Kim In Soo, Lee Hyung Seok, Jang Jinha, An Jung Nam, Kim Sung Gyun, Kim Jwa-Kyung
Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea.
Am J Nephrol. 2024;55(6):607-617. doi: 10.1159/000540948. Epub 2024 Aug 17.
The relationship between fat mass and osteoporosis, sarcopenia, and osteosarcopenia is complex. While higher fat mass generally has a negative impact on bone and muscle health in the general population, the impact in peritoneal dialysis (PD) patients is less well understood.
In this study of 359 PD patients, sarcopenia was identified using appendicular skeletal muscle per square meter (ASM/m2), with cut-off values of <7.0 kg/m2 for men and <5.5 kg/m2 for women. Fat tissue index (FTI) and lean tissue index (LTI) were determined using body composition monitoring, with the lowest tertile classified as low FTI and low LTI. Bone mineral density was measured, with a T-score below -2.5 indicating osteoporosis.
The prevalence of osteoporosis, sarcopenia, and osteosarcopenia was 25%, 32%, and 15%, respectively. Notably, 60% of osteoporotic patients had sarcopenia, and about 45% of sarcopenic patients had osteoporosis. Patients with osteoporosis were older and had significantly lower LTI (15.3 vs. 12.7 kg/m2, p < 0.001) and ASM (7.3 vs. 5.8 kg/m2, p < 0.001). Osteoporotic patients also had lower FTI, but this was more pronounced in men than in women. Patients with both sarcopenia and osteoporosis had the lowest LTI and FTI compared to those with only one or neither condition. Low FTI was a significant determinant for osteoporosis (OR, 2.34; 95% CI, 1.43-3.85; p = 0.001), sarcopenia (OR, 2.91; 95% CI, 1.82-4.64; p < 0.001), and osteosarcopenia (OR, 2.34; 95% CI, 1.30-4.24; p = 0.005) in univariate analysis, and these associations remained significant after adjustment for age and body mass index.
Osteoporosis and sarcopenia are common and interrelated in PD patients. Low fat mass, but not normal/high fat mass, was significantly associated with these conditions, suggesting the importance of maintaining adequate fat mass in PD patients.
脂肪量与骨质疏松症、肌肉减少症和骨肌减少症之间的关系很复杂。虽然在一般人群中，较高的脂肪量通常对骨骼和肌肉健康有负面影响，但在腹膜透析（PD）患者中的影响尚不太清楚。
在这项对359例PD患者的研究中，采用每平方米四肢骨骼肌（ASM/m2）来确定肌肉减少症，男性的临界值为<7.0 kg/m2，女性为<5.5 kg/m2。通过身体成分监测确定脂肪组织指数（FTI）和瘦组织指数（LTI），最低三分位数被归类为低FTI和低LTI。测量骨密度，T值低于-2.5表明患有骨质疏松症。
骨质疏松症、肌肉减少症和骨肌减少症的患病率分别为25%、32%和15%。值得注意的是，60%的骨质疏松症患者患有肌肉减少症，约45%的肌肉减少症患者患有骨质疏松症。骨质疏松症患者年龄较大，LTI（15.3对12.7 kg/m2，p<0.001）和ASM（7.3对5.8 kg/m2，p<0.001）显著更低。骨质疏松症患者的FTI也较低，但在男性中比在女性中更明显。与仅患有一种疾病或两种疾病都未患的患者相比，同时患有肌肉减少症和骨质疏松症的患者LTI和FTI最低。在单因素分析中，低FTI是骨质疏松症（OR，2.34；95%CI，1.43 - 3.85；p = 0.001）、肌肉减少症（OR，2.91；95%CI，1.82 - 4.64；p<0.001）和骨肌减少症（OR，2.34；95%CI，1.30 - 4.24；p = 0.005）的重要决定因素，在调整年龄和体重指数后，这些关联仍然显著。
骨质疏松症和肌肉减少症在PD患者中很常见且相互关联。低脂肪量而非正常/高脂肪量与这些疾病显著相关，这表明在PD患者中维持足够脂肪量的重要性。
