Arm Muscular Area Research Articles

#5405 MALNUTRITION DIAGNOSIS IN CKD PATIENTS

Abstract Background and Aims Malnutrition is a prevalent condition in patients with chronic kidney disease (CKD) receiving replacement therapy by peritoneal dialysis (PD). Geriatric nutritional risk index (GNRI) is an effective tool for screening nutritional status in maintenance hemodialysis patients. The purpose of this study was to determine the information content of GNRI for the diagnosis of protein-energy malnutrition in patients with CKD receiving replacement therapy with PD when compared to malnutrition inflammation score (MIS) and 7-point subjective global assessment (7p-SGA). Method A prospective cohort study included 222 adults PD-patients (man 100, female 112, age 44±14). All patients received continuous ambulatory peritoneal dialysis. Median duration PD before inclusion in the study was 12 months, the observation period of patients was 36 months. Nutritional status assessment included anthropometric (body mass index, triceps skinfold thickness, midupper arm muscular area) and biochemical (albumin, C-reactive protein, total iron-binding capacity, total cholesterol, hemoglobin and others) examinations as well as bioelectrical impedance analysis (BIA – fat mass). GNRI calculated according to the formula GNRI = 1.489 × albumin (g/dL)] + [41.7 × (body wt/ideal body wt)], where the ideal body weight for women is: height (cm)–100–[(height–152) × 0.2], ideal body weight for men is equal to: height (cm) -100 - [(height - 152) × 0.4]. We used MIS and 7p-SGA as a reference standard, a score ≥6 and ≤5, respectively, defined malnutrition. The cutoff of GNRI the diagnosis of malnutrition were derived from these ROC-analysis. Results Most of the individual nutritional indexes, including the anthropometric, biochemical and BIA indexes, were significantly (P<0.001) lower in the patients with MIS score ≥6 and 7p-SGA score ≤5, thus both nutritional screening tools were considered reasonable as a reference standard to determine the information content GNRI in PD-patients. The GNRI fluctuated in the range 66–126 (median 99), MIS score – 2–24 (median 7) and 7p-SGA score – 2–7 (median 5). The GNRI showed a significantly negative correlation with MIS (r = -0,708, p<0.0001) and a significantly positive correlation with 7p-SGA (r = 0.636, p<0.0001) (Fig. 1). The most accurate GNRI cutoff to identify a malnourished patient according to the MIS was ≤99 (Fig. 2). The frequency of malnutrition among the observed patients was 52.3% when using GNRI≤99, 55.9% when using MIS≥6 and 51.4% when using 7p-SGA≤5 (n.s.). The values for sensitivity and specificity with a GNRI of ≤99 in predicting malnutrition based on the MIS were 77.4% (95%CI 69.0-84.4%) and 79.6% (95%CI 70.3-87.1%) respectively. Positive predictive value and negative predictive value also had high scores respectively 73.7% (95%CI 64.9-80.9%) and 72.2 (95%CI 63.1-79.8%). The application of the GNRI to the PD-patients found significant (p<0.001) differences in the various nutrition-related indexes (anthropometric, biochemical and BIA) between the group with a GNRI≤99 and that with GNRI>99. Mortality from all causes among patients with GNRI>99 was one case per 54.9 patient-years, among patients with GNRI≤99 was one case per 29.7 patient-years. Conclusion In PD-patients GNRI closely correlates with MIS and 7p-SGA, characterized by high sensitivity and specificity. GNRI can be used to determine the nutritional status of PD patients.

Longitudinal Anthropometry and Body Composition in Children With SARS-CoV-2-Associated Multisystem Inflammatory Syndrome.

Acute coronavirus disease 2019 infection has been shown to negatively affect body composition among adult and malnourished or obesity children. Our aim is to longitudinally evaluate body composition in children affected by the Multisystem Inflammatory Syndrome (MIS-C). In this cohort study, we recruited 40 patients affected by MIS-C, aged 2-18 years old, who were admitted in our clinic between December 2020 and February 2021. Physical examination for each participant included weight, height, body mass index (BMI) z score, circumferences, and skinfolds assessment. The same measurements were repeated during outpatient follow-up at 10 (T2), 30 (T3), 90 (T4), and 180 (T5) days after hospital discharge. Fat mass and fat free mass were calculated according to skinfolds predictive equations for children and adolescents. A control group was randomly selected among patients attending a pediatric nutritional outpatient clinic. BMI z score significantly decrease between preadmission and hospital discharge. Similarly, arm circumference z score, arm muscular area z score, and arm fat area z score significantly decreased, during hospital stay. Fat mass index (FMI) significantly increased over time, peaking at T3. Fat free mass index decreased during hospitalization. To the best of our knowledge, this is the first study to assess body composition in a numerically large pediatric MIS-C population from acute infection to 6 months after triggering event. FMI and anthropometric parameters linked to fat deposits were significantly higher 6 months after acute event. Thus, limiting physical activity and having sedentary lifestyle may lead to an accumulation of adipose tissue even in healthy children who experienced MIS-C and long hospitalization.

Ultrasonographic Size of the Thenar Muscles of the Nondominant Hand Correlates with Total Body Lean Mass in Healthy Subjects

Sarcopenia is associated with adverse outcomes in clinical situations such as elderly population, in-hospital setting and oncologic patients. However, no direct measurement of muscular mass is routinely available for clinicians. The aim of this study was to assess the correlation between thenar musculature of the nondominant hand evaluated by ultrasound and body fat-free mass. In this one-center, cross-sectional, observational study, the width and depth of thenar muscles of both hands was assessed by ultrasonography. Nondominant hand musculature was taken as reference as a better estimator of total body muscular mass. These data were compared to body composition by bioimpedance analysis and dual-energy X-ray absorptiometry (DXA), hand grip strength, arm muscular area and physical activity (with International Physical Activity Questionnaire ). Statistical correlation was determined for each parameter. We obtained ultrasonographic measurements, International Physical Activity Questionnaire and hand grip strength from 83 subjects, whereas bioimpedance was performed in 64 subjects and DXA in 29 subjects. The strongest correlations were found between longitudinal thenar depth vs fat-free mass index (fat-free mass in DXA [kg]/height2 [m]) (r = 0.63, p < 0.001, 95%CI 0.34-0.81), longitudinal depth and hand dynamometry (r = 0.72, p < 0.001, 95%CI 0.59-0.81), longitudinal depth and DXA fat-free total mass (r = 0.76, p < 0.001, 95%CI 0.54-0.88), transversal thenar depth vs fat-free mass index (r = 0.67, p < 0.001, 95%CI 0.41-0.83), transversal width and DXA fat-free total mass (r = 0.62, p < 0.001, 95%CI 0.33-0.8), transversal depth and DXA nonfat total mass (r = 0.81, p < 0.001, 95%CI 0.63-0.91). Ultrasonographic examination of the nondominant thenar musculature is a fast and simple way of assessing total body fat-free mass, showing a good correlation with body composition measured by bioimpedance analysis and DXA, hand grip strength and arm muscular area.

Factors Associated With Anthropometric Indicators of Nutritional Status in Children With Chronic Kidney Disease Undergoing Peritoneal Dialysis, Hemodialysis, and After Kidney Transplant

The objective of the study was to demonstrate that there are differences in the factors associated with anthropometric indicators of nutritional status, with particular emphasis on arm indicators, in children with end-stage kidney disease undergoing peritoneal dialysis (PD), hemodialysis (HD), and after kidney transplant (KT). An analytical cross-sectional study of consecutive cases included 130 children and adolescents with end-stage kidney disease undergoing substitutive treatment: 49 patients who underwent KT, 33 undergoing PD, and 47 undergoing HD. Socioeconomic data were obtained from all the 3 groups; anthropometric indicators of nutritional status were calculated. Student's t-test and analysis of variance were used for parametric variables. Chi-square test, Mann-Whitney U test, Kruskal-Wallis test, and odds ratio (OR) were used for nonparametric variables. The number of parents living as couples was higher for patients who underwent KT (OR=3.5 [95% confidence interval {CI} 1.34-9.0]) and undergoing PD (OR=3.0 [95% CI 1.06-8.8]) than those undergoing HD. The number of mothers who worked outside the home was higher for patients who underwent KT and undergoing PD than the mothers of patients undergoing HD (OR=13.7 [95% CI: 4.56-41.05]; OR=15.4 [CI 95% 4.8-49], respectively). Family income was higher for patients who underwent KT and undergoing PD (P=.019, P=.093, respectively). More than 40% of patients in all the 3 groups had growth impairment. Body mass index, mid-upper arm circumference, tricipital and subscapular skinfolds, total arm area, and arm fat area were affected in HD and PD groups (9 to 40%), while of the patients who underwent KT, 36.7% were overweight or obese. More than 50% of patients who underwent KT and undergoing HD and PD had involvement in the arm muscular area. Socioeconomic conditions are more influential for children in the HD program. The nutritional status of children after KT improves; however, not all anthropometric indicators are fully recovered. Children after KT are up to 9 times more likely to be overweight or obese.

MON-P199: Neck Circumference: Is there Correlation with the Arm Muscular Area in Children and Adolescents with Malignant Neoplasms?

MON-P199: Neck Circumference: Is there Correlation with the Arm Muscular Area in Children and Adolescents with Malignant Neoplasms?

Dietary Intake, Nutritional Status, and Body Composition in Children With End-Stage Kidney Disease on Hemodialysis or Peritoneal Dialysis

This study aimed to demonstrate that dietary intake, anthropometric indicators, and body composition in children with end-stage kidney disease differs between those on peritoneal dialysis (PD) and those on hemodialysis (HD). This was a cross-sectional and consecutive study that included 55 children and adolescents with end-stage kidney disease who were undergoing replacement therapy (22 PD patients and 33 HD patients). Two 24-hour dietary recall surveys were conducted for each patient. Anthropometric, biochemical, and body composition indicators were estimated. A Student's t-test and a Mann-Whitney U test were used for the parametric variables, whereas association tests were estimated for the nonparametric variables (i.e., χ2, Fisher exact test, and odds ratio). Regression models were designed to predict dietary intake on anthropometric and body composition indicators. The mid-upper arm circumference was greater on the patients undergoing HD than on the PD patients (odds ratio=15.8 [95% confidence interval (CI): 2.9, 85.1], P<.001); the arm muscular area was greater in the HD patients than in the PD patients (P=.07). Children on PD had significantly greater creatinine concentration (8.4±3.0mg/dL vs. 4.6±1.2mg/dL, P<.001), urea (101±27mg/dL vs. 50 ±17mg/dL, P< .001), and glucose (87±14.4mg/dL vs. 77 ±10.2mg/dL, P=.003). Children on PD had lower lipid intake (31.2±15.8 vs. 40.9±19.1g/day, P=.032), lower percentage of adequacy of vitamin C (128±66 vs. 146 ±70, P=.046), and lower sodium (62±43 vs. 79 ±42, P=.044) than children on HD. Dietary intake predicted 40% to 80% of the variability in the nutritional status in children on PD and 28% to 60% in children on HD. Nutritional status is affected in most patients on dialysis treatment, which differs significantly among those who are undergoing PD or HD.

Exercise Effect Upon Plasma Irisin And Its Association With Some Metabolic And Anthropometric Variables.

BACKGROUND: Irisin, a recently identified myokine, is induced by muscular contraction and activates profound changes in the subcutaneous adipose tissue, promoting thermogenesis and energy expenditure. Plasma irisin level and its change after recreational physical activity (RPA) have not been clearly elucidated PURPOSE : To assess the change in plasma irisin after eight weeks of RPA and its association with metabolic and anthropometric variables. METHODS: Thirty six sedentary obese children were included in this study. RPA training program consisted in 4 weekly sessions during 8 weeks. Each 60 minutes session was divided in 10 minutes warm-up, 40 minutes exercise, and 10 minutes cool-down. Anthropometric (weight, height, waist circumference, triceps and subscapularis skinfolds), blood pressure and metabolic (glucose, cholesterol, triglycerides, HDL, and irisin) measures were obtained in each participant before and after the intervention. Data are presented as medians with ranks. Analysis included paired student’s t test, and Spearman’s correlation. RESULTS: From a total of 36 children included (age, 9.5 + 1.5 years; body mass index, 23.8 (19.1-36.2 Kg/m2), 19 boys (52.8%) and 17 girls (47.2%) were studied. An increment in muscle area of the arm was observed 2583(1677-4563 mm2) to 2742 (1592-4336 mm2, p<0.03). Triglycerides decreased from 111 (60-227 mg/dl) to 91 (56-238 mg/dl, p<0.01). Plasma irisin levels did no change after the RPA program 11.2 (6-22 ng/ml) to 11.1 (5-22 ng/ml, p=0.9).Before the RPA, plasma irisin was correlated with systolic blood pressure (r=0.47, p<0.05) and diastolic blood pressure (r=0.36, p<0.05). There were no significant correlations between irisin and anthropemetrics measurements before the RPA; while plasma irisin was positively correlated with the arm muscular area (r=0.45, p<0.05) after the RPA. CONCLUSION: Similar to other studies, no changes were observed in plasma irisin levels after an RPA program. Nevertheless, the increased arm muscle area after 8 weeks of RPA was related to plasma irisin. Further studies are needed to clarify the mechanisms of this correlation in obese children.

Adductor pollicis muscle as predictor of malnutrition in surgical patients

BackgroundIn the compromised nutritional status, there is excessive skeletal muscle loss and decreased inflammatory response, contributing to increased morbidity and mortality and length of stay.AimTo estimate the prevalence of malnutrition by measuring adductor pollicis muscle using cutoffs for surgical patients suggested in the literature.MethodsCross-sectional study with 151 patients scheduled for elective surgical procedure. Nutritional assessment was performed by classical anthropometric measurements: arm circumference, triceps skinfold thickness, arm muscle circumference, corrected arm muscle area, BMI and percentage of weight loss and the extent of the adductor pollicis muscle in both hands.ResultsThe prevalence of malnutrition in patients was high. A significant association between nutritional diagnosis according to the measures of adductor pollicis muscle and arm circumference, BMI and triceps skinfold thickness but there was no association with arm muscular circumference, arm muscular area or percentage of weight loss.ConclusionThe adductor pollicis muscle has proved to be a good method to diagnose muscle depletion and malnutrition in surgical patients.

Elderly subjects with type 2 diabetes show altered tissue electrical properties

ObjectiveThe aim of the present research was to show the characteristics of body composition in a sample of elderly subjects with type 2 diabetes compared with healthy controls matched by age and body mass index (BMI) by bioelectrical impedance vector analysis. MethodsThe sample consisted of 144 free-living patients (84 women and 60 men) with type 2 diabetes 60 to 84 y old and 209 age-matched controls (116 women and 93 men). Anthropometric measurements (weight; height; upper arm, hip, waist, and calf circumferences; biceps; triceps; and subscapular and suprailiac skinfolds) were taken. Blood samples for the assessment of plasma glucose and glycated hemoglobin were collected. The BMI, upper arm muscular area, and waist-to-hip ratio were calculated. Bioelectrical impedance vector analysis was applied. The analysis was performed in the entire diabetic sample and the healthy BMI-matched groups. ResultsCompared with healthy subjects, patients had greater weight (P < 0.01 in women), higher BMI (P < 0.01 in women), smaller muscular area (P < 0.01 in men), and thicker skinfolds (P < 0.01 in women and men). Female and male patients showed larger phase angles (P < 0.01). Moreover, female patients showed a shorter vector length and lower resistance (P < 0.01) and male patients showed a higher reactance (P < 0.01). The BMI-matched analysis confirmed that patients were characterized by larger phase angles. ConclusionsOlder patients with type 2 diabetes were characterized by peculiar anthropometric and bioelectrical patterns, which can be related to their smaller appendicular muscular area and lower extracellular/intracellular water ratio.

Resistance Exercise Program: Intervention To Reduce Inflammation And Improve Nutritional Status In Hemodialysis Patients

Exercise programs have been recommended as nutritional interventions in hemodialysis (HD) patients to minimize loss of muscle mass, improve physical and functional capacity, inflammation thus controlling or preventing cardiovascular diseases (CVD), which accounts for 50% of mortality in dialysis patients. Therefore the purpose of this study was to analyze the effects of a resistance exercise (RE) program on biochemical parameters, inflammation markers, and body composition in HD patients. Thirty- six HD patients (61.1% men, mean age 46.7±2.5yrs) were studied. The anthropometric and biochemical parameters are presented in Table. There were significant differences after 6 months of RE in albumin and CRP plasma levels and body composition parameters. The HD patients gained nearly 3kg of lean mass and lost about 3% of body fat. Parameters Before(n=30) After(n=30) BMI (kg/m 2 ) 22.8±4.0 23.3±4.3 Arm muscular area (cm) 30.3±13.7 35.4±13.8 * Body Fat (%) 31.5±5.6 28.4±5.9 * Lean mass (kg) 42.4±10.0 45.5±11.0 * Albumin (g/dL) 3.6±0.3 3.8±0.2 * Globulin (g/dL) 3.2±0.3 2.8±0.5 ** Interleukin-6 (pg/mL) 81.3±9.4 78.7±10.4 TNF-α (pg/mL) 25.7±6.5 24.3±8.7 Creatinine (mg/dL) 12.5±3.6 12.2±3.7 CRP (pg/mL) 2.9±0.4 2.0±0.1 * ⁎ p<001. ⁎⁎ p<05. In conclusion, statistically significant improvements were observed in body composition, albumin and CRP levels after 6 months of resistance exercises. Therefore, RE provide better prognosis in HD patients reducing cardiovascular risk, inflammation and loss of muscle mass.

Intensive nutritional support in genetically identical triplets of nine months old with primary and severe malnutrition

ObjectiveTo characterize the gain in velocity of growth of nine months old, genetically identical triplet infants with severe and primary protein energy malnutrition after a six weeks‐periods of intensive nutritional supportSubjectsMother: 18 years old, 28 weeks of gestational age and father of 20 years old. First Triplet: Apgar 7‐9, birth weight 890g with respiratory distress. Second triplet: Apgar 8‐9, multiple congenital abnormalities in thoracic members that were diagnosed as arthrogryposis, birth weight 1100g. Third triplet: Apgar 3‐8 with respiratory distress. They were genetically identical. First and second triplets received milk infant formula lactose free, and the third triplet soy formula. At two, four and six weeks they received liquids (mL/kg/d) (189, 236 and 256), energy kcal/kg/d (141, 189, and 205), and proteins g/kg/d (3.2, 4.1 and 4.4) respectively.ResultsInitial weight at admission: first triplet 3540g, second 3320g, third 3935g. The cost of weight gain (g) was 4.3, 3.7 and 4.3 kcal/kg/d and 0.10, 0.08 and 0.10 g/kg/d of proteins respectively.ConclusionThe weight increase among triplets was identical in the six weeks‐periods. The velocity of increase of arm circumference, arm muscular area and arm fat area was lower in the second triplet with arthrogryposis.

Effects of passive stretching on post-activation potentiation and fibre conduction velocity of biceps brachii muscle

Stretching is usually part of warm-up routines in many sports, but it affects the subsequent muscle force; therefore, it could negatively influence post-activation po- tentiation (PAP), one of the warm-up's main effects. The aim of this study was to evaluate the acute effects of pas- sive stretching on PAP and fibre conduction velocity (CV). Seven subjects underwent 2 experimental sessions, con- trol (C) and stretching (S), each consisting of 2 series (7 min resting) of 3 maximal voluntary contractions (MVC) of biceps brachii (5 s isometric contraction, 10 s recov- ery). During the resting phase of the S session, the biceps brachii was passively stretched (5×45 s stretches, 15 s re- covery). Root mean square (RMS), mean frequency (MF) and CV were calculated from electromyography. Peak torque (pT) and half-contraction time (½CT) were mea- sured and normalised by the arm muscular area (pTn). After C, pTn increased and ½CT decreased (p<0.05); moreover, MF and CV increased (p<0.05). After S, ½CT increased (p<0.05) and RMS decreased (p<0.05). Passive stretching could blunt the effects of PAP, presumably due to mechanical and neuromuscular changes. The observed changes in CV suggest a possible decrease in Ca 2+ sensi- tivity in contractile proteins. Therefore, the use of passive stretching in warm-up routines remains questionable.

Amyotrophic lateral sclerosis: combined nutritional, respiratory and functional assessment

To establish correlations between nutritional, functional and respiratory indices of patients with amyotrophic lateral sclerosis (ALS). Twenty patients (13 appendicular-GA and 7 bulbar-GB) were included in the multidisciplinary study at the Neurological Clinic Ambulatory of the University of Campinas Hospital. Among the GA type significant correlation was observed between maximal inspiratory (MIP) and expiratory (MEP) pressure (r=-0.76), MEP and pulse oxymetry (r=0.58), MIP and percent weight loss (%WL; r=0.59), and between MIP, total and subscale respiratory scores (ALSFRS-R) with %WL. With regard to the GB, correlation was found between MEP and body mass index (BMI) (r=0.97). In both GA and GB correlations were noticed between the BMI and the variables mass (kg), fat (%), arm and wrist circumference (cm), and tricipital, subscapular and supra-iliac skinfolds (mm), as well as the arm muscle circumference (cm) and fatty arm muscular area (mm2). It is suggested that the application of simple anthropometric measurements could be useful in routine monitoring of patients with ALS.

Value of nutritional parameters in the prediction of postoperative complications in elective gastrointestinal surgery.

The following nutritional parameters were assessed in 117 patients before major gastrointestinal surgery: percentage recent weight loss: percentage ideal body weight; tricipital skinfold; arm muscular area; grip strength dynamometry; serum albumin (ALB); serum transferrin (TFN); delayed hypersensitivity skin tests (DH); total lymphocyte count; prognostic nutritional index (PNI) and clinical assessment of malnutrition. Comparing the results in patients without complications (n = 99) with those in patients with complications (n = 18) and the results in patients who survived (n = 109) with those who died (n = 8), we found that only ALB, DH, TFN and PNI showed significant differences in both comparisons. Correlations of complications with combined parameters was made by multiple linear regression analysis; a modified PNI (mPNI), including these three single variables, has emerged. Considering its risk values, the nutritional parameters showed the following sensitivity and specificity, respectively: ALB less than 3.2 g/dl (72 and 71 per cent), anergy (67 and 64 per cent), TFN less than 205 mg/dl (67 and 55 per cent) and mPNI less than 20 (72 and 70 per cent). Using Bayes' theorems, ALB, DH and calculated indices showed the same predictive capacity and we conclude that single or multiple association of nutritional parameters have no additive effect. To predict complications of nutritional origin it seems only necessary to consider ALB, taking into account the type of operation and the normal duration of postoperative hospital stay without oral intake.

Relação entre sobrepeso, adiposidade e distribuição de gordura com a pressão arterial de adolescentes no município do Rio de Janeiro

Estudo elaborado com o objetivo de avaliar se o sobrepeso, a adiposidade e a distribuição de gordura seriam fatores explicativos para a associação entre o crescimento e o aumento de pressão arterial. Uma amostra probabilística dos adolescentes do município do Rio de Janeiro foi obtida com base em 2040 domicílios. Foram estimados 857 adolescentes de 12 a 19 anos, 86% participaram da pesquisa (646 adolescentes), sendo avaliados 646 adolescentes, em relação às medidas de pressão arterial sistólica e diastólica, peso, altura, dobras cutâneas triciptal e subescapular, circunferências de braço, cintura e quadril. Os meninos apresentaram maior prevalência de sobrepeso (22,9 ± 2,3) quando comparados com as meninas (12,5 ± 1,9), considerando o percentil 90 do Índice de Massa Corporal (IMC-Kg/m²) da população brasileira, bem como maior prevalência de hipertensão arterial, considerando o percentil 95 da população americana. As variáveis antropométricas correlacionaram-se mais com a pressão arterial sistólica do que com a diastólica, em ambos os sexos. A área de gordura braquial permaneceu significativamente correlacionada com a pressão arterial, após o ajuste pela idade, pelo IMC e pela área muscular do braço (p&lt;0,05). Os resultados encontrados sugerem que o controle de peso em idades precoces possa ter impacto sobre a prevalência de hipertensão arterial.

Effect of recombinant human erythropoietin on insulin, amino acid, and lipid metabolism in uremia

OBJECTIVE: To determine whether anemia is important in the pathogenesis of metabolic abnormalities in insulin, amino acid, and lipid metabolism in uremia. METHODS: Twelve adolescents (15 ± 1 years of age) undergoing long-term dialysis were studied before and after correction of their anemia by human recombinant erythropoietin at a mean interval of 6 months. Six patients received hemodialysis, and six received continuous-cycling peritoneal dialysis. Insulin sensitivity was measured by the euglycemic clamp technique and insulin secretion by the hyperglycemic clamp technique in these patients. RESULTS: Hematocrit increased from 0.219 ± 0.006 to 0.344 ± 0.007 ( p <0.01). Ferritin concentration did not change significantly (11,252 ± 356 mg/dl to 785 ± 226 mg/dl). Serum iron concentration decreased from 134 ± 13 mg/dl to 83 ± 11 mg/dl, and percentage saturation decreased from 56 ± 4 to 41 ± 5 ( p <0.05 in both cases). There were no significant changes in weight, height, blood pressure, caloric intake, triceps skinfold thickness, or arm muscular area. There were also no significant changes in serum calcium, phosphate, bicarbonate, albumin, creatinine, or blood urea nitrogen concentration. Insulin sensitivity increased by 33% ( p<0.01), but insulin secretion did not change significantly. Insulin sensitivity during the euglycemic clamp studies in patients before erythropoietin therapy was lower (145 ± 10 mg/m 2 per minute; p <0.01) than published normal values (201 ± 12 mg/m 2 per minute) and was normal after erythropoietin therapy (193 ± 11 mg/m 2 per minute). Insulin secretion was low in patients before erythropoietin therapy (44 ± 8 μU/ml) compared with published normal values (68 ± 6 μU/ml) and did not change after erythropoietin therapy (46 ± 4 μU/ml). Plasma concentrations of branched-chain amino acids and lipids in the patients were compared with values from eight healthy adolescents. Plasma concentrations of valine, leucine, and isoleucine were low before treatment and were normal after 6 months of erythropoietin therapy. Plasma concentrations of triglycerides, total cholesterol, and low-density lipoprotein cholesterol were all high before treatment and were normal after treatment of anemia. CONCLUSIONS: Treatment of anemia by erythropoietin reversed insulin resistance as well as amino acid and lipid abnormalities in adolescents undergoing dialysis. (J P EDIATR 1996;129:97-104)