Sarcopenic obesity in dialysis patients strongly and independently linked to diabetes

A recent article published in Journal of Renal Nutrition pointed out that, in chronic hemodialysis patients, sarcopenic obesity is very common. The prevalence of sarcopenic obesity was demonstrated to be a substantial and independent factor of diabetes. Diabetes was found to be a significant predictor of all-cause death, regardless of the participants' current weight, obesity, sarcopenia, or sarcopenic obesity status.

Eiji Ishimura and team conducted this retrospective cohort study to look at the relationship between diabetes and mortality in hemodialysis patients, as well as the prevalence of obesity, sarcopenia, and sarcopenic obesity, as well as the prevalence of diabetes.

For this study, in 308 chronic hemodialysis patients (age 58.0 +/- 11.9 years, hemodialysis duration 6.5 +/- 6.0 years, men 60.1%, diabetes 32.8%), muscle strength, muscle mass, and fat mass were measured using a hand dynamometer and dual-energy X-ray absorptiometry, respectively. Sarcopenia was classified using new criteria developed by the Asian Working Group on Sarcopenia in 2019. Obesity was defined as a percentage of body fat mass (males 25%, ladies 35%).

The key findings of this study were as follow:

1. The enrolled patients were split into four categories: normal (38.7%), obesity (18.8%), sarcopenia (26.9%), and sarcopenic obesity (15.6%).

2. Diabetes prevalence was highly skewed among the four groups, with the sarcopenic obese group (54.2%) having a greater rate than the others (25.9-33.7% ).

3. After adjusting for multiple co-founders, multivariate regression analysis revealed that diabetes was strongly and independently linked with sarcopenic obesity, but not with sarcopenia.

4. During the 76 +/- 35-month follow-up period, 100 individuals died.

5. When compared to patients in the normal and obesity groups, those with sarcopenia and sarcopenic obesity had considerably higher rates of all-cause mortality.

In conclusion, diabetes was found to be strongly and independently linked to sarcopenic obesity, with body mass indexes that were not significantly different from the normal group but significantly different from the sarcopenia group. It's worth noting that diabetes is a substantial independent predictor of all-cause mortality in sarcopenic obesity patients, regardless of the presence of obesity, sarcopenia, or sarcopenic obesity.

Reference:

Ishimura E, Okuno S, Nakatani S, Mori K, Miyawaki J, Okazaki H, Sugie N, Norimine K, Yamakawa K, Tsujimoto Y, Shoji S, Inaba M, Yamakawa T, Emoto M. Significant Association of Diabetes With Mortality of Chronic Hemodialysis Patients, Independent of the Presence of Obesity, Sarcopenia, and Sarcopenic Obesity. J Ren Nutr. 2022 Jan;32(1):94-101. doi:10.1053/j.jrn.2021.07.003.