Sarcopenic Obesity Definitions by Body Composition and Mortality in the Hemodialysis Patients

Abstract

Objective Sarcopenic obesity (SO), a combination of low muscle mass and high fat mass, is considered as risk factor for mortality in general population. It is unclear if SO affects mortality in maintenance hemodialysis (MHD) patients. In this study, we aimed to determine whether body composition as assessed by currently available SO definitions are related to all-cause mortality in MHD subjects. We also examined the impact of applying different definitions on the prevalence of SO in our MHD database. Design Retrospective analysis Subjects and Settings Adult patients on MHD for at least 3 months with no acute illness studied in the clinical research center between 2003 and 2011. Intervention Assessment of body composition was performed using dual energy x-ray absorptiometry (DEXA). SO (Appendicular Skeletal Mass (ASM): arm lean mass + leg lean mass and fat mass) was defined according to Baumgartner definition, Janssen Criteria 1 and Janssen Criteria 2. Main Outcome Measure All-cause mortality and prevalence of SO. Patient deaths were ascertained from medical records and United States social security death index. Results Of 122 participants, 62% were male; mean age was 46 (interquartile range [IQR] 40, 54) in men and 50 (44, 61) in women. Prevalence of SO ranged from 12% to 62% in men and 2% to 74% in female according to different definitions. SO prevalence was lowest using the Baumgartner criteria (all: 8%, men 12%, women: 2%), and highest according to the Janssen Criteria 2 (all: 57%, men 46%, women 74%). There were 45 deaths during a median follow-up period of 44 (20, 76) months. SO by any definition was not statistically significantly associated with mortality during follow up. Conclusions The current SO definitions are not applicable to predict increased risk of death in MHD patients. We found high degree of variation in the rates of SO when using different definitions. Future studies should focus on establishing MHD population-specific thresholds of muscle mass and adiposity for accurate prognostication.

Evaluation of body composition monitoring for assessment of nutritional status in hemodialysis patients

“…Low LTI and high FTI were found in 14.3% of male HD patients and 11.3% of females. These findings were in concordance with previous studies [9,[17][18][19], and confirm that low muscle mass can occur despite fat mass accumulation, a phenomenon called 'sarcopenic obesity'.…”

Association between obesity with low muscle mass and dialysis mortality

“…Several studies had demonstrated the association between low muscle mass and mortality . Nonetheless, the associations between body composition parameters and dialysis mortality have not been well established . Different definitions of sarcopenic obesity and hypervolaemic status might distort the association.…”

“…6,22 Nonetheless, the associations between body composition parameters and dialysis mortality have not been well established. 27 Different definitions of sarcopenic obesity and hypervolaemic status might distort the association. Low muscle mass was associated with chronic inflammation, which was the key factor of protein energy wasting (PEW).…”

The prevalence of muscle wasting (sarcopenia) in peritoneal dialysis patients varies with ethnicity due to differences in muscle mass measured by bioimpedance

“…As with the differences in cut points for defining sarcopenia, there are differences in defining sarcopenic obesity [28]. We chose a BMI of ≥30 [14], and found a much lower prevalence of < 3% for all categories of sarcopenia, part from ALM adjusted for BMI, compared to previous reports, with estimates ranging from 12-62% for men and 2-78% for women [29].…”