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For Dialysis patients, Skinny is dangerous
Newswise — Dialysis patients with low body
fat are at increased risk of death—even
compared to patients at the highest level of
body fat percentage, according to research
being presented at the American Society of
Nephrology's 42nd Annual Meeting and
Scientific Exposition in San Diego.
"Our study indicates that body fat may be
protective in dialysis patients," comments
Kamyar Kalantar-Zadeh, PhD (LABioMed at
Harbor-UCLA). "The results add to the
increasing number of reports about the
'obesity paradox' or 'reverse epidemiology'
in patients with chronic kidney disease and
other chronic diseases." The research will
be presented by Youngmee Kim, RN.
Nephrologists have puzzled over the "obesity
paradox" in dialysis patients,
Kalantar-Zadeh explains.
"Counter-intuitively, higher body mass index
is associated with greater survival in
hemodialysis patients. We hypothesized that
very low body fat—less than ten
percent—would be a strong predictor of
mortality."
Using near-infrared interactance technology,
the researchers measured body fat percentage
in 671 hemodialysis patients from eight
California dialysis centers. They then
compared five-year mortality rates for
patients at different levels of body fat
percentage.
The mortality rate was highest for dialysis
patients with less than 10 percent body
fat—2.5 to 3 times higher than for those
with body fat of 20 to 30 percent. The
increased risk of death for patients with
very low body fat remained after adjustment
for age, sex, race, other illnesses, and key
laboratory results.
Further analyses using continuous values of
body fat (rather than categories) confirmed
a direct, linear relationship between body
fat and mortality risk: "The higher the body
fat, the greater the survival," said
Kalantar-Zadeh. Although more research is
needed, the results suggest that the obesity
paradox may be explained by an increased
risk of death for patients with very low
body fat, compared to those with average—or
even very high—body fat percentage.
The observational study had the same
limitations as other epidemiological
studies, Kalantar-Zadeh points out. "In
addition, we estimated body fat by measuring
the subcutaneous fat of the upper arm, which
may be different from the intra-abdominal
fat."
The study was sponsored by grants from the
National Institutes of Health (NIH). Study
co-authors include Youngmee Kim, RN, FNP,
PhD; Claudia Luna; Amanda Luna; Allen R
Nissenson, MD; Debbie Benner, MS, RD; and
Csaba P Kovesdy, MD.
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