Beberashvili Ilia, Azar Ada, Khatib Amin, Abu Hamad Ramzia, Neheman Amos, Efrati Shai, Doenyas-Barak Keren
Nephrology Division, Yitzhak Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel.
Nutrition Department, Yitzhak Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel.
J Ren Nutr. 2023 Jan;33(1):147-156. doi: 10.1053/j.jrn.2022.05.003. Epub 2022 May 18.
Sarcopenia and sarcopenic obesity (SO) are linked to unfavorable prognosis in maintenance hemodialysis (MHD) populations. We tested whether nonobese sarcopenia and SO, as different stages of extreme protein-energy wasting, have different prognoses.
In this prospective observational study, 261 MHD patients were recruited from October 2010 to April 2012 and followed until October 2020. Two definitions were used to diagnose sarcopenia: the European Working Group on Sarcopenia in Older People consensus and the Foundation for the National Institutes of Health (FNIH) Biomarkers Consortium criteria. Obesity was determined as the percentage of total body fat, ≥27% for men and ≥38% for women. Data for all-cause and cardiovascular morbidity and mortality, baseline nutrition markers, inflammation and oxidative stress, adipokines, body composition parameters, handgrip strength, and quality of life (QoL) scores were measured.
According to European Working Group on Sarcopenia in Older People, 115 (44.1%) patients were sarcopenic and 120 (46.0%) according to FNIH definitions. Of them, 28.4% and 34.5% were SO, respectively. Higher levels of albumin, creatinine, uric acid, leptin, phase angle, better nutritional scores, and lower adiponectin levels characterized SO patients compared with nonobese sarcopenic patients regardless of indexing method. Better QoL scores were noted in SO compared with nonobese sarcopenic patients using the FNIH sarcopenia criteria. The hazard of all-cause death, cardiovascular death, and first cardiovascular event for patients with SO was lower compared with the nonobese patients after multivariate adjustments. Statistical significance of these associations disappeared after including fat mass in multivariate models.
MHD patients with SO have better nutritional status and prognosis for cardiovascular events, all-cause and cardiovascular disease mortality, and possibly better QoL compared with nonobese sarcopenic MHD patients. The better prognosis appears to be entirely due to the excess fat, which is protective in sarcopenic MHD patients similar to that described in the entire MHD population.
肌肉减少症和肌肉减少性肥胖（SO）与维持性血液透析（MHD）人群的不良预后相关。我们测试了非肥胖型肌肉减少症和SO作为极端蛋白质能量消耗的不同阶段，是否具有不同的预后。
在这项前瞻性观察研究中，2010年10月至2012年4月招募了261例MHD患者，并随访至2020年10月。使用两种定义来诊断肌肉减少症：老年人肌肉减少症欧洲工作组共识和美国国立卫生研究院（FNIH）生物标志物联盟标准。肥胖定义为体脂百分比，男性≥27%，女性≥38%。测量全因和心血管疾病发病率及死亡率、基线营养指标、炎症和氧化应激、脂肪因子、身体成分参数、握力和生活质量（QoL）评分的数据。
根据老年人肌肉减少症欧洲工作组的标准，115例（44.1%）患者存在肌肉减少症，根据FNIH定义为120例（46.0%）。其中，分别有28.4%和34.5%为SO。与非肥胖型肌肉减少症患者相比，无论采用何种索引方法，SO患者的白蛋白、肌酐、尿酸、瘦素水平更高，相位角更大，营养评分更好，脂联素水平更低。使用FNIH肌肉减少症标准时，与非肥胖型肌肉减少症患者相比，SO患者的QoL评分更高。多变量调整后，SO患者的全因死亡、心血管死亡和首次心血管事件的风险低于非肥胖患者。在多变量模型中纳入脂肪量后，这些关联的统计学意义消失。
与非肥胖型肌肉减少症的MHD患者相比，患有SO的MHD患者营养状况更好，心血管事件、全因和心血管疾病死亡率的预后更好，生活质量可能也更好。更好的预后似乎完全归因于多余的脂肪，这在肌肉减少症的MHD患者中具有保护作用，类似于在整个MHD人群中所描述的那样。
