES

Malnutrition occurs as a complication of hemodialysis (HD) and has been identified as a risk factor for osteoporosis, sarcopenia, and low physical performance. The aim of this study was to assess the associations among nutrition, bone mineral density (BMD), body composition, and handgrip strength (HGS) in patients receiving HD.

METHODS

We enrolled 164 patients receiving HD who have undergone the dual energy x-ray absorptiometry (DXA) examination, categorized according to baseline Geriatric Nutritional Risk Index (GNRI) values calculated by serum albumin levels and body weight index. GNRI was used to evaluate nutritional status, and DXA to investigate BMD and body composition. Additionally, HGS test was performed. Multiple stepwise linear regression analysis was used to identify the factors associated with BMD, T-score, and HGS.

RESULTS

Compared with patients with tertile 1 of GNRI, those with tertile 3 of GNRI tend to have higher lumbar spine BMD and T-score, higher femoral neck BMD, higher total hip BMD, higher left distal mid-third radius BMD and T-score, higher fat mass index, higher android-to-gynoid ratio, higher lean mass index, and higher HGS. An increase in GNRI tertile was associated with an increase of BMD and a decrease of osteoporosis prevalence. The GNRI was positively correlated with BMD and T-score, body composition, and HGS. Low lean mass index and high parathyroid hormone were significantly associated with low BMD and T-score. Additionally, high GNRI and high left distal mid-third radius BMD were significantly associated with high HGS.

CONCLUSIONS

The present study demonstrated that good nutrition, indicated as high GNRI, resulted in higher BMD and T-score, lean mass index, and HGS in patients receiving HD. Using GNRI to evaluate nutritional status and using DXA to investigate BMD and body composition in patients receiving HD is important to bone health and physical performance.

摘要

目的

营养不良是血液透析（HD）的并发症之一，已被确定为骨质疏松症、肌肉减少症和低身体机能的危险因素。本研究旨在评估 HD 患者的营养状况、骨矿物质密度（BMD）、身体成分和握力（HGS）之间的相关性。

方法

我们纳入了 164 名接受 HD 治疗且已接受双能 X 射线吸收法（DXA）检查的患者，根据血清白蛋白水平和体重指数计算的基线老年营养风险指数（GNRI）值进行分类。GNRI 用于评估营养状况，DXA 用于调查 BMD 和身体成分。此外，还进行了 HGS 测试。采用多元逐步线性回归分析来确定与 BMD、T 评分和 HGS 相关的因素。

结果

与 GNRI 三分位 1 的患者相比，GNRI 三分位 3 的患者腰椎 BMD 和 T 评分较高，股骨颈 BMD、总髋 BMD、左侧远端中三分之一桡骨 BMD 和 T 评分较高，脂肪质量指数较高，安卓到臀围比例较高，瘦体重指数较高，HGS 较高。GNRI 三分位的增加与 BMD 的增加和骨质疏松症患病率的降低相关。GNRI 与 BMD 和 T 评分、身体成分和 HGS 呈正相关。低瘦体重指数和高甲状旁腺激素与低 BMD 和 T 评分显著相关。此外，高 GNRI 和高左侧远端中三分之一桡骨 BMD 与高 HGS 显著相关。