Longitudinal study of nutritional status, body composition, and physical function in hemodialysis patients
Longitudinal study of nutritional status, body composition, and physical function in hemodialysis patients
复制标题
DOI：
10.1093/ajcn/77.4.842
复制
发表时间：
2003-04-01
影响因子：
7.1
通讯作者：
Chertow, GM
中科院分区：
文献类型：
--
作者：
Johansen, KL;Kaysen, GA;Chertow, GM
背景：横断面研究显示透析持续时间与营养状况之间存在关联，提供了消瘦的证据。目的：目的是确定血液透析患者消瘦的程度、速度、决定因素和最佳评估方法。设计：对54例血液透析患者在1年内进行了4次实验室变量、身体成分、体力活动、功能和表现测试。评估重复测量的变化，并根据年龄、性别、种族、糖尿病状况和透析年份（即开始透析后的时间）调整基线差异。结果：没有观察到体重、脂肪量、瘦体重或实验室变量的显著变化。相位角，一个与体细胞质量相关的生物电阻抗分析衍生变量，显著下降（线性估计：-0.043度/月，或接近0.5度/年；P = 0.001）。加速度计测量的体力活动下降3.4%/月（P = 0.01）。人类活动剖面（HAP）的最大活动评分也显著下降（线性估计：-0.50/月，或约6点/年；P = 0.025）。白细胞介素1 β (IL- 1 β)浓度越高，相位角越窄（P = 0.004），相位角随时间下降越快（时间× IL-1 β相互作用，P = 0.01）；观察到il -1 β对身体活动的类似影响。膳食蛋白质和能量摄入与HAP的变化有关。结论：在本队列中观察到身体组成和身体活动、功能和表现的不利变化，以及炎症和饮食摄入对这些变化的适度影响的证据。可能需要生物电阻抗分析、加速度计和HAP等工具来识别细微的变化。
Background: Cross-sectional studies have shown an association between the duration (y) of dialysis and nutritional status, providing evidence of wasting.Objective: The aim was to determine the extent, pace, determinants, and optimal methods of assessing wasting in patients undergoing hemodialysis.Design: Laboratory variables, body composition, and physical activity, function, and performance were tested 4 times over 1 y in 54 hemodialysis patients. Changes in repeated measures were evaluated, with adjustment for baseline differences by age, sex, race, diabetes status, and dialysis vintage (ie, time since initiation of dialysis).Results: No significant changes in body weight, fat mass, lean body mass, or laboratory variables were observed. Phase angle, a bioelectrical impedance analysis-derived variable related to body cell mass, decreased significantly (linear estimate: -0.043 degrees/mo, or approximate to0.5 degrees/y; P = 0.001). Physical activity measured by accelerometry declined 3.4%/mo (P = 0.01). The Maximum Activity Score of the Human Activity Profile (HAP) also declined significantly (linear estimate: -0.50/mo, or approximate to6 points/y; P = 0.025). Higher interleukin 1beta (IL- 1beta) concentrations were associated with a narrower phase angle (P = 0.004) and with a more rapid decline in phase angle with time (time x IL-1beta interaction, P = 0.01); similar effects of IL-1beta on physical activity were observed. Dietary protein and energy intakes were associated with changes in the HAP.Conclusions: Evidence of adverse changes in body composition and physical activity, function, and performance and of a modest influence of inflammation and dietary intake on these changes was observed in this cohort. Tools such as bioelectrical impedance analysis, accelerometry, and the HAP may be required to identify subtle changes.