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Usefulness of the conicity index together with the conjoint use of adipocytokines and nutritional-inflammatory markers in hemodialysis patients

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Abstract

Abdominal fat has been recognized as the most hormonally active tissue secreting a variety of adipocytokines and, therefore, potentially contributing to inflammation. The conicity index (Cindex) has been considered a valuable indicator of central obesity. This study aims to relate plasma concentrations of leptin, adiponectin, interleukin-6 (IL-6), and serum C-reactive protein (CRP) with Cindex values in hemodialysis (HD) patients. Cross-sectional study in 45 HD patients (55.6 % men; DM 20 %; mean age, 68.1 year). Cindex and nutritional-inflammatory markers were used for the abdominal fat depot assessment. Patients were classified as having a low or high median Cindex (MCindex): low group (men, <1.39; women, <1.33) and high group (men, ≥1.39; women, ≥1.33). A combination of plasma leptin, IL-6, adiponectin, and CRP was used to design an inflammatory index (Iindex) while a protein-energy wasting index (PEWindex) was calculated from the Iindex plus the malnutrition-inflammation score (MIS). Waist circumference (WC) and Cindex but not BMI were significantly higher in men than in women (p < 0.01). The MCindex was significantly associated with the adipocytokine profile (CRP, leptin, and adiponectin). Patients with a high MCindex had a higher Iindex and PEWindex (p < 0.01). ROC curve analyses measured by area under the curve (AUC) were 0.69 and 0.68 (p < 0.05), for the Cindex and MCindex, respectively, demonstrating the usefulness of the Cindex as an abdominal fat mass biomarker able for wasting-inflamed HD patients. These findings in HD patients underscore the importance of incorporating the evaluation of one abdominal fat indicator, such as the Cindex and an inflammatory biomarker such as the IL-6 and CRP, in substitution of the BMI, in current clinical practice.

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Abbreviations

AUC:

Area under curve

BIVA:

Bioimpedance vector analysis

BMI:

Body mass index

Cindex :

Conicity index

CKD:

Chronic kidney disease

CRP:

C-reactive protein

CVD:

Cardiovascular disease

ESRD:

End-stage renal disease

HD:

Hemodialysis

FM:

Fat mass

FMI:

Fat mass index

Iindex :

Inflammatory index

IL-6:

Interleukin-6

Kt/V urea (sp):

Single pool urea kinetic model

LBM:

Lean body mass

LBMI:

Lean body mass index

MIS:

Malnutrition-inflammation score

PEW:

Protein-energy wasting

PEWindex :

Protein-energy wasting index

TNF-α:

Tumor necrosis alpha

WC:

Waist circumference

WHR:

Waist-height ratio

References

  1. Axelsson J, Rashid QA, Suliman ME, Honda H, Pecoits-Filho R, Heimburger O et al (2004) Truncal fat mass as a contributor to inflammation in end-stage renal disease. Am J Clin Nutr 80:1222–1221

    CAS  PubMed  Google Scholar 

  2. Axelsson J, Heimburger O, Stenvinkel P (2006) Adipose tissue and inflammation in chronic kidney disease. Contrib Nephrol 151:165–174

    Article  PubMed  Google Scholar 

  3. Beberashvili I, Sinuani I, Azar A, Yasur H, Feldman L, Averbukh Z et al (2011) Longitudinal study of leptin levels in chronic hemodialysis patients. Nutr J 10:68

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Beddhu S, Pappas LM, Ramkumar N, Samore M (2003) Effects of body size and body composition on survival in hemodialysis patients. J Am Soc Nephrol 14:2366–2372

    Article  PubMed  Google Scholar 

  5. Bossola M, Muscaritoli M, Tazza L, Panocchia N, Liberatori M, Giungi S et al (2005) Variables associated with reduced dietary intake in hemodialysis patients. J Ren Nutr 15:244–252

    Article  PubMed  Google Scholar 

  6. Chertow GM, Lazarus JM, Lew NL, Ma L, Lowrie EG (1997) Bioimpedance norms for the hemodialysis population. Kidney Int 52:1617–1621

    Article  CAS  PubMed  Google Scholar 

  7. Choi J, Joseph L, Pilote L (2013) Obesity and C-reactive protein in various populations: a systematic review and meta-analysis. Obes Rev 14:232–244

    Article  CAS  PubMed  Google Scholar 

  8. Cordeiro AC, Qureshi AR, Stenvinkel P, Heimburger O, Axelsson J, Barany P et al (2010) Abdominal fat deposition is associated with increased inflammation, protein-energy wasting and worse outcome in patients undergoing haemodialysis. Nephrol Dial Transplant 25:562–568

    Article  PubMed  Google Scholar 

  9. DeVita MV, Stall SH (1999) Dual-energy X-ray absorptiometry: a review. J Ren Nutr 9:178–181

    Article  CAS  PubMed  Google Scholar 

  10. Festa A, D'Agostino R, Williams K, Karter AJ, Mayer-Davis EJ, Tracy RP et al (2001) The relation of body fat mass and distribution to markers of chronic inflammation. Int J Obes Relat Metab Disord 25:1407–1415

    Article  CAS  PubMed  Google Scholar 

  11. Gotoh H, Gohda T, Tanimoto M, Gotoh Y, Horikoshi S, Tomino Y (2009) Contribution of subcutaneous fat accumulation to insulin resistance and atherosclerosis in haemodialysis patients. Nephrol Dial Transplant 24:3474–3480

    Article  CAS  PubMed  Google Scholar 

  12. Honda H, Qureshi AR, Axelsson J, Heimburger O, Suliman ME, Barany P et al (2007) Obese sarcopenia in patients with end-stage renal disease is associated with inflammation and increased mortality. Am J Clin Nutr 86:633–638

    CAS  PubMed  Google Scholar 

  13. Kakiya R, Shoji T, Tsujimoto Y, Tatsumi N, Hatsuda S, Shinohara K et al (2006) Body fat mass and lean mass as predictors of survival in hemodialysis patients. Kidney Int 70:549–556

    Article  CAS  PubMed  Google Scholar 

  14. Kalantar-Zadeh K, Kopple JD, Block G, Humphreys MH (2001) A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients. Am J Kidney Dis 38:1251–1263

    Article  CAS  PubMed  Google Scholar 

  15. Kalantar-Zadeh K, Abbott KC, Salahudeen AK, Kilpatrick RD, Horwich TB (2005) Survival advantages of obesity in dialysis patients. Am J Clin Nutr 81:543–554

    CAS  PubMed  Google Scholar 

  16. Kalantar-Zadeh K, Kopple JD (2006) Obesity paradox in patients on maintenance dialysis. Contrib Nephrol 151:57–69

    Article  PubMed  Google Scholar 

  17. Lee CM, Huxley RR, Wildman RP, Woodward M (2008) Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis. J Clin Epidemiol 61:646–653

    Article  PubMed  Google Scholar 

  18. Lee P, O'Neal D, Murphy B, Best J (1997) The role of abdominal adiposity and insulin resistance in dyslipidemia of chronic renal failure. Am J Kidney Dis 29:54–65

    Article  CAS  PubMed  Google Scholar 

  19. Nishimura M, Hashimoto T, Kobayashi H, Yamazaki S, Okino K, Fujita H et al (2006) Association of the circulating adiponectin concentration with coronary in-stent restenosis in haemodialysis patients. Nephrol Dial Transplant 21:1640–1647

    Article  CAS  PubMed  Google Scholar 

  20. Pecoits-Filho R, Barany P, Lindholm B, Heimburger O, Stenvinkel P (2002) Interleukin-6 is an independent predictor of mortality in patients starting dialysis treatment. Nephrol Dial Transplant 17:1684–1688

    Article  CAS  PubMed  Google Scholar 

  21. Piche ME, Lemieux S, Weisnagel SJ, Corneau L, Nadeau A, Bergeron J (2005) Relation of high sensitivity C-reactive protein, interleukin-6, tumor necrosis factor-alpha, and fibrinogen to abdominal adipose tissue, blood pressure, and cholesterol and triglyceride levels in healthy postmenopausal women. Am J Cardiol 96:92–97

    Article  CAS  PubMed  Google Scholar 

  22. Postorino M, Marino C, Tripepi G, Zoccali C (2011) Abdominal obesity modifies the risk of hypertriglyceridemia for all-cause and cardiovascular mortality in hemodialysis patients. Kidney Int 79:765–772

    Article  CAS  PubMed  Google Scholar 

  23. Rambod M, Kovesdy CP, Kalantar-Zadeh K (2008) Malnutrition-Inflammation Score for risk stratification of patients with CKD: is it the promised gold standard? Nat Clin Pract Nephrol 4:354–355

    Article  PubMed  Google Scholar 

  24. Rambod M, Bross R, Zitterkoph J, Benner D, Pithia J, Colman S et al (2009) Association of Malnutrition-Inflammation Score with quality of life and mortality in hemodialysis patients: a 5-year prospective cohort study. Am J Kidney Dis 53:298–309

    Article  PubMed  Google Scholar 

  25. Reddan DN, Klassen PS, Szczech LA, Coladonato JA, O'Shea S, Owen WF et al (2003) White blood cells as a novel mortality predictor in haemodialysis patients. Nephrol Dial Transplant 18:1167–1173

    Article  CAS  PubMed  Google Scholar 

  26. Ruperto M, Barril G, Sánchez-Muniz FJ (2013) Conicity index as a contributor marker of inflammation in haemodialysis patients. Nutr Hosp 28:1688–1695

    PubMed  Google Scholar 

  27. Sabbah I, Sabbah H, Sabbah S, Akumoun H, Droubi N (2012) Central obesity and comorbidity risk in hemodialysis patients: a cross sectional study in Lebanon. Open Journal of Nephrology 2:109–115

    Article  Google Scholar 

  28. Shoji T, Shinohara K, Hatsuda S, Kimoto E, Fukumoto S, Emoto M et al (2005) Altered relationship between body fat and plasma adiponectin in end-stage renal disease. Metabolism 54:330–334

    Article  CAS  PubMed  Google Scholar 

  29. Valdez R (1991) A simple model-based index of abdominal adiposity. J Clin Epidemiol 44:955–956

    Article  CAS  PubMed  Google Scholar 

  30. Valdez R, Seidell JC, Ahn YI, Weiss KM (1993) A new index of abdominal adiposity as an indicator of risk for cardiovascular disease. A cross-population study. Int J Obes Relat Metab Disord 17:77–82

    CAS  PubMed  Google Scholar 

  31. World Health Organisation (2011) Waist circumference and waist-hip ratio: report of a WHO expert consultation

  32. Zoccali C, Postorino M, Marino C, Pizzini P, Cutrupi S, Tripepi G (2011) Waist circumference modifies the relationship between the adipose tissue cytokines leptin and adiponectin and all-cause and cardiovascular mortality in haemodialysis patients. J Intern Med 269:172–181

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Departamento de Nutrición y Bromatología I (Nutrición), Facultad de Farmacia, Universidad Complutense de Madrid, Plaza Ramón y Cajal s/n, 28040, Madrid, Spain

    Mar Ruperto & Francisco J Sánchez-Muniz

  2. Servicio de Nefrología, Hospital Universitario La Princesa, Madrid, Spain

    Guillermina Barril

Authors
  1. Mar Ruperto
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  2. Guillermina Barril
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  3. Francisco J Sánchez-Muniz
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Corresponding author

Correspondence to Mar Ruperto.

Ethics declarations

This observational, descriptive, and cross-sectional study was conducted in accordance with Declaration of Helsinki and was approved by the Ethics Committee at Hospital Universitario La Princesa, Madrid (Spain). Informed consent was obtained from each patient prior inclusion at the study.

Author contributions

All authors have significantly contributed to the paper, had access to all study data, and approved the final version of the manuscript to be submitted for publication. MR is the corresponding author and guarantor of the paper and has contributed to the study design, data discussion, and writing of the paper. FJS-M Mhascon tributed to data analysis and discussion and review of writing of the paper and GB have contributed to the data analysis of the paper.

Conflict of interest

The authors declare that they have no conflict of interest.

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Ruperto, M., Barril, G. & Sánchez-Muniz, F.J. Usefulness of the conicity index together with the conjoint use of adipocytokines and nutritional-inflammatory markers in hemodialysis patients. J Physiol Biochem 73, 67–75 (2017). https://doi.org/10.1007/s13105-016-0525-1

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  • DOI: https://doi.org/10.1007/s13105-016-0525-1

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