Body Adiposity Index Assess Body Fat with High Accuracy in Nondialyzed Chronic Kidney Disease Patients
Clinical and Experimental Physiopathology Program, Rio de Janeiro State University, Rio de Janeiro, Brazil. . Obesity
(Impact Factor: 3.73).
03/2013; 21(3):546-552. DOI: 10.1002/oby.20261
High body fat (BF) is an alarming condition that also affects nondialyzed chronic kidney disease (CKD) patients. Distinct methods are used to evaluate BF; however, in CKD population it remains unclear which one is more reliable showing high accuracy. Dual-energy X-ray absorptiometry (DXA), used as reference method to estimate adiposity, is expensive and time consuming to be applied in clinical settings. Recently, a new body adiposity index (BAI), that estimates BF from easily accessible measures, was validated in the general population. The aim of this study was to evaluate which simple and practical method, routinely used to estimate BF, shows the highest accuracy compared with DXA, in nondialyzed CKD patients.
In this cross-sectional study BF was estimated by DXA, bioelectrical impedance analysis (BIA), anthropometry (ANTHRO), and BAI. Serum leptin levels were determined.
Studied patients (n = 134) were 55% males, 54% overweight/obese, and 64.9 ± 12.5 years old, with estimated glomerular filtration rate (eGFR) = 29.0 ± 12.7 ml/min. The correlation coefficient was higher between DXA vs. ANTHRO (r = 0.76) and BAI (r = 0.61) than with BIA (r = 0.57), after adjusting for gender, age, and eGFR (P < 0.0001). Therefore, the Lin's concordance correlation coefficient and Bland–Altman plots were performed to measure the accuracy (C_b) between DXA with both ANTHRO and BAI. A higher accuracy (C_b = 0.82) and lower mean difference (−3.4%) was observed for BAI than for ANTHRO (C_b = 0.61; −8.4%). Leptin levels correlated (P < 0.0001) with DXA (r = 0.56) and BAI (r = 0.59).
These findings suggest that BAI estimates BF with high accuracy in nondialyzed CKD patients and may be helpful in the treatment of this population with increased BF.
Available from: Maciej Banach
- "Recently, some newer obesity indices were proposed for better description of obesity, such as waist-to-height ratio (WHtR), visceral adiposity index (VAI), and body adiposity index (BAI); however, their clinical usefulness in determining CKD risk in obese subjects is unknown [14,17,19–21]. "
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The aim of this study was to estimate obesity parameters: waist circumference (WC), waist-to-hip ratio (WHR), weight-to-height ratio (WHtR), visceral adiposity index (VAI), body adiposity index (BAI), and serum adipokines (leptin, adiponectin, resistin) and their associations with estimated glomerular filtration rate (eGFR), serum creatinine, and microalbuminuria (MA) in patients with early stages of CKD and in non-CKD obese patients.
67 non-diabetic obese (BMI ≥30 mg/kg2) out-clinic patients (25 males, 42 females), aged from 36.5 to 64 years were divided into 2 groups: Group A (n=15) – patients with early stages of CKD (eGFR between 30 and 60 ml/min/1.73 m2 or with MA >20 mg/l in morning urine sample independently from GFR) and Group B – patients without chronic CKD (n=52).
In Group A compared to Group B, BAI and leptin were higher (42.2±7.1 vs. 37.5±7.0; p<0.05 and 51.8±26.7 ng/mL vs. 35.3±24.9 ng/mL; p<0.05; respectively) and negative correlations occurred between eGFR and BAI (r=−0.709; p=0.003), leptin (r=−0.68; p=0.005), and resistin (r=−0.528; p<0.05). In Group B, negative correlations occurred between creatinine and VAI (r=−0.332; p<0.05), BAI (r=−0.619; p<0.0001), leptin (r=−0.676; p<0.0001), and adiponectin (r=−0.423; p=0.002), and between eGFR and resistin (r=−0.276; p<0.05).
BAI may be a valuable obesity parameter as a predictor of early stages of CKD in patients with obesity. Leptin may be an important pathogenic factor in obese patients with early stages of CKD. Resistin is associated with eGFR in obese patients, independently of CKD.
Available from: Carmine Zoccali
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ABSTRACT: Obesity, the epidemic of the 21st century, carries a markedly increased risk for comorbid complications, such as type 2 diabetes, cancer, hypertension, dyslipidemia, cardiovascular disease, and sleep apnea. In addition, obesity increases the risk for CKD and its progression to ESRD. Paradoxically, even morbid obesity associates with better outcomes in studies of ESRD patients on maintenance dialysis. Because the number of obese CKD and maintenance dialysis patients is projected to increase markedly in developed as well as low- and middle-income countries, obesity is a rapidly emerging problem for the international renal community. Targeting the obesity epidemic represents an unprecedented opportunity for health officials to ameliorate the current worldwide increase in CKD prevalence. Nephrologists need more information about assessing and managing obesity in the setting of CKD. Specifically, more precise estimation of regional fat distribution and the amount of muscle mass should be introduced into regular clinical practice to complement more commonly used practical markers, such as body mass index. Studies examining the effects of obesity on kidney disease progression and other clinical outcomes along with weight management strategies are much needed in this orphan area of research.
Available from: Paulo Amorim
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This study aimed to verify the validity of BAI in predicting %BF in a sample of Brazilian women
Design and methods:
A total of 102 women (average age 60.3 ± 9.8) were assessed. To determine percentage body fat (% BF), dual-energy X-ray absorptiometry (DXA) was used as the "gold standard." To evaluate the association between body adiposity index (BAI) and % BF assessed by DXA, we used Pearson's correlation coefficient. Paired sample t-test was used to test differences in mean % BF between BAI and DXA. To evaluate the concordance between % BF measured by DXA and estimated by BAI, we used the Lin's concordance correlation coefficient and the agreement analysis of Bland-Altman.
The correlation between % BF obtained by DXA and that estimated by BAI was r = 0.65, P < 0.001. Paired t-test showed significant mean difference between methods (P < 0.0001). Lin's concordance correlation coefficient was C_b = 0.73, which is classified as poor, while the Bland-Altman plots showed BAI underestimating % BF in relation to the used criterion measure in a large portion of the sample.
Results of the present study show that BAI presented low agreement with % BF measured by DXA, which is not recommended for % BF prediction in this studied sample.
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