Abstract
BackgroundThis study investigated the prevalence of sarcopenia or sarcopenic obesity and their association with frailty and protein-energy wasting (PEW) in hemodialysis patients.MethodsThe present study enrolled 117 adult hemodialysis patients (35% female, 64 ± 12 years old) from single units of a hemodialysis center. The patients were divided into four groups: normal, obese, sarcopenia, and sarcopenic obesity. Sarcopenia was diagnosed by Asian Working Group for Sarcopenia (AWGS) criteria, and obesity was defined as an extensive percent body fat mass greater than 40% in females and 30% in males. Skeletal muscle mass and percent fat mass were evaluated by multifrequency whole-body bioimpedance electrical analysis after a midweek dialysis session. Handgrip strength and a short physical performance battery (SPPB) were assessed before a dialysis session as indicators of muscle strength and physical performance. Moreover, participants completed the Kihon Checklist and the criteria proposed by the International Society of Renal Nutrition and Metabolism expert panel to classify frailty and PEW. We performed multivariate logistic regression analysis to identify the clinical risk of frailty and PEW in patients with sarcopenia or sarcopenic obesity.ResultsForty-six (39.3%) patients were classified as normal; 18 (15.4%), as obese; 35 (29.9%), as having sarcopenia; and 18 (15.4%), as having sarcopenic obesity. The sarcopenia or sarcopenic obesity group had significantly lower handgrip strength than the normal or obesity group (all p < 0.05). In addition, the sarcopenia and sarcopenic obesity groups had significantly lower SPPB scores than the normal group (p < 0.05, respectively). In the multivariate analysis, the sarcopenic obesity group had a significantly higher risk of frailty than the normal group in the multivariate analysis after adjusting for age and gender (OR 4.518, 95%CI 1.218–16.752, p = 0.024). However, sarcopenic obesity was not associated with a higher likelihood of PEW, and sarcopenia imposed a significantly higher risk of PEW (OR 4.272, 95%CI 1.157–15.778, p = 0.029) than that in the normal group after adjusting for confounding factors.ConclusionSarcopenic obesity was closely associated with frailty compared with the normal condition in HD patients. However, sarcopenic obesity was not associated with a higher likelihood of PEW.
Highlights
Obesity is an independent risk factor for morbidity or mortality in the general population [1]
The patients were divided into four groups on the basis of sarcopenia and obesity: 46 (39.3%) patients were normal, 18 (15.4%) were obese, 35 (29.9%) had sarcopenia, and 18 (15.4%) had sarcopenic obesity
We found that sarcopenic obesity was associated with reduced muscle strength and physical performance and with a greater risk of frailty than was the normal condition in HD patients
Summary
Obesity is an independent risk factor for morbidity or mortality in the general population [1]. The survival rate of obese patients with hemodialysis (HD) is reported to be better than that of normal weight HD patients [2], which has been referred to as the “obesity paradox.”. Several studies have shown that obesity can coexist with sarcopenia [3], which is termed sarcopenic obesity Both sarcopenia and obesity are linked to functional impairment, frailty or disability, sarcopenic obesity, has been associated with worse morbidity and mortality than either sarcopenia or obesity alone [4]. This study investigated the prevalence of sarcopenia or sarcopenic obesity and their association with frailty and protein-energy wasting (PEW) in hemodialysis patients
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