Prevalence of Malnutrition Assessed by Bioimpedance Analysis and Anthropometry in Children on Peritoneal Dialysis

Abstract

To evaluate the sensitivity of anthropometry and bioelectrical impedance analysis (BIA) in detecting alterations in body composition of children treated with peritoneal dialysis (PD), and to determine the prevalence of malnutrition in this population, in short- and long-term PD duration, using anthropometric and BIA-derived indices. Eighteen children treated with automated PD (11 males, 7 females; mean age 8.7 +/- 4.7 years). Eighteen patients were studied using anthropometry and BIA at the start (t0) and after 6 months (t1) of PD, 15 of these patients at 12 months (t2), and 8 at 24 months (t3) of PD. Midarm muscle circumference (MAMC), arm muscle area (AMA), and arm fat area (AFA) were calculated from anthropometric measures according to Frisancho (FrisanchoAR. New norms of upper limb fat and muscle areas for assessment of nutritional status. Am J Clin Nutr 1981; 34:2540-5.). The bioelectrical measures of resistance (R) and reactance (Xc) were obtained directly from the impedance signal; phase angle (PA) and distance (D) were calculated using mathematical formulas. Nutritional status was assessed by anthropometric measurements and BIA-derived indices, expressed as standard deviation scores (SDS), and by a score system based on BIA and anthropometric parameters. The percentage of children with values of anthropometric and BIA-derived indices below the 3rd percentile or between the 3rd and 25th percentiles, and the percentage of children with scores of 7-12 and 4-6 were calculated in order to detect patients with severe or moderate derangement of nutritional status. The mean SDS values of Xc, PA, and D significantly improved (p = 0.05, p = 0.001, p = 0.02) during the first 6 months of PD and remained almost stable during the following months. The SDS values of the anthropometric indices were less compromised than those of the BIA-derived indices, particularly at the start of dialysis. By 6 months, the percentages of children with values of BIA and anthropometric indices below the 3rd percentile had decreased. The percentages of patients with moderate and severe derangement of BIA and anthropometric indices remained substantially unchanged after 12 months. However, at 24 months, the percentage of patients with moderate derangement of BIA indices increased. All these findings were confirmed by the nutritional score system. BIA is more sensitive than anthropometry in detecting alterations in body composition of children on PD. The prevalence of malnutrition, high at the commencement of PD, decreases during the first year of treatment but not over the long term.