Chronic kidney disease and high eGFR according to body composition phenotype in adults with normal BMI

CT-based muscle and adipose measurements predict prognosis in patients with digestive system malignancy

The role of skeletal muscle and adipose tissue in the progression of cancer has been gradually discussed, but it needs further exploration. The objective of this study was to provide an in-depth analysis of skeletal muscle and fat in digestive malignancies and to construct novel predictors for clinical management. This is a retrospective study that includes data from Cancer Center, the First Hospital of Jilin University. Basic characteristic information was analyzed by T tests. Correlation matrices were drawn to explore the relationship between CT-related indicators and other indicators. Cox risk regression analyses were performed to analyze the association between the overall survivals (OS) and various types of indicators. A new indicator body composition score (BCS) was then created and a time-dependent receiver operating characteristic curve was plotted to analyze the efficacy of the BCS. Finally, a nomogram was produced to develop a scored-CT system based on BCS and other indicators. C-index and calibration curve analyses were performed to validate the predictive accuracy of the scored-CT system. A total of 575 participants were enrolled in the study. Cox risk regression model revealed that VFD, L3 SMI and VFA/SFA were associated with prognosis of cancer patients. After adjustment, BCS index based on CT was significantly associated with prognosis, both in all study population and in subgroup analysis according to tumor types (all study population: HR 2.036, P < 0.001; colorectal cancer: HR 2.693, P < 0.001; hepatocellular carcinoma: HR 4.863, P < 0.001; esophageal cancer: HR 4.431, P = 0.008; pancreatic cancer: HR 1.905, P = 0.016; biliary system malignancies: HR 23.829, P = 0.035). The scored-CT system was constructed according to tumor type, stage, KPS, PG-SGA and BCS index, and it was of great predictive validity. This study identified VFD, L3 SMI and VFA/SFA associated with digestive malignancies outcomes. BCS was created and the scored-CT system was established to predict the OS of cancer patients.

Renal impairment is prevalent in pediatric NAFLD/MASLD and associated with disease severity

OBJECTIVES

Renal impairment is prevalent in adults with nonalcoholic fatty liver disease (NAFLD/metabolic dysfunction associated steatotic liver disease [MASLD]) and is associated with increased mortality. Pediatric data are limited. Our objective was to determine the prevalence of hyperfiltration or chronic kidney disease (CKD) in children with NAFLD/MASLD and determine links with liver disease severity.

METHODS

Data from children who had previously participated in prospective, multicenter, pediatric studies by the Nonalcoholic Steatohepatitis Clinical Research Network (NASH-CRN) were collected. Renal function was determined using the calculated glomerular filtration rate (cGFR). Hyperfiltration was defined as cGFR > 135 mL/min/1.73m2, while CKD stage 2 or higher as cGFR < 90 mL/min/1.73 m2. Renal dysfunction progression was defined as transition from normal to hyperfiltration or to CKD stage ≥ 2, or change in CKD by ≥1 stage. Multinomial logistic regression models were used to determine the prevalence of CKD and independent associations between CKD and liver disease severity.

RESULTS

The study included 1164 children (age 13 ± 3 years, 72% male, 71% Hispanic). The median cGFR was 121 mL/min/1.73 m2; 12% had CKD stage 2-5, while 27% had hyperfiltration. Hyperfiltration was independently associated with significant liver fibrosis (odds ratio: 1.45). Baseline renal function was not associated with progression in liver disease over a 2-year period (n = 145). Renal dysfunction worsened in 19% independently of other clinical risk factors. Progression of renal impairment was not associated with change in liver disease severity.

CONCLUSIONS

Renal impairment is prevalent in children with NAFLD/MASLD and hyperfiltration is independently associated with significant liver fibrosis. Almost 1/5 children have evidence of progression in renal dysfunction over 2 years, not associated with change in liver disease severity. Future assessments including additional renal impairment biomarkers are needed.

Positive Association of Pulse Pressure with Presence of Albuminuria in Chinese Adults with Prediabetes: A Community-Based Study

Purpose: There has been limited evidence for the association between pulse pressure (PP) and proteinuria in prediabetes. The aim of our study was to explore the association between PP and albuminuria in community-dwelling Chinese adults with prediabetes. Materials and Methods: PP and urinary albumin-to-creatinine ratio (ACR) were measured in 2012 prediabetic patients and 3596 control subjects with normal glucose tolerance. Multivariate logistic regression models were used to evaluate the possible association of PP with the risk of presence of albuminuria. Results: PP was positively associated with the presence of albuminuria, and subjects in the higher PP quartiles had higher urinary ACR and presence of albuminuria as compared with those in the lowest quartile in both prediabetes and control groups (all P < 0.01). Multivariate logistic regression analysis demonstrated that the highest PP quartile was positively associated with increased risk of presence of albuminuria in all prediabetic subjects [odds ratio (OR): 2.289, 95% confidence interval (CI) 1.364-3.842, P < 0.01) and prediabetic subjects without anti-hypertensive drugs (OR: 1.932, 95% CI 1.116-3.343, P < 0.01), whereas higher PP quartile has nothing to do with the risk of presence of albuminuria in control subjects with and without anti-hypertensive drugs after adjustment for potential confounders (all P > 0.01). Consistently, stratified analysis showed that in the prediabetes group, the risks of presence of albuminuria progressively elevated with increasing PP quartiles in men, those aged 60 years or older, and with overweight/obesity, normal high-density lipoprotein cholesterol, and appropriate low-density lipoprotein cholesterol (all P for trend <0.05). Conclusion: Higher PP is independently related to increased risk of presence of albuminuria in community-dwelling Chinese adults with prediabetes.

Sex Difference in Cutoff and Prevalence of Sarcopenia among 300,090 Urban Korean Population: Association with Metabolic Syndrome

Background and Objectives: The study aimed to establish the threshold values and prevalence of sarcopenia and to investigate the association of sarcopenia with metabolic syndrome in an urban Korean population. Materials and Methods: The study included 300,090 adults who underwent anthropometric analyses by bioelectrical impedance analyzer. Sarcopenia was defined as: (1) class I, skeletal muscle mass index (SMI) within −1 to −2 standard deviations (SDs); (2) or class II, <−2 SD of SMI in a young population. Results: Low SMI threshold levels for class I and class II sarcopenia were 39.8 and 36.7% in men, and 35.5 and 32.3% in women. Among all age groups, the prevalence rates of sarcopenia were highest in the age group 80−89 years. Following adjustment for possible confounders including age, sex, height, metabolic and health behavioral factors, adjusted odds ratios (95% confidence intervals) for the risk of metabolic syndrome were 2.43 (2.33−2.54) for class I and 2.69 (2.49−2.91) for class II sarcopenia, compared with the normal reference. Sarcopenia was more strongly associated with metabolic syndrome in women than men (p for interaction < 0.01). The threshold values and prevalence of sarcopenia were demonstrated in a large Korean urban population. Conclusions: This study identified that sarcopenia was associated with increased risk of metabolic syndrome, showing itself to be significantly higher in women than men.

Effect of Online Home-Based Training on Functional Capacity and Strength in Two CKD Patients: A Case Study

Chronic kidney disease (CKD) is a clinical condition characterized by the loss of kidney function over time, as well as several complications affecting gastrointestinal, cardiovascular, and musculoskeletal systems. Physical exercise seems to induce positive adaptations in CKD patients, without side effects. Usually, these patients show a reduced physical activity and physical performance. The aim of this case-report was to evaluate the effects of an online training protocol on functional capacity and on muscle mass, in CKD stage III patients. Methods: Two CKD (stage III according to KDIGO guidelines) participants (1 female, Patient A; 1 male, Patient B) were enrolled and they performed an online tailored-supervised combined training lasting 12 weeks, including multi-joint strength exercises using TheraBand and an aerobic session at 65–70% of the patients' heart rate reserve. Results: Both patients showed an improving trend on functional capacity (6 minutes walking test: Patient A = +3%; Patient B = +5.3%) and on strength of the upper arms (handgrip strength test-right: Patient A = +13.4%; Patient B = +19.1%; handgrip strength test-left: Patient A = +42.8%; Patient B= +12.9%), as well as a reduction in inflammation and oxidative stress biomarkers. The protocol was feasible, and no side effects were evidenced. These case studies suggest that the online combined training can produce beneficial effects in CKD patients under conservative therapy, by reducing the CKD-related complications and improving the adherence to exercise of this population of patients, overcoming logistic barriers such as transportation, availability of facilities, and working and personal-life schedule.

Augmented Renal Clearance, Muscle Catabolism and Urinary Nitrogen Loss: Implications for Nutritional Support in Critically Ill Trauma Patients

The main objective of this pilot study was to determine the association between augmented renal clearance (ARC), urinary nitrogen loss and muscle wasting in critically ill trauma patients. We conducted a retrospective analysis of a local database in 162 critically ill trauma patients without chronic renal dysfunction. Nutritional-related parameters and 24 h urinary biochemical analyses were prospectively collected and averaged over the first ten days after admission. Augmented renal clearance was defined by a mean creatinine clearance (CL_CR) > 130 mL/min/1.73 m². The main outcome was the cumulated nitrogen balance at day 10. The secondary outcome was the variation of muscle psoas cross-sectional area (ΔCSA) calculated in the subgroup of patients who underwent at least two abdominal CT scans during the ICU length of stay. Overall, there was a significant correlation between mean CL_CR and mean urinary nitrogen loss (normalized coefficient: 0.47 ± 0.07, p < 0.0001). ARC was associated with a significantly higher urinary nitrogen loss (17 ± 5 vs. 14 ± 4 g/day, p < 0.0001) and a lower nitrogen balance (−6 ± 5 vs. −4 ± 5 g/day, p = 0.0002), without difference regarding the mean protein intake (0.7 ± 0.2 vs. 0.7 ± 0.3 g/kg/day, p = 0.260). In the subgroup of patients who underwent a second abdominal CT scan (N = 47), both ΔCSA and %ΔCSA were higher in ARC patients (−33 [−41; −25] vs. −15 [−29; −5] mm²/day, p = 0.010 and −3 [−3; −2] vs. −1 [−3; −1] %/day, p = 0.008). Critically ill trauma patients with ARC are thus characterized by a lower nitrogen balance and increased muscle loss over the 10 first days after ICU admission. The interest of an increased protein intake (>1.5 g/kg/day) in such patients remains a matter of controversy and must be confirmed by further randomized trials.

Reference values of skeletal muscle mass, fat mass and fat-to-muscle ratio for rural middle age and older adults in western China

BACKGROUND

Skeletal muscle mass (SMM), fat mass (FM) and fat-to-muscle ratio (FMR) are significant indicators in epidemiology studies and clinical settings. The aim of this study was to establish age-related and sex-specific reference values for skeletal muscle mass index (SMMI), fat mass index (FMI) and FMR by bioelectrical impedance analysis (BIA) for healthy rural adults in western China.

METHODS

This study is a cross-sectional study from Ningxia cohort study, included 13,790 individuals aged 35 to 74 years. Bioelectrical impedance analysis (BIA) was performed to measure body composition. Lambda-mu-sigma method was used to establish age-related and sex-specific percentile curves for SMMI, FMI and FMR.

RESULTS

Overall, men had higher SMMI, but lower FMI and FMR than women for all ages. The SMMI decreased rapidly with age for men and women after 55 years and 45 years, respectively. FMI in men remain stable until 70 years; women's FMI showed a rapidly increasing after 50 years. The FMR increased consistently after 35 years for both men and women. These age-related and sex-specific reference values were established with the mean ± SD as the normal reference range.

CONCLUSIONS

These reference values could be used as simple tools to identify age-specific low SMMI or high FMI and facilitate earlier identification sarcopenia or sarcopenic obesity in rural Chinese adults.

Combined Effects of Dyslipidemia and High Adiposity on the Estimated Glomerular Filtration Rate in a Middle-Aged Chinese Population

BACKGROUND

Some studies have reported that chronic kidney disease (CKD) or the estimated glomerular filtration rate (eGFR) is significantly associated with metabolic abnormalities.

METHODS

Six hundred forty-six community residents aged 45-60 years without overt renal dysfunction were recruited in this cross-sectional study. eGFR was estimated by serum creatinine measurement. The visceral fat area (VFA) and subcutaneous fat area (SFA) were assessed by magnetic resonance imaging (MRI). The body mass index (BMI) and waist-hip ratio (WHR) were also evaluated. Additionally, we tested the subjects' blood lipid levels to diagnose dyslipidemia.

RESULTS

Compared with the subjects with neither dyslipidemia nor obesity, men with both dyslipidemia and high obesity indices, such as BMI, WHR and VFA, showed a significantly lower mean eGFR; women with dyslipidemia with high WHR, VFA or SFA also showed a significantly lower mean eGFR. Although an independent association between the metabolic variables and eGFR was not found except for BMI, some of the combined effects of each variable were related to eGFR decline. Comorbidity of dyslipidemia and high WHR was significant risk factor for eGFR reduction (β -8.805, SD 4.116, p < 0.05). Additionally, comorbidity of dyslipidemia and high obesity indices such as BMI (β -12.942, SD 5.268, p < 0.05) and VFA (β -7.069, SD 3.394, p < 0.05) were significant risk factors for eGFR reduction in men.

CONCLUSION

The combined effect of dyslipidemia and high obesity indices is significantly related to the decline in eGFR. The association is more profound in men.

Relationship between Decreased Estimated Glomerular Filtration Rate and Sarcopenic Obesity among Postmenopausal Women: Korea National Health and Nutrition Examination Survey (2008-2011)

Background

Previous studies have shown that body composition is associated with chronic kidney disease (CKD), and perimenopause is associated with increased fat mass and decreased lean body mass. Muscle wasting is common among patients with CKD. Sarcopenic obesity (SO) refers to excess adiposity with decreased muscle mass. However, little is known about the relationship between SO and renal function decline. Here, we identified the relationship between SO and decreased estimated glomerular filtration rate (eGFR) in postmenopausal women.

Methods

We conducted a cross-sectional study based on the data from the Korea National Health and Nutrition Examination Survey (2008–2011). We analyzed 4,560 postmenopausal women who underwent dual energy X-ray absorptiometry. Sarcopenia was defined based on weight-adjusted appendicular skeletal muscle mass. Obesity was defined based on body mass index. The eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Subjects were classified into four groups: normal, obese, sarcopenic, and sarcopenic obese. Logistic regression analysis was performed to examine the association between SO and decreased eGFR. The results were adjusted for variable confounders.

Results

In the unadjusted model, the odds ratio (OR) of decreased eGFR for SO was 1.67 (95% confidence interval [CI], 1.23–2.26). The obese and sarcopenic groups had ORs of 0.67 (95% CI, 0.44–1.03) and 0.70 (95% CI, 0.44–1.10), respectively. After controlling for confounding variables, there was also a significant association between SO and decreased eGFR (adjusted OR, 1.48; 95% Cl, 1.05–2.07).

Conclusion

SO was independently associated with decreased eGFR in postmenopausal Korean women.

Development of Taiwan Risk Score for Sarcopenia (TRSS) for Sarcopenia Screening among Community-Dwelling Older Adults

The SARC-F questionnaire has been suggested by the European Working Group on Sarcopenia in Older People (EWGSOP) as a first-step screening tool for sarcopenia. However, the sensitivity to SARC-F is low among community-dwelling older adults. Therefore, this study aimed to develop a new prediction model for sarcopenia screening in the community setting. We conducted a cross-sectional analysis of data from the Taiwan Integration of Health and Welfare (TIHW) study. Covariates including comorbidities, socioeconomic status, social support, health behaviors, body composition, and serum biomarkers were collected for analysis. Sarcopenia was defined using handgrip strength and gait speed cut-off values suggested by the Asian Working Group for Sarcopenia. Risk scores for sarcopenia were estimated by stepwise logistic regression. Among 1025 participants (mean age, 71.95 ± 6.89 years), 179 (17.5%) had sarcopenia. Seven items, including age, female sex, receiving social assistance pension, absence of exercise, being underweight, abnormal fasting glucose levels, and abnormal creatinine levels were selected for the Taiwan Risk Scores for Sarcopenia (TRSS) with a cutoff value of 76 (sensitivity, 71.8%; specificity, 71.1%) and area under the curve (AUC) of 0.757. Our results suggested that the TRSS model could be applied cost-effectively in the community for early detection of sarcopenia.

10-Year Renal Function Trajectories in Community-Dwelling Older Adults: Exploring the Risk Factors for Different Patterns

Longitudinal changes of renal function help inform patients’ clinical courses and improve risk stratification. Rare studies address risk factors predicting changes in estimated glomerular filtration rate (eGFR) over time in older adults, particularly of Chinese ethnicity. We identified prospectively enrolled community-dwelling older adults (≥65 years) receiving annual health examinations between 2005 and 2015 with serum creatinine available continuously in a single institute, and used linear regression to derive individual’s annual eGFR changes, followed by multivariate logistic regression analyses to identify features associated with different eGFR change patterns. Among 500 elderly (71.3 ± 4.2 years), their mean annual eGFR changes were 0.84 ± 1.67 mL/min/1.73 m²/year, with 136 (27.2%) and 238 (47.6%) classified as having downward (annual eGFR change <0 mL/min/1.73 m²/year) and upward eGFR (≥1 mL/min/1.73 m²/year) trajectories, respectively. Multivariate logistic regression showed that higher age (odds ratio (OR) 1.08), worse renal function (OR 13.2), and more severe proteinuria (OR 9.86) or hematuria (OR 3.39) were predictive of a declining eGFR while greater waist circumference (OR 1.06) and higher leukocyte counts (OR 1.21) were predictive of an uprising 10-year eGFR. These findings elucidate important features associated with geriatric renal function variations, which are expected to improve their renal care.

The Benefit of Anti-Inflammatory and Renal-Protective Dietary Ingredients on the Biological Processes of Aging in the Kidney

One of the significant organ systems which decline in aging is the kidney. While the causes of age-associated decline in renal function are likely multifactorial, oxidative stress and inflammation are hypothesized to play important roles in the structural and functional changes of the kidney. During aging there is a general decline in the glomerular filtration rate (GFR), a primary measurement used to assess kidney function. Inflammation and oxidative stress have been hypothesized to have a significant detrimental effect on renal function in aging and this may be attenuated by renal protective dietary ingredients. These dietary ingredients may affect renal function directly or through a microbiome-mediated secondary product. Likewise, structural changes including renal tubular atrophy, interstitial fibrosis, and glomerulosclerosis have all been described in aging. Such detrimental changes may benefit from dietary ingredients that may delay or attenuate the occurrence of such changes. This review will describe the physiology and pathophysiology of aging in renal function with an emphasis on dogs and cats that develop a decline in kidney function naturally. In addition, the varying biomarkers of health and renal dysfunction will be discussed. Finally, we will evaluate the aid in the management of this normal decline through dietary intervention in animal models.

Sarcopenic obesity associated with high-sensitivity C-reactive protein in age and sex comparison: a two-center study in South Korea

OBJECTIVES

To evaluate the association between high-sensitivity C-reactive protein (hs-CRP) and sarcopenic obesity, and to determine age or sex differences underlying the relationship between hs-CRP and sarcopenic obesity.

DESIGN

Observational study.

PARTICIPANTS

The study included 237 838 participants whose body composition and hs-CRP were analysed at the two health promotion centres in South Korea. Participants were divided into four groups based on body composition: normal, obesity only, sarcopenia only and sarcopenic obesity.

PRIMARY MEASURES

The levels of hs-CRP and proportion of participants with high (≥1.0 mg/L) hs-CRP. Sarcopenic obesity was defined as subjects fulfilling the criteria for sarcopenia (below 2 SD of mean of Skeletal Muscle Mass Index for young adults) and obesity (waist circumference ≥90 cm for men and ≥85 cm for women).

RESULTS

The level of hs-CRP was highest in the sarcopenic obesity group. Following adjustment for various confounders including age, sex, comorbidities, metabolic, health-related behaviour and demographic factors, the adjusted ORs (95% CI) for subjects with high hs-CRP associated with obesity, sarcopenia and sarcopenic obesity compared with normal group (reference) were 1.17 (1.05 to 1.31), 2.23 (1.21 to 4.07) and 3.23 (2.71 to 3.83), respectively. In age subgroup analyses, multivariate logistic regression analysis revealed that the association of high hs-CRP with sarcopenic obesity was stronger in younger (<60 years) participants than in older (≥60 years) participants (p for interaction <0.001). In subgroup analyses for sex, the association of high hs-CRP with sarcopenic obesity was higher in female participants than in males (p for interaction <0.001).

CONCLUSIONS

This study demonstrated that high level of hs-CRP was independently associated with sarcopenic obesity in Korean population. We found for the first time that there was a strong association between increased hs-CRP and sarcopenic obesity in female and younger (<60 years) subjects.

Relationship between skeletal muscle mass and lung function in Korean adults without clinically apparent lung disease

Previous studies have demonstrated that low skeletal muscle mass is related to decreased lung function in patients with chronic obstructive pulmonary disease. However, there is little information about the relationship between skeletal muscle mass and lung function in asymptomatic adults without clinically apparent lung disease.This was a cross-sectional study of 240,562 Korean adults without known lung disease. All subjects underwent both pulmonary function test (PFT) and bioelectrical impedance analysis in the health checkup program at Kangbuk Samsung Hospital. Skeletal muscle mass index (SMI) was estimated as skeletal muscle mass/weight×100. We analyzed the relationship between SMI and PFT using multivariate logistic regression models.Of the 240,562 study subjects, values for forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and peak expiratory flow (PEF) were decreased across quartiles (Qs) of decreasing SMI. After adjustments for various confounders including demographic and health behavior-related factors, odds ratios (ORs; 95% confidence interval) for subjects with FVC% <80% for Q1-Q3 compared with Q4 (reference) were 2.97 (2.74-3.17), 2.11 (1.99-2.27), and 1.66 (1.52-1.83), respectively. ORs for subjects with FEV1% <80% for Q1-Q3 compared with Q4 were 2.64 (2.43-2.83), 1.96 (1.83-2.09), and 1.51 (1.43-1.62), respectively. Lastly, OR for subjects with PEF% <80% for Q1-Q3 compared with Q4 were 1.73 (1.58-1.89), 1.35 (1.26-1.45), and 1.23 (1.15-1.30), individually. Subgroup analyses for gender and all age groups showed the associations of decreasing SMI Qs with lower FVC%, FEV1%, and PEF% remained significant.Decreased SMI was independently associated with decline in lung function in apparently healthy adults. This association was sustained in subgroup analyses by gender and all age groups.