Wesley J Visser, Manon de Geus, Isabel M van Ruijven, Anneke M E van Egmond-de Mik, Lucie Venrooij, Robbert C Minnee, Pim Moeskops, Edwin H G Oei, Manouk Dam, David Severs
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引用次数: 0
Abstract
Objective: Malnutrition is highly prevalent in patients with kidney failure. Since body weight does not reflect body composition, other methods are needed to determine muscle mass, often estimated by fat-free mass (FFM). Bioimpedance spectroscopy (BIS) is frequently used for monitoring body composition in patients with kidney failure. Unfortunately, BIS-derived lean tissue mass (LTMBIS) is not suitable for comparison with FFM cutoff values for the diagnosis of malnutrition, or for calculating dietary protein requirements. Hypothetically, FFM could be derived from BIS (FFMBIS). This study aims to compare FFMBIS and LTMBIS with computed tomography (CT) derived FFM (FFMCT). Secondarily, we aimed to explore the impact of different methods on calculated protein requirements.
Methods: CT scans of 60 patients with kidney failure stages 4-5 were analyzed at the L3 level for muscle cross-sectional area, which was converted to FFMCT. Spearman rank correlation coefficient and 95% limits of agreement were calculated to compare FFMBIS and LTMBIS with FFMCT. Protein requirements were determined based on FFMCT, FFMBIS, and adjusted body weight. Deviations over 10% were considered clinically relevant.
Results: FFMCT correlated most strongly with FFMBIS (r = 0.78, P < .001), in males (r = 0.72, P < .001) and in females (r = 0.60, P < .001). A mean difference of -0.54 kg was found between FFMBIS and FFMCT (limits of agreement: -14.88 to 13.7 kg, P = .544). Between LTMBIS and FFMCT a mean difference of -12.2 kg was apparent (limits of agreement: -28.7 to 4.2 kg, P < .001). Using FFMCT as a reference, FFMBIS best predicted protein requirements. The mean difference between protein requirements according to FFMBIS and FFMCT was -0.7 ± 9.9 g in males and -0.9 ± 10.9 g in females.
Conclusion: FFMBIS correlates well with FFMCT at a group level, but shows large variation within individuals. As expected, large clinically relevant differences were observed in calculated protein requirements.
期刊介绍：
The Journal of Renal Nutrition is devoted exclusively to renal nutrition science and renal dietetics. Its content is appropriate for nutritionists, physicians and researchers working in nephrology. Each issue contains a state-of-the-art review, original research, articles on the clinical management and education of patients, a current literature review, and nutritional analysis of food products that have clinical relevance.
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