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Abnormalities of bioimpedance measures in overweight and obese hemodialyzed patients

International Journal of Obesity volume 25, pages 265–272 (2001)Cite this article

Abstract

BACKGROUND: The body composition in overweight and obese hemodialyzed patients (HD) remains ill-defined. This study evaluates in HD patients the influence of body size, as indicated by body mass index (BMI, kg/m2), on body composition by measuring bioimpedance analysis (BIA)-derived variables (phase angle (PA), fat-free mass (FFM) and body cell mass (BCM).

METHODS: We studied 50 Caucasian patients (mean age 62.8±9.2 y) on standard bicarbonate hemodialysis for at least 12 months who regularly achieved dry weight in post-HD, received similar dialysis doses and were free from inflammation/infection. Thirty-eight gender- and age-matched healthy subjects were included as controls (CON). Both HD and CON were divided into three groups on the basis of their BMI(kg/m2) 18.5–24.9, normal-weight (NW); 25–29.9, overweight (OW); and ≥30, obese (OB). In HD patients, BIA was performed 30 min after the end of dialysis.

RESULTS: Seven patients were obese (12%) while 16 were overweight (32%); in CON, 12 were obese (31%) and 12 overweight (31%). BIA-measured extracellular water was comparable in all groups. PA, which was similar in normal-weight HD and CON (6.2±0.9° and 6.3±0.8°), decreased in OW- and OB-HD patients (5.3±1.0° and 5.2±0.6°, respectively; P<0.05 vs NW-HD) while it was unchanged in OW- and OB-CON (6.1±0.8° and 5.9±0.5°, P<0.05 vs respective HD groups). In OW and OB patients, the lower PA values were coupled with a major reduction of BIA-derived percentage BCM and FFM (P<0.05 vs NW-HD, and vs OW- and OB-CON). In patients, PA and BCM correlated with anthropometry-measured FFM. Of note, serum albumin and protein catabolic rate were significantly reduced in OB patients.

CONCLUSION: In overweight and obese HD patients, BIA-derived FFM, BCM and PA are significantly lower with respect to normal-weight patients and BMI-matched controls. These abnormalities of body composition are coupled with reduction of anthropometric measures of lean mass and a decrease of protein intake that, however, becomes significant only in the obese. We therefore suggest that overweight and obese HD patients are at risk of protein malnutrition in spite of excessive energy intake. BIA may be considered as a useful diagnostic tool to detect such a condition early.

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Authors and Affiliations

  1. Department of Neuroscience/Physiology Nutrition Section, University Federico II, Naples, Italy

    B Guida, P Pecoraro, R Trio & F Di Paola

  2. Second University of Naples, Naples, Italy

    L De Nicola & C Iodice

  3. Lauria Hospital, Naples, Italy

    V Bellizzi

  4. Division of Nephrology, University Federico II, Naples, Italy

    B Memoli

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  1. B Guida
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  2. L De Nicola
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Correspondence to B Guida.

Appendix

Appendix

List of abbreviations

BIA, bioelectrical impedance analysis;

HD, hemodialysis;

R, resistance;

Xc, reactance;

PA, phase angle;

TBW, total body water;

BCM, body cell mass;

FFM, fat free mass;

FM, fat mass;

ECW%, extracellular water as a percentage of total body water;

BCM%, body cell mass as a percentage of body weight;

FFM%, fat free mass as a percentage of body weight;

FM%, fat mass as a percentage of body weight;

BMI, body mass index.

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Guida, B., De Nicola, L., Pecoraro, P. et al. Abnormalities of bioimpedance measures in overweight and obese hemodialyzed patients. Int J Obes 25, 265–272 (2001). https://doi.org/10.1038/sj.ijo.0801475

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