Obese sarcopenia in patients with end-stage renal disease is associated with inflammation and increased mortality

BACKGROUND: Adipose tissue in overweight patients with end-stage renal disease (ESRD) is a source of proinflammatory mediators, which could contribute to protein-energy wasting (PEW), cardiovascular disease, and increased mortality. Overweight in ESRD patients, however, is reported to be associated...

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Veröffentlicht in:The American journal of clinical nutrition 2007-09, Vol.86 (3), p.633-638
Hauptverfasser: Honda, Hirokazu, Qureshi, Abdul Rashid, Axelsson, Jonas, Heimburger, Olof, Suliman, Mohamed E, Barany, Peter, Stenvinkel, Peter, Lindholm, Bengt
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container_issue 3
container_start_page 633
container_title The American journal of clinical nutrition
container_volume 86
creator Honda, Hirokazu
Qureshi, Abdul Rashid
Axelsson, Jonas
Heimburger, Olof
Suliman, Mohamed E
Barany, Peter
Stenvinkel, Peter
Lindholm, Bengt
description BACKGROUND: Adipose tissue in overweight patients with end-stage renal disease (ESRD) is a source of proinflammatory mediators, which could contribute to protein-energy wasting (PEW), cardiovascular disease, and increased mortality. Overweight in ESRD patients, however, is reported to be associated with better survival. OBJECTIVE: We investigated the associations between overweight [body mass index (BMI; in kg/m²) > 25], inflammation, PEW, and mortality in ESRD patients starting dialysis. DESIGN: In 328 ESRD patients (age: 53 ± 12 y; 201 men), inflammatory biomarkers, nutritional status, and dual-energy X-ray absorptiometry data were analyzed close to the start of treatment. We compared clinical and laboratory data in patients in 3 BMI groups, with and without PEW. RESULTS: The prevalence of PEW was high in patients in all 3 BMI groups. PEW was associated with both high fat body mass index (FBMI) and low lean body mass index (LBMI). Both PEW and high BMI were associated with inflammation. The highest concentrations of inflammatory mediators and the highest FBMI were seen in overweight patients with PEW. BMI as such did not predict clinical outcome; however, for each BMI group, the presence of PEW was associated with increased mortality. With BMI 20-25 as the reference group, BMI < 20 did not predict mortality, overweight (BMI > 25) was associated with a survival advantage, and low FBMI was found to be an independent predictor of mortality. CONCLUSIONS: PEW is common in overweight ESRD patients and is associated with high FBMI, low LBMI, and inflammation. PEW was a predictor of mortality in both obese and nonobese sarcopenia patients. BMI as such, however, was a poor predictor of mortality, but after adjustment for various confounders, including PEW, a high BMI and a high FBMI were associated with survival advantage.
doi_str_mv 10.1093/ajcn/86.3.633
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Overweight in ESRD patients, however, is reported to be associated with better survival. OBJECTIVE: We investigated the associations between overweight [body mass index (BMI; in kg/m²) &gt; 25], inflammation, PEW, and mortality in ESRD patients starting dialysis. DESIGN: In 328 ESRD patients (age: 53 ± 12 y; 201 men), inflammatory biomarkers, nutritional status, and dual-energy X-ray absorptiometry data were analyzed close to the start of treatment. We compared clinical and laboratory data in patients in 3 BMI groups, with and without PEW. RESULTS: The prevalence of PEW was high in patients in all 3 BMI groups. PEW was associated with both high fat body mass index (FBMI) and low lean body mass index (LBMI). Both PEW and high BMI were associated with inflammation. The highest concentrations of inflammatory mediators and the highest FBMI were seen in overweight patients with PEW. BMI as such did not predict clinical outcome; however, for each BMI group, the presence of PEW was associated with increased mortality. With BMI 20-25 as the reference group, BMI &lt; 20 did not predict mortality, overweight (BMI &gt; 25) was associated with a survival advantage, and low FBMI was found to be an independent predictor of mortality. CONCLUSIONS: PEW is common in overweight ESRD patients and is associated with high FBMI, low LBMI, and inflammation. PEW was a predictor of mortality in both obese and nonobese sarcopenia patients. BMI as such, however, was a poor predictor of mortality, but after adjustment for various confounders, including PEW, a high BMI and a high FBMI were associated with survival advantage.</description><identifier>ISSN: 0002-9165</identifier><identifier>EISSN: 1938-3207</identifier><identifier>DOI: 10.1093/ajcn/86.3.633</identifier><identifier>PMID: 17823427</identifier><identifier>CODEN: AJCNAC</identifier><language>eng</language><publisher>Bethesda, MD: American Society for Nutrition</publisher><subject>Absorptiometry, Photon - methods ; adipose tissue ; Adipose Tissue - metabolism ; Adult ; Analysis of Variance ; Biological and medical sciences ; Body Composition - physiology ; body fat ; Body Mass Index ; Comorbidity ; end-stage renal disease ; Feeding. Feeding behavior ; Female ; Fundamental and applied biological sciences. 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Overweight in ESRD patients, however, is reported to be associated with better survival. OBJECTIVE: We investigated the associations between overweight [body mass index (BMI; in kg/m²) &gt; 25], inflammation, PEW, and mortality in ESRD patients starting dialysis. DESIGN: In 328 ESRD patients (age: 53 ± 12 y; 201 men), inflammatory biomarkers, nutritional status, and dual-energy X-ray absorptiometry data were analyzed close to the start of treatment. We compared clinical and laboratory data in patients in 3 BMI groups, with and without PEW. RESULTS: The prevalence of PEW was high in patients in all 3 BMI groups. PEW was associated with both high fat body mass index (FBMI) and low lean body mass index (LBMI). Both PEW and high BMI were associated with inflammation. The highest concentrations of inflammatory mediators and the highest FBMI were seen in overweight patients with PEW. 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Psychology</topic><topic>Humans</topic><topic>inflammation</topic><topic>Inflammation - blood</topic><topic>Inflammation - epidemiology</topic><topic>Kidney Failure, Chronic - mortality</topic><topic>Male</topic><topic>Medicin och hälsovetenskap</topic><topic>men</topic><topic>Middle Aged</topic><topic>mortality</topic><topic>Muscular Atrophy - epidemiology</topic><topic>Nutritional Status</topic><topic>obesity</topic><topic>Obesity - epidemiology</topic><topic>overweight</topic><topic>patients</topic><topic>Prevalence</topic><topic>protein energy malnutrition</topic><topic>Protein-Energy Malnutrition - epidemiology</topic><topic>renal failure</topic><topic>Risk Factors</topic><topic>ROC Curve</topic><topic>sarcopenia</topic><topic>skeletal muscle</topic><topic>Statistics, Nonparametric</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><topic>Vertebrates: anatomy and physiology, studies on body, several organs or systems</topic><topic>women</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Honda, Hirokazu</creatorcontrib><creatorcontrib>Qureshi, Abdul Rashid</creatorcontrib><creatorcontrib>Axelsson, Jonas</creatorcontrib><creatorcontrib>Heimburger, Olof</creatorcontrib><creatorcontrib>Suliman, Mohamed E</creatorcontrib><creatorcontrib>Barany, Peter</creatorcontrib><creatorcontrib>Stenvinkel, Peter</creatorcontrib><creatorcontrib>Lindholm, Bengt</creatorcontrib><collection>AGRIS</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SwePub Articles full text</collection><jtitle>The American journal of clinical nutrition</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Honda, Hirokazu</au><au>Qureshi, Abdul Rashid</au><au>Axelsson, Jonas</au><au>Heimburger, Olof</au><au>Suliman, Mohamed E</au><au>Barany, Peter</au><au>Stenvinkel, Peter</au><au>Lindholm, Bengt</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Obese sarcopenia in patients with end-stage renal disease is associated with inflammation and increased mortality</atitle><jtitle>The American journal of clinical nutrition</jtitle><addtitle>Am J Clin Nutr</addtitle><date>2007-09-01</date><risdate>2007</risdate><volume>86</volume><issue>3</issue><spage>633</spage><epage>638</epage><pages>633-638</pages><issn>0002-9165</issn><eissn>1938-3207</eissn><coden>AJCNAC</coden><abstract>BACKGROUND: Adipose tissue in overweight patients with end-stage renal disease (ESRD) is a source of proinflammatory mediators, which could contribute to protein-energy wasting (PEW), cardiovascular disease, and increased mortality. Overweight in ESRD patients, however, is reported to be associated with better survival. OBJECTIVE: We investigated the associations between overweight [body mass index (BMI; in kg/m²) &gt; 25], inflammation, PEW, and mortality in ESRD patients starting dialysis. DESIGN: In 328 ESRD patients (age: 53 ± 12 y; 201 men), inflammatory biomarkers, nutritional status, and dual-energy X-ray absorptiometry data were analyzed close to the start of treatment. We compared clinical and laboratory data in patients in 3 BMI groups, with and without PEW. RESULTS: The prevalence of PEW was high in patients in all 3 BMI groups. PEW was associated with both high fat body mass index (FBMI) and low lean body mass index (LBMI). Both PEW and high BMI were associated with inflammation. The highest concentrations of inflammatory mediators and the highest FBMI were seen in overweight patients with PEW. BMI as such did not predict clinical outcome; however, for each BMI group, the presence of PEW was associated with increased mortality. With BMI 20-25 as the reference group, BMI &lt; 20 did not predict mortality, overweight (BMI &gt; 25) was associated with a survival advantage, and low FBMI was found to be an independent predictor of mortality. CONCLUSIONS: PEW is common in overweight ESRD patients and is associated with high FBMI, low LBMI, and inflammation. PEW was a predictor of mortality in both obese and nonobese sarcopenia patients. BMI as such, however, was a poor predictor of mortality, but after adjustment for various confounders, including PEW, a high BMI and a high FBMI were associated with survival advantage.</abstract><cop>Bethesda, MD</cop><pub>American Society for Nutrition</pub><pmid>17823427</pmid><doi>10.1093/ajcn/86.3.633</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record>
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subjects Absorptiometry, Photon - methods
adipose tissue
Adipose Tissue - metabolism
Adult
Analysis of Variance
Biological and medical sciences
Body Composition - physiology
body fat
Body Mass Index
Comorbidity
end-stage renal disease
Feeding. Feeding behavior
Female
Fundamental and applied biological sciences. Psychology
Humans
inflammation
Inflammation - blood
Inflammation - epidemiology
Kidney Failure, Chronic - mortality
Male
Medicin och hälsovetenskap
men
Middle Aged
mortality
Muscular Atrophy - epidemiology
Nutritional Status
obesity
Obesity - epidemiology
overweight
patients
Prevalence
protein energy malnutrition
Protein-Energy Malnutrition - epidemiology
renal failure
Risk Factors
ROC Curve
sarcopenia
skeletal muscle
Statistics, Nonparametric
Survival Analysis
Treatment Outcome
Vertebrates: anatomy and physiology, studies on body, several organs or systems
women
title Obese sarcopenia in patients with end-stage renal disease is associated with inflammation and increased mortality
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