慢性肾脏病患儿的体脂——生物电阻抗分析与双能X线吸收法的比较研究
Body Fat in Children with Chronic Kidney Disease - A Comparative Study of Bio-impedance Analysis with Dual Energy X-ray Absorptiometry.
作者信息
Iyengar Arpana, Kuriyan Rebecca, Kurpad Anura V, Vasudevan Anil
机构信息
Department of Pediatric Nephrology, St John's Medical College Hospital, Bengaluru, Karnataka, India.
Division of Nutrition, St John's Research Institute, St John's National Academy of Health Sciences, Bengaluru, Karnataka, India.
出版信息
Indian J Nephrol. 2021 Jan-Feb;31(1):39-42. doi: 10.4103/ijn.IJN_368_19. Epub 2020 Nov 7.
INTRODUCTION
Nutritional impairment in patients with chronic kidney disease (CKD) is due to decreased body stores of both protein and fat. We need a tool that can be used in clinics to determine and monitor fat composition with a special focus on normalizing fat measurements to height in these children. Bio-impedance analysis (BIA), a portable and simple tool, has been used to estimate body fat in children with CKD but needs validation against the reference tool dual energy X-ray absorptiometry (DXA). The purpose of the cross-sectional study was to estimate the prevalence of low body fat in children with stages 2-5 CKD (non-dialysis) and CKD 5D (dialysis), and to compare fat measures from two different methods namely BIA and DXA.
METHOD
Children in stages 2-5 CKD ( = 19) and in CKD 5D ( = 14) were recruited for assessment of fat mass (FM, Kg) by BIA and DXA, from which percent body fat (BF %) and fat mass index (FMI, Kg/M) were obtained. Low body fat was defined as <5 age and gender centile for BF% or FMI by DXA and BF% by BIA.
RESULTS
Low body fat was detected equally using BF% and FMI in 18% of children by DXA while only 12% were detected using BF% by BIA. In children with CKD2-5, a good degree of reliability was found with FMI measurements (ICC 0.76 CI [0.48,0.9]) and poor reliability in children with CKD 5D (ICC 0.58 CI [0.1,0.84]). BF% had poor to fair reliability in the children with CKD 2-5 and CKD 5D (ICC 0.64 [0.28,0.84] and 0.53 [0.02,0.82]), respectively. Comparing BF% and FMI obtained by BIA and DEXA, BIA overestimated BF% by 3.5% in comparison to DXA.
CONCLUSION
In children with CKD, body fat is preserved in the majority. Among the two measures of fat, BF% estimated by BIA did not compare well with DXA while FMI measure was comparable with a lower bias. However, due to lack of reference values in Indian children for FMI obtained by BIA, BIA cannot be used to measure fat in this population.
引言
慢性肾脏病（CKD）患者的营养障碍是由于蛋白质和脂肪的身体储备减少所致。我们需要一种可在临床中使用的工具，以确定和监测脂肪成分，尤其要关注使这些儿童的脂肪测量值与身高标准化。生物电阻抗分析（BIA）是一种便携式且简单的工具，已用于估计CKD儿童的身体脂肪，但需要与参考工具双能X线吸收法（DXA）进行验证。这项横断面研究的目的是估计2 - 5期CKD（非透析）和CKD 5D（透析）儿童中低体脂的患病率，并比较两种不同方法（即BIA和DXA）测得的脂肪指标。
方法
招募2 - 5期CKD（n = 19）和CKD 5D（n = 14）的儿童，通过BIA和DXA评估脂肪量（FM，千克），并由此得出体脂百分比（BF%）和脂肪量指数（FMI，千克/米）。低体脂定义为根据DXA测得的BF%或FMI以及根据BIA测得的BF%低于年龄和性别的第5百分位数。
结果
通过DXA，使用BF%和FMI在18%的儿童中均检测到低体脂，而通过BIA使用BF%仅检测到12%。在CKD2 - 5期儿童中，FMI测量具有良好的可靠性（组内相关系数ICC 0.76，置信区间CI [0.48,0.9]），而在CKD 5D期儿童中可靠性较差（ICC 0.58，CI [0.1,0.84]）。在CKD 2 - 5期和CKD 5D期儿童中，BF%的可靠性分别为差到一般（ICC分别为0.64 [0.28,0.84]和0.53 [0.02,0.82]）。比较通过BIA和DEXA获得的BF%和FMI，与DXA相比，BIA高估BF% 3.5%。
结论
在CKD儿童中，大多数儿童的体脂得以保留。在两种脂肪测量方法中，BIA估计的BF%与DXA相比效果不佳，而FMI测量结果具有可比性且偏差较小。然而，由于印度儿童中缺乏通过BIA获得的FMI的参考值，BIA不能用于测量该人群的脂肪。
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