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      High rates of central obesity and sarcopenia in CKD irrespective of renal replacement therapy – an observational cross-sectional study

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          Abstract

          Background

          Poor nutritional status of patients with renal disease has been associated with worsening of renal function and poor health outcomes. Simply measuring weight and height for calculation of the body mass index does however not capture the true picture of nutritional status in these patients. Therefore, we measured nutritional status by BMI, body composition, waist circumference, dietary intake and nutritional screening in three groups of renal patients.

          Methods

          Patients with chronic kidney disease not on renal replacement therapy (CKD stages 3–5, n = 112), after renal transplantation ( n = 72) and patients treated with hemodialysis ( n = 24) were recruited in a tertiary hospital in Bergen, Norway in a cross-sectional observational study. Dietary intake was assessed by a single 24 h recall. All patients underwent nutritional screening, anthropometric measurements, body composition measurement andfunctional measurements (hand grip strength). The prevalence of overweight and obesity, central obesity, sarcopenia, sarcopenic obesity and nutritional risk was calculated.

          Results

          Central obesity and sarcopenia were present in 49% and 35% of patients, respectively. 49% of patients with central obesity were normal weight or overweight according to their BMI. Factors associated with central obesity were a diagnosis of diabetes and increased fat mass, while factors associated with sarcopenia were age, female gender, number of medications. An increase in the BMI was associated with lower risk for sarcopenia.

          Conclusion

          Central obesity and sarcopenia were present in renal patients at all disease stages. More attention to these unfavorable nutritional states is warranted in these patients.

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          Most cited references22

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          Hand grip strength: outcome predictor and marker of nutritional status.

          Among all muscle function tests, measurement of hand grip strength has gained attention as a simple, non-invasive marker of muscle strength of upper extremities, well suitable for clinical use. This review outlines the prognostic relevance of grip strength in various clinical and epidemiologic settings and investigates its suitability as marker of nutritional status in cross-sectional as well as intervention studies. Studies investigating grip strength as prognostic marker or nutritional parameter in cross-sectional or intervention studies were summarized. Numerous clinical and epidemiological studies have shown the predictive potential of hand grip strength regarding short and long-term mortality and morbidity. In patients, impaired grip strength is an indicator of increased postoperative complications, increased length of hospitalization, higher rehospitalisation rate and decreased physical status. In elderly in particular, loss of grip strength implies loss of independence. Epidemiological studies have moreover demonstrated that low grip strength in healthy adults predicts increased risk of functional limitations and disability in higher age as well as all-cause mortality. As muscle function reacts early to nutritional deprivation, hand grip strength has also become a popular marker of nutritional status and is increasingly being employed as outcome variable in nutritional intervention studies. Copyright © 2010 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
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            Effects of energy-restricted high-protein, low-fat compared with standard-protein, low-fat diets: a meta-analysis of randomized controlled trials.

            It is currently unclear whether altering the carbohydrate-to-protein ratio of low-fat, energy-restricted diets augments weight loss and cardiometabolic risk markers. The objective was to conduct a systematic review and meta-analysis of studies that compared energy-restricted, isocaloric, high-protein, low-fat (HP) diets with standard-protein, low-fat (SP) diets on weight loss, body composition, resting energy expenditure (REE), satiety and appetite, and cardiometabolic risk factors. Systematic searches were conducted by using MEDLINE, EMBASE, PubMed, and the Cochrane Central Register of Controlled Trials to identify weight-loss trials that compared isocalorically prescribed diets matched for fat intake but that differed in protein and carbohydrate intakes in participants aged ≥18 y. Twenty-four trials that included 1063 individuals satisfied the inclusion criteria. Mean (±SD) diet duration was 12.1 ± 9.3 wk. Compared with an SP diet, an HP diet produced more favorable changes in weighted mean differences for reductions in body weight (-0.79 kg; 95% CI: -1.50, -0.08 kg), fat mass (FM; -0.87 kg; 95% CI: -1.26, -0.48 kg), and triglycerides (-0.23 mmol/L; 95% CI: -0.33, -0.12 mmol/L) and mitigation of reductions in fat-free mass (FFM; 0.43 kg; 95% CI: 0.09, 0.78 kg) and REE (595.5 kJ/d; 95% CI: 67.0, 1124.1 kJ/d). Changes in fasting plasma glucose, fasting insulin, blood pressure, and total, LDL, and HDL cholesterol were similar across dietary treatments (P ≥ 0.20). Greater satiety with HP was reported in 3 of 5 studies. Compared with an energy-restricted SP diet, an isocalorically prescribed HP diet provides modest benefits for reductions in body weight, FM, and triglycerides and for mitigating reductions in FFM and REE.
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              Preserving Healthy Muscle during Weight Loss.

              Weight loss is the cornerstone of therapy for people with obesity because it can ameliorate or completely resolve the metabolic risk factors for diabetes, coronary artery disease, and obesity-associated cancers. The potential health benefits of diet-induced weight loss are thought to be compromised by the weight-loss-associated loss of lean body mass, which could increase the risk of sarcopenia (low muscle mass and impaired muscle function). The objective of this review is to provide an overview of what is known about weight-loss-induced muscle loss and its implications for overall physical function (e.g., ability to lift items, walk, and climb stairs). The currently available data in the literature show the following: 1) compared with persons with normal weight, those with obesity have more muscle mass but poor muscle quality; 2) diet-induced weight loss reduces muscle mass without adversely affecting muscle strength; 3) weight loss improves global physical function, most likely because of reduced fat mass; 4) high protein intake helps preserve lean body and muscle mass during weight loss but does not improve muscle strength and could have adverse effects on metabolic function; 5) both endurance- and resistance-type exercise help preserve muscle mass during weight loss, and resistance-type exercise also improves muscle strength. We therefore conclude that weight-loss therapy, including a hypocaloric diet with adequate (but not excessive) protein intake and increased physical activity (particularly resistance-type exercise), should be promoted to maintain muscle mass and improve muscle strength and physical function in persons with obesity.
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                Author and article information

                Contributors
                0047 55977344 , jutta.dierkes@uib.no
                helene.dahl@uib.no
                natasha.welland@outlook.com
                kristina247@gmail.com
                kristin.sele@helse-bergen.no
                ingegjerd.sekse@helse-bergen.no
                hans-peter.marti@uib.no
                Journal
                BMC Nephrol
                BMC Nephrol
                BMC Nephrology
                BioMed Central (London )
                1471-2369
                11 October 2018
                11 October 2018
                2018
                : 19
                : 259
                Affiliations
                [1 ]ISNI 0000 0004 1936 7443, GRID grid.7914.b, Department of Clinical Medicine, Center for Nutrition, , University of Bergen, ; Jonas Lies vei 68, 5021 Bergen, Norway
                [2 ]ISNI 0000 0000 9753 1393, GRID grid.412008.f, Department of Nephrology, , Haukeland University Hospital, ; Jonas Lies vei 65, 5021 Bergen, Norway
                Author information
                http://orcid.org/0000-0003-0663-877X
                Article
                1055
                10.1186/s12882-018-1055-6
                6180401
                30305034
                554c215d-9430-4080-99c3-81f9f3ac3698
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 28 September 2017
                : 24 September 2018
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Nephrology
                esrd,renal disease,nutritional status,sarcopenia
                Nephrology
                esrd, renal disease, nutritional status, sarcopenia

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