{"title":"非透析依赖型慢性肾病患者骨质密度的变化与身体成分有关。","authors":"","doi":"10.1053/j.jrn.2024.03.011","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>Chronic kidney disease (CKD) and low bone mineral density (BMD) are highly prevalent and can co-exist. Parameters of mineral metabolism are associated with BMD in CKD, but other contributing factors may contribute. The aim of this study was to assess changes in BMD and its determinants in patients with nondialysis-dependent CKD (NDD-CKD).</p></div><div><h3>Methods</h3><p>Body composition and biochemical profiles were assessed in a retrospective hospital-based cohort study of patients with NDD-CKD. BMD, lean soft tissue (LST), appendicular LST (ALST), and percentage fat mass were assessed by dual-energy X-ray absorptiometry. The ALST index (ALSTI, ALST/height<sup>2</sup>) and load-capacity index (LCI, fat mass/LST) were calculated. Low BMD was defined as T-score ≤ −1.0.</p></div><div><h3>Results</h3><p>The mean time between assessments was 2.8 ± 1.3 years; 46 patients were included. A reduction in renal function was observed. Changes in body composition included reductions in ALST (<em>P</em> = .031), ALSTI (<em>P</em> = .021), a trend for BMD (<em>P</em> = .053), and an increase in percentage fat mass (<em>P</em> = .044) and LCI (<em>P</em> = .032). Females had a reduction in BMD (<em>P</em> = .034), ALST (<em>P</em> = .026), and ALSTI (<em>P</em> = .037). Patients with low BMD at baseline had lower LST (<em>P</em> = .013), ALST (<em>P</em> = .023), and percentage fat mass (<em>P</em> = .037) than those with normal BMD. Additionally, reductions in LST (<em>P</em> = .041), ALST (<em>P</em> = .006), and ALSTI (<em>P</em> = .008) were observed in patients who had low BMD at baseline, while no significant changes in body composition were observed in those with normal BMD at baseline. The following body composition parameters at baseline were determinants of BMD status at follow-up: LST (odds ratio [OR]: 0.899, 95% confidence interval [CI]: 0.829-0.976, <em>P</em> = .010), ALST (OR: 0.825, 95% CI: 0.704-0.967, <em>P</em> = .017), and ALSTI (OR: 0.586, 95% CI: 0.354-0.968, <em>P</em> = .037), independent of fat mass and LCI.</p></div><div><h3>Conclusions</h3><p>Detrimental body composition changes were observed without changes in body weight; these were more significant in females. Moreover, this is the first longitudinal study showing a protective effect of LST against BMD loss in patients with NDD-CKD.</p></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":null,"pages":null},"PeriodicalIF":3.4000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1051227624000633/pdfft?md5=8e6e1240a29b6cc293fee5bf4c93fb1e&pid=1-s2.0-S1051227624000633-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Changes in Bone Mineral Density in Patients With Non-dialysis-Dependent Chronic Kidney Disease Are Associated With Body Composition\",\"authors\":\"\",\"doi\":\"10.1053/j.jrn.2024.03.011\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>Chronic kidney disease (CKD) and low bone mineral density (BMD) are highly prevalent and can co-exist. Parameters of mineral metabolism are associated with BMD in CKD, but other contributing factors may contribute. The aim of this study was to assess changes in BMD and its determinants in patients with nondialysis-dependent CKD (NDD-CKD).</p></div><div><h3>Methods</h3><p>Body composition and biochemical profiles were assessed in a retrospective hospital-based cohort study of patients with NDD-CKD. BMD, lean soft tissue (LST), appendicular LST (ALST), and percentage fat mass were assessed by dual-energy X-ray absorptiometry. The ALST index (ALSTI, ALST/height<sup>2</sup>) and load-capacity index (LCI, fat mass/LST) were calculated. Low BMD was defined as T-score ≤ −1.0.</p></div><div><h3>Results</h3><p>The mean time between assessments was 2.8 ± 1.3 years; 46 patients were included. A reduction in renal function was observed. Changes in body composition included reductions in ALST (<em>P</em> = .031), ALSTI (<em>P</em> = .021), a trend for BMD (<em>P</em> = .053), and an increase in percentage fat mass (<em>P</em> = .044) and LCI (<em>P</em> = .032). Females had a reduction in BMD (<em>P</em> = .034), ALST (<em>P</em> = .026), and ALSTI (<em>P</em> = .037). Patients with low BMD at baseline had lower LST (<em>P</em> = .013), ALST (<em>P</em> = .023), and percentage fat mass (<em>P</em> = .037) than those with normal BMD. Additionally, reductions in LST (<em>P</em> = .041), ALST (<em>P</em> = .006), and ALSTI (<em>P</em> = .008) were observed in patients who had low BMD at baseline, while no significant changes in body composition were observed in those with normal BMD at baseline. The following body composition parameters at baseline were determinants of BMD status at follow-up: LST (odds ratio [OR]: 0.899, 95% confidence interval [CI]: 0.829-0.976, <em>P</em> = .010), ALST (OR: 0.825, 95% CI: 0.704-0.967, <em>P</em> = .017), and ALSTI (OR: 0.586, 95% CI: 0.354-0.968, <em>P</em> = .037), independent of fat mass and LCI.</p></div><div><h3>Conclusions</h3><p>Detrimental body composition changes were observed without changes in body weight; these were more significant in females. Moreover, this is the first longitudinal study showing a protective effect of LST against BMD loss in patients with NDD-CKD.</p></div>\",\"PeriodicalId\":50066,\"journal\":{\"name\":\"Journal of Renal Nutrition\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.4000,\"publicationDate\":\"2024-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S1051227624000633/pdfft?md5=8e6e1240a29b6cc293fee5bf4c93fb1e&pid=1-s2.0-S1051227624000633-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Renal Nutrition\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1051227624000633\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"NUTRITION & DIETETICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Renal Nutrition","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1051227624000633","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"NUTRITION & DIETETICS","Score":null,"Total":0}
Changes in Bone Mineral Density in Patients With Non-dialysis-Dependent Chronic Kidney Disease Are Associated With Body Composition
Objective
Chronic kidney disease (CKD) and low bone mineral density (BMD) are highly prevalent and can co-exist. Parameters of mineral metabolism are associated with BMD in CKD, but other contributing factors may contribute. The aim of this study was to assess changes in BMD and its determinants in patients with nondialysis-dependent CKD (NDD-CKD).
Methods
Body composition and biochemical profiles were assessed in a retrospective hospital-based cohort study of patients with NDD-CKD. BMD, lean soft tissue (LST), appendicular LST (ALST), and percentage fat mass were assessed by dual-energy X-ray absorptiometry. The ALST index (ALSTI, ALST/height2) and load-capacity index (LCI, fat mass/LST) were calculated. Low BMD was defined as T-score ≤ −1.0.
Results
The mean time between assessments was 2.8 ± 1.3 years; 46 patients were included. A reduction in renal function was observed. Changes in body composition included reductions in ALST (P = .031), ALSTI (P = .021), a trend for BMD (P = .053), and an increase in percentage fat mass (P = .044) and LCI (P = .032). Females had a reduction in BMD (P = .034), ALST (P = .026), and ALSTI (P = .037). Patients with low BMD at baseline had lower LST (P = .013), ALST (P = .023), and percentage fat mass (P = .037) than those with normal BMD. Additionally, reductions in LST (P = .041), ALST (P = .006), and ALSTI (P = .008) were observed in patients who had low BMD at baseline, while no significant changes in body composition were observed in those with normal BMD at baseline. The following body composition parameters at baseline were determinants of BMD status at follow-up: LST (odds ratio [OR]: 0.899, 95% confidence interval [CI]: 0.829-0.976, P = .010), ALST (OR: 0.825, 95% CI: 0.704-0.967, P = .017), and ALSTI (OR: 0.586, 95% CI: 0.354-0.968, P = .037), independent of fat mass and LCI.
Conclusions
Detrimental body composition changes were observed without changes in body weight; these were more significant in females. Moreover, this is the first longitudinal study showing a protective effect of LST against BMD loss in patients with NDD-CKD.
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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