Macedo Catarina, Amaral Teresa F, Rodrigues Juliana, Santin Fernanda, Avesani Carla Maria
Faculty of Nutrition and Food Science, University of Porto, Porto, Portugal.
Graduation Program in Food, Nutrition and Health, Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil.
Front Nutr. 2021 Sep 17;8:721941. doi: 10.3389/fnut.2021.721941. eCollection 2021.
Sarcopenia and malnutrition are highly prevalent in older adults undergoing hemodialysis (HD) and are associated with negative outcomes. This study aimed to evaluate the role of sarcopenia and malnutrition combined on the nutritional markers, quality of life, and survival in a cohort of older adults on chronic HD. This was an observational, longitudinal, and multicenter study including 170 patients on HD aged >60 years. Nutritional status was assessed by 7-point-subjective global assessment (7p-SGA), body composition (anthropometry and bioelectrical impedance), and appendicular skeletal muscle mass (Baumgartner's prediction equation). Quality of life was assessed by KDQoL-SF. The cutoffs for low muscle mass and low muscle strength established by the 2019 European Working group on sarcopenia for Older People (EWGSOP) were used for the diagnosis of sarcopenia. Individuals with a 7p-SGA score ≤5 were considered malnourished, individuals with low strength or low muscle mass were pre-sarcopenic, and those with low muscle mass and low muscle strength combined as sarcopenic. The sample was divided into four groups: sarcopenia and malnutrition; sarcopenia and no-malnutrition; no-sarcopenia with malnutrition; and no-sarcopenia and no-malnutrition. Follow-up for survival lasted 23.5 (12.2; 34.4) months. Pre-sarcopenia, sarcopenia, and malnutrition were present in 35.3, 14.1, and 58.8% of the patients, respectively. The frequency of malnutrition in the group of patients with sarcopenia was not significantly higher than in the patients without sarcopenia (66.7 vs. 51.2%; = 0.12). When comparing groups according to the occurrence of sarcopenia and malnutrition, the sarcopenia and malnutrition group were older and presented significantly lower BMI, calf circumference, body fat, phase angle, body cell mass, and mid-arm muscle circumference. In the survival analysis, the group with sarcopenia and malnutrition showed a higher hazard ratio 2.99 (95% CI: 1.23: 7.25) for mortality when compared to a group with no-sarcopenia and no-malnutrition. Older adults on HD with sarcopenia and malnutrition combined showed worse nutritional parameters, quality of life, and higher mortality risk. In addition, malnutrition can be present even in patients without sarcopenia. These findings highlight the importance of complete nutritional assessment in patients on dialysis.
肌肉减少症和营养不良在接受血液透析（HD）的老年人中非常普遍，并且与不良后果相关。本研究旨在评估肌肉减少症和营养不良合并存在对一组慢性血液透析老年患者营养指标、生活质量和生存率的影响。这是一项观察性、纵向、多中心研究，纳入了170例年龄>60岁的血液透析患者。通过7分主观全面评定法（7p-SGA）、身体成分（人体测量和生物电阻抗）以及附属骨骼肌质量（鲍姆加特纳预测方程）评估营养状况。通过KDQoL-SF评估生活质量。采用2019年欧洲老年人肌肉减少症工作组（EWGSOP）制定的低肌肉量和低肌肉力量的临界值来诊断肌肉减少症。7p-SGA评分≤5分的个体被视为营养不良，肌肉力量低或肌肉量低的个体为肌肉减少症前期，肌肉量和肌肉力量均低的个体为肌肉减少症。样本分为四组：肌肉减少症合并营养不良；肌肉减少症但无营养不良；无肌肉减少症合并营养不良；无肌肉减少症且无营养不良。生存随访持续23.5（12.2；34.4）个月。肌肉减少症前期、肌肉减少症和营养不良分别在35.3%、14.1%和58.8%的患者中存在。肌肉减少症患者组的营养不良发生率并不显著高于无肌肉减少症的患者（66.7%对51.2%；P = 0.12）。根据肌肉减少症和营养不良的发生情况比较各组时，肌肉减少症合并营养不良组年龄更大，且体重指数、小腿围、体脂、相位角、身体细胞量和上臂中部肌肉围显著更低。在生存分析中，与无肌肉减少症且无营养不良组相比，肌肉减少症合并营养不良组的死亡风险比更高，为2.99（95%CI：1.23：7.25）。合并肌肉减少症和营养不良的血液透析老年患者营养参数更差、生活质量更低且死亡风险更高。此外，即使在无肌肉减少症的患者中也可能存在营养不良。这些发现凸显了对透析患者进行全面营养评估的重要性。
