Applied nutritional investigationIs a body mass index of 23 kg/m2 a reliable marker of protein-energy wasting in hemodialysis patients?

ObjectiveTo evaluate the body composition and inflammatory status in patients on hemodialysis (HD) according to the cutoff of 23 kg/m2 for the body mass index (BMI).MethodsForty-seven patients (30 men, 11 diabetics, 53.8 ± 12.2 y of age, 58.2 ± 50.9 mo on HD) were studied. Anthropometric data and handgrip strength were evaluated. C-reactive protein, tumor necrosis factor-α, leptin, and interleukin-6 were measured. Mortality was assessed after 24 mo of follow-up.ResultsNineteen patients (40.4%) presented BMI values lower than 23 kg/m2 and leptin levels, midarm muscle area, and free-fat mass were significantly lower in these patients. The prevalence of functional muscle loss according to handgrip strength was not different between the BMI groups. The sum of skinfold thicknesses, the percentage of body fat, fat mass, the fat mass/free-fat mass ratio, and waist circumference were significantly lower in patients with a BMI lower than 23 kg/m2, but the mean values did not indicate energy wasting. Patients with a BMI higher than 23 kg/m2 presented a higher prevalence of inflammation and higher waist circumference and body fat values. The adiposity parameters were correlated with C-reactive protein and leptin. A Cox multivariate regression analysis demonstrated that C-reactive protein, tumor necrosis factor-α, and interleukin-6 predict cardiovascular mortality.ConclusionPatients on HD with a BMI lower than 23 kg/m2 did not present signs of energy wasting, whereas those with a BMI higher than 23 kg/m2 had more inflammation, probably because of a greater adiposity. Thus, the BMI value of 23 kg/m2 does not seem to be a reliable marker of protein-energy wasting in patients on HD.