Malnutrition according to GLIM criteria in stable renal transplant recipients: Reduced muscle mass as predominant phenotypic criterion
Malnutrition according to GLIM criteria in stable renal transplant recipients: Reduced muscle mass as predominant phenotypic criterion
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DOI：
10.1016/j.clnu.2020.11.034
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发表时间：
2021-05-01
影响因子：
6.3
通讯作者：
Navis, Gerjan J.
中科院分区：
文献类型：
--
作者：
Boslooper-Meulenbelt, K.;van Vliet, Iris M. Y.;Navis, Gerjan J.
背景和目标：营养不良对肾移植受者 (RTR) 的生活质量和生存产生负面影响。因此，营养不良检测在 RTR 中很重要，但这可能会因体重增加和超重同时存在而受到阻碍。最近，全球营养不良领导倡议（GLIM）制定了一套营养不良诊断标准。我们的目的是根据 GLIM 标准和 RTR 表型标准的分布来评估营养不良的患病率。此外，我们还检查了 24 小时尿肌酐排泄率 (CER) 作为肌肉质量减少标准的替代衡量标准的潜在价值。方法：我们使用 TransplantLines 队列和生物库研究 (NCT02811835) 中包含的稳定门诊 RTR 数据。体重减轻和摄入或同化减少的情况来自患者主观整体评估 (PG-SGA) 项目评分。通过多频生物电阻抗分析 (MF-BIA) 评估肌肉质量减少，并将其定义为男性阑尾骨骼肌质量指数 (ASMI) < 7 kg/m(2) 和 5 mg/L。营养不良被定义为存在至少一种表型（体重减轻和/或低 BMI 和/或肌肉质量减少）和一种病因标准（摄入/同化减少和/或疾病负担/炎症）。 结果：我们纳入了 599 名 RTR（55 +/- 13 岁，62% 男性，BMI 27.2 +/- 4.7 kg/m(2)），中位年龄为 3.1 年移植后。根据GLIM标准，14%的人营养不良，其中91%符合肌肉质量减少的表型标准。使用 CHI 作为肌肉质量的衡量标准也发现了类似的结果（13% 营养不良，其中 79% 肌肉质量减少）。结论：七分之一的稳定 RTR 中存在营养不良，其中肌肉质量减少是主要的表型标准。在日常护理中需要评估营养状况，最重要的是肌肉状况，以防止 RTR 中的营养不良未被发现和治疗。 24小时尿CER在这方面的诊断价值需要进一步研究。 (C) 2020 作者。由爱思唯尔有限公司出版
Background & aims: Malnutrition has a negative impact on quality of life and survival in renal transplant recipients (RTR). Therefore, malnutrition detection is important in RTR, but this may be hampered by concomitant presence of weight gain and overweight. Recently, the Global Leadership Initiative on Malnutrition (GLIM) developed a set of diagnostic criteria for malnutrition. We aimed to assess the prevalence of malnutrition according to the GLIM criteria and the distribution of phenotypic criteria in RTR. Additionally, we examined the potential value of 24-h urinary creatinine excretion rate (CER) as alternative measure for the criterion reduced muscle mass.Methods: We used data from stable outpatient RTR included in the TransplantLines Cohort and Biobank Study (NCT02811835). Presence of weight loss and reduced intake or assimilation were derived from Patient-Generated Subjective Global Assessment (PG-SGA) item scores. Reduced muscle mass was assessed by multi-frequency bio-electrical impedance analysis (MF-BIA) and defined as an appendicular skeletal muscle mass index (ASMI) < 7 kg/m(2) for men and 5 mg/L. Malnutrition was defined as presence of at least one phenotypic (weight loss and/or low BMI and/or reduced muscle mass) and one etiologic criterion (reduced intake/assimilation and/or disease burden/inflammation).Results: We included 599 RTR (55 +/- 13 years old, 62% male, BMI 27.2 +/- 4.7 kg/m(2)) at a median of 3.1 years after transplantation. According to GLIM criteria, 14% was malnourished, of which 91% met the phenotypic criterion for reduced muscle mass. Similar results were found by using CHI as measure for muscle mass (13% malnutrition of which 79% with reduced muscle mass).Conclusions: Malnutrition is present in one in 7 stable RTR, with reduced muscle mass as the predominant phenotypic criterion. Assessment of nutritional status, most importantly muscle status, is warranted in routine care, to prevent malnutrition in RTR from remaining undetected and untreated. The diagnostic value of 24-h urinary CER in this regard requires further investigation. (C) 2020 The Author(s). Published by Elsevier Ltd.