Longitudinal study of nutritional status, body composition, and physical function in hemodialysis patients

被引:145
作者
Johansen, KL
Kaysen, GA
Young, BS
Hung, AM
da Silva, M
Chertow, GM
机构
[1] Vet Adm Med Ctr, Div Nephrol, San Francisco, CA 94121 USA
[2] Univ Calif San Francisco, Mt Zion Med Ctr, San Francisco, CA 94143 USA
[3] Univ Calif San Francisco, San Francisco, CA 94143 USA
[4] Univ Calif Davis, Div Nephrol, Davis, CA 95616 USA
关键词
end-stage renal disease; hemodialysis; nutritional status; physical activity; physical performance; physical function; inflammation; longitudinal study;
D O I
10.1093/ajcn/77.4.842
中图分类号
R15 [营养卫生、食品卫生]; TS201 [基础科学];
学科分类号
100403 ;
摘要
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.
引用
收藏
页码:842 / 846
页数:5
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