Associations of Body Mass Index and Body Fat With Markers of Inflammation and Nutrition Among Patients Receiving Hemodialysis

Cynthia Delgado, Glenn M. Chertow, George Kaysen, Lorien Dalrymple, John Kornak, Barbara Grimes, Kirsten L. Johansen

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Understanding the extent to which visceral and subcutaneous body fat are associated with markers of nutrition and inflammation in patients on dialysis therapy could shed light on the obesity paradox and the biology of subcutaneous fat. Study Design: Cross-sectional. Setting & Participants: 609 adults receiving hemodialysis who participated in the ACTIVE/ADIPOSE Study. Predictors: Body mass index (BMI), waist circumference, and bioelectrical impedance spectroscopy-derived estimates of percent body fat. Outcomes: C-Reactive protein (CRP), interleukin 6 (IL-6), prealbumin, albumin, leptin, and adiponectin concentrations. Measurements: We performed linear regression analyses to examine the extent to which proxies of visceral and subcutaneous fat were associated with inflammation, nutrition, and adiposity-related hormones. Results: BMI was directly associated with markers of inflammation (standardized estimate for ln[CRP in mg/L]: 0.30 [95% CI, 0.22-0.38] per 10kg/m2; for ln[IL-6 in pg/mL]: 0.10 [95% CI, 0.02-0.18] per 10kg/m2), but was not associated with markers of nutrition. BMI was also inversely associated with adiponectin and directly associated with leptin. With waist circumference and percent body fat (as a proxy of visceral and subcutaneous fat, respectively) modeled together, waist circumference was associated with markers of inflammation (standardized estimate for ln[CRP in mg/L]: 0.21 [95% CI, 0.09-0.34] per 10cm; for ln[IL-6 in pg/mL]: 0.18 [95% CI, 0.07-0.29] per 10cm), whereas percent body fat was not associated with CRP (standardized estimate for ln[CRP in mg/L]: 0.03 [95% CI, -0.10 to 0.15] per 1%) and was inversely associated with IL-6 (standardized estimate for ln[IL-6 in pg/mL]: -0.15 [95% CI, -0.27 to -0.02] per 1%). In addition, waist circumference was inversely associated with prealbumin and albumin (standardized estimates of -0.12 [95% CI, -0.23 to -0.02] mg/dL per 10cm and -0.17 [95% CI, -0.28 to -0.06] g/dL per 10cm, respectively), and percent body fat was directly associated with prealbumin and albumin (0.20 [95% CI, 0.07-0.32] mg/dL and 0.15 [95% CI, 0.02-0.28] g/dL per 1%, respectively). Higher waist circumference was associated indirectly with adiponectin and directly with leptin concentrations. Limitations: Although the observed associations implicate visceral fat as the cause of inflammation, it cannot be determined in this cross-sectional study. Conclusions: Proxies of visceral and subcutaneous fat appear to have opposing associations with biomarkers of inflammation and nutrition. Subcutaneous fat may be an indicator of nutritional status, and visceral fat, an indicator of inflammation.

Original languageEnglish (US)
JournalAmerican Journal of Kidney Diseases
DOIs
StateAccepted/In press - 2017

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Subcutaneous Fat
Renal Dialysis
Adipose Tissue
Intra-Abdominal Fat
Body Mass Index
Waist Circumference
Inflammation
C-Reactive Protein
Interleukin-6
Prealbumin
Adiponectin
Proxy
Leptin
Albumins
Cross-Sectional Studies
Dielectric Spectroscopy
Adiposity
Nutritional Status
Electric Impedance
Dialysis

Keywords

  • Adiposity
  • Body composition
  • Body fat
  • Body mass index (BMI)
  • C-reactive protein (CRP)
  • End-stage renal disease (ESRD)
  • Hemodialysis
  • Inflammation
  • Interleukin 6 (IL-6)
  • Nutrition
  • Obesity
  • Obesity paradox
  • Subcutaneous fat
  • Visceral fat
  • Waist circumference

ASJC Scopus subject areas

  • Nephrology

Cite this

Associations of Body Mass Index and Body Fat With Markers of Inflammation and Nutrition Among Patients Receiving Hemodialysis. / Delgado, Cynthia; Chertow, Glenn M.; Kaysen, George; Dalrymple, Lorien; Kornak, John; Grimes, Barbara; Johansen, Kirsten L.

In: American Journal of Kidney Diseases, 2017.

Research output: Contribution to journalArticle

Delgado, Cynthia ; Chertow, Glenn M. ; Kaysen, George ; Dalrymple, Lorien ; Kornak, John ; Grimes, Barbara ; Johansen, Kirsten L. / Associations of Body Mass Index and Body Fat With Markers of Inflammation and Nutrition Among Patients Receiving Hemodialysis. In: American Journal of Kidney Diseases. 2017.
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abstract = "Background: Understanding the extent to which visceral and subcutaneous body fat are associated with markers of nutrition and inflammation in patients on dialysis therapy could shed light on the obesity paradox and the biology of subcutaneous fat. Study Design: Cross-sectional. Setting & Participants: 609 adults receiving hemodialysis who participated in the ACTIVE/ADIPOSE Study. Predictors: Body mass index (BMI), waist circumference, and bioelectrical impedance spectroscopy-derived estimates of percent body fat. Outcomes: C-Reactive protein (CRP), interleukin 6 (IL-6), prealbumin, albumin, leptin, and adiponectin concentrations. Measurements: We performed linear regression analyses to examine the extent to which proxies of visceral and subcutaneous fat were associated with inflammation, nutrition, and adiposity-related hormones. Results: BMI was directly associated with markers of inflammation (standardized estimate for ln[CRP in mg/L]: 0.30 [95{\%} CI, 0.22-0.38] per 10kg/m2; for ln[IL-6 in pg/mL]: 0.10 [95{\%} CI, 0.02-0.18] per 10kg/m2), but was not associated with markers of nutrition. BMI was also inversely associated with adiponectin and directly associated with leptin. With waist circumference and percent body fat (as a proxy of visceral and subcutaneous fat, respectively) modeled together, waist circumference was associated with markers of inflammation (standardized estimate for ln[CRP in mg/L]: 0.21 [95{\%} CI, 0.09-0.34] per 10cm; for ln[IL-6 in pg/mL]: 0.18 [95{\%} CI, 0.07-0.29] per 10cm), whereas percent body fat was not associated with CRP (standardized estimate for ln[CRP in mg/L]: 0.03 [95{\%} CI, -0.10 to 0.15] per 1{\%}) and was inversely associated with IL-6 (standardized estimate for ln[IL-6 in pg/mL]: -0.15 [95{\%} CI, -0.27 to -0.02] per 1{\%}). In addition, waist circumference was inversely associated with prealbumin and albumin (standardized estimates of -0.12 [95{\%} CI, -0.23 to -0.02] mg/dL per 10cm and -0.17 [95{\%} CI, -0.28 to -0.06] g/dL per 10cm, respectively), and percent body fat was directly associated with prealbumin and albumin (0.20 [95{\%} CI, 0.07-0.32] mg/dL and 0.15 [95{\%} CI, 0.02-0.28] g/dL per 1{\%}, respectively). Higher waist circumference was associated indirectly with adiponectin and directly with leptin concentrations. Limitations: Although the observed associations implicate visceral fat as the cause of inflammation, it cannot be determined in this cross-sectional study. Conclusions: Proxies of visceral and subcutaneous fat appear to have opposing associations with biomarkers of inflammation and nutrition. Subcutaneous fat may be an indicator of nutritional status, and visceral fat, an indicator of inflammation.",
keywords = "Adiposity, Body composition, Body fat, Body mass index (BMI), C-reactive protein (CRP), End-stage renal disease (ESRD), Hemodialysis, Inflammation, Interleukin 6 (IL-6), Nutrition, Obesity, Obesity paradox, Subcutaneous fat, Visceral fat, Waist circumference",
author = "Cynthia Delgado and Chertow, {Glenn M.} and George Kaysen and Lorien Dalrymple and John Kornak and Barbara Grimes and Johansen, {Kirsten L.}",
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TY - JOUR

T1 - Associations of Body Mass Index and Body Fat With Markers of Inflammation and Nutrition Among Patients Receiving Hemodialysis

AU - Delgado, Cynthia

AU - Chertow, Glenn M.

AU - Kaysen, George

AU - Dalrymple, Lorien

AU - Kornak, John

AU - Grimes, Barbara

AU - Johansen, Kirsten L.

PY - 2017

Y1 - 2017

N2 - Background: Understanding the extent to which visceral and subcutaneous body fat are associated with markers of nutrition and inflammation in patients on dialysis therapy could shed light on the obesity paradox and the biology of subcutaneous fat. Study Design: Cross-sectional. Setting & Participants: 609 adults receiving hemodialysis who participated in the ACTIVE/ADIPOSE Study. Predictors: Body mass index (BMI), waist circumference, and bioelectrical impedance spectroscopy-derived estimates of percent body fat. Outcomes: C-Reactive protein (CRP), interleukin 6 (IL-6), prealbumin, albumin, leptin, and adiponectin concentrations. Measurements: We performed linear regression analyses to examine the extent to which proxies of visceral and subcutaneous fat were associated with inflammation, nutrition, and adiposity-related hormones. Results: BMI was directly associated with markers of inflammation (standardized estimate for ln[CRP in mg/L]: 0.30 [95% CI, 0.22-0.38] per 10kg/m2; for ln[IL-6 in pg/mL]: 0.10 [95% CI, 0.02-0.18] per 10kg/m2), but was not associated with markers of nutrition. BMI was also inversely associated with adiponectin and directly associated with leptin. With waist circumference and percent body fat (as a proxy of visceral and subcutaneous fat, respectively) modeled together, waist circumference was associated with markers of inflammation (standardized estimate for ln[CRP in mg/L]: 0.21 [95% CI, 0.09-0.34] per 10cm; for ln[IL-6 in pg/mL]: 0.18 [95% CI, 0.07-0.29] per 10cm), whereas percent body fat was not associated with CRP (standardized estimate for ln[CRP in mg/L]: 0.03 [95% CI, -0.10 to 0.15] per 1%) and was inversely associated with IL-6 (standardized estimate for ln[IL-6 in pg/mL]: -0.15 [95% CI, -0.27 to -0.02] per 1%). In addition, waist circumference was inversely associated with prealbumin and albumin (standardized estimates of -0.12 [95% CI, -0.23 to -0.02] mg/dL per 10cm and -0.17 [95% CI, -0.28 to -0.06] g/dL per 10cm, respectively), and percent body fat was directly associated with prealbumin and albumin (0.20 [95% CI, 0.07-0.32] mg/dL and 0.15 [95% CI, 0.02-0.28] g/dL per 1%, respectively). Higher waist circumference was associated indirectly with adiponectin and directly with leptin concentrations. Limitations: Although the observed associations implicate visceral fat as the cause of inflammation, it cannot be determined in this cross-sectional study. Conclusions: Proxies of visceral and subcutaneous fat appear to have opposing associations with biomarkers of inflammation and nutrition. Subcutaneous fat may be an indicator of nutritional status, and visceral fat, an indicator of inflammation.

AB - Background: Understanding the extent to which visceral and subcutaneous body fat are associated with markers of nutrition and inflammation in patients on dialysis therapy could shed light on the obesity paradox and the biology of subcutaneous fat. Study Design: Cross-sectional. Setting & Participants: 609 adults receiving hemodialysis who participated in the ACTIVE/ADIPOSE Study. Predictors: Body mass index (BMI), waist circumference, and bioelectrical impedance spectroscopy-derived estimates of percent body fat. Outcomes: C-Reactive protein (CRP), interleukin 6 (IL-6), prealbumin, albumin, leptin, and adiponectin concentrations. Measurements: We performed linear regression analyses to examine the extent to which proxies of visceral and subcutaneous fat were associated with inflammation, nutrition, and adiposity-related hormones. Results: BMI was directly associated with markers of inflammation (standardized estimate for ln[CRP in mg/L]: 0.30 [95% CI, 0.22-0.38] per 10kg/m2; for ln[IL-6 in pg/mL]: 0.10 [95% CI, 0.02-0.18] per 10kg/m2), but was not associated with markers of nutrition. BMI was also inversely associated with adiponectin and directly associated with leptin. With waist circumference and percent body fat (as a proxy of visceral and subcutaneous fat, respectively) modeled together, waist circumference was associated with markers of inflammation (standardized estimate for ln[CRP in mg/L]: 0.21 [95% CI, 0.09-0.34] per 10cm; for ln[IL-6 in pg/mL]: 0.18 [95% CI, 0.07-0.29] per 10cm), whereas percent body fat was not associated with CRP (standardized estimate for ln[CRP in mg/L]: 0.03 [95% CI, -0.10 to 0.15] per 1%) and was inversely associated with IL-6 (standardized estimate for ln[IL-6 in pg/mL]: -0.15 [95% CI, -0.27 to -0.02] per 1%). In addition, waist circumference was inversely associated with prealbumin and albumin (standardized estimates of -0.12 [95% CI, -0.23 to -0.02] mg/dL per 10cm and -0.17 [95% CI, -0.28 to -0.06] g/dL per 10cm, respectively), and percent body fat was directly associated with prealbumin and albumin (0.20 [95% CI, 0.07-0.32] mg/dL and 0.15 [95% CI, 0.02-0.28] g/dL per 1%, respectively). Higher waist circumference was associated indirectly with adiponectin and directly with leptin concentrations. Limitations: Although the observed associations implicate visceral fat as the cause of inflammation, it cannot be determined in this cross-sectional study. Conclusions: Proxies of visceral and subcutaneous fat appear to have opposing associations with biomarkers of inflammation and nutrition. Subcutaneous fat may be an indicator of nutritional status, and visceral fat, an indicator of inflammation.

KW - Adiposity

KW - Body composition

KW - Body fat

KW - Body mass index (BMI)

KW - C-reactive protein (CRP)

KW - End-stage renal disease (ESRD)

KW - Hemodialysis

KW - Inflammation

KW - Interleukin 6 (IL-6)

KW - Nutrition

KW - Obesity

KW - Obesity paradox

KW - Subcutaneous fat

KW - Visceral fat

KW - Waist circumference

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JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

SN - 0272-6386

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