Author
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Lukaski, Henry |
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Submitted to: Transactions of the American Society of Artificial Internal Organs
Publication Type: Review Article Publication Acceptance Date: 8/16/1996 Publication Date: N/A Citation: N/A Interpretive Summary: Estimation of body composition is an important component of human nutritional assessment because it provides a measure of body energy stores. Among healthy individuals, traditional approaches for estimating body fat and lean tissue masses are commonly used. In patients with disrupted body fluid and electrolyte balances and decreased bone mineral quality, these traditional methods are not acceptable because the basic assumptions for the methods are not valid in patient populations, particularly those patients with chronic kidney disease that require dialysis. Increased body fluid volumes result in increased values for skinfold thicknesses; bone loss results in decreased bone mineral quality and decreased whole body density. Some methods that can overcome these limitations include measurement of body potassium with whole body counting of potassium-40, an index of body cell mass, dual x-ray absorptiometry for determination of body fat, bioelectrical impedance for assessment of fluid distribution. Routine assessment of body composition in patients on long- term dialysis is needed to estimate the amount of fluid to be removed during the dialysis treatment and to evaluate the nutritional status (fat and lean components) of individuals with kidney disease. This information will be useful to medical personnel and nutritionists who provide medical care and nutritional support to patients with chronic renal disease. Technical Abstract: Assessment of body composition remains a goal for the routine assessment of nutritional status of patients on chronic dialysis. Methods generally available for estimation of body fatness in healthy individuals are limited by practicality and availability for use in this patient population. Anthropometry, which is cost-effective and easy to perform, is limited by the lack of appropriate reference standards for dialysis patients and artifact caused by changed hydration status. Bioelectrical impedance affords new opportunities for non-invasive assessment of fluid volume and its distribution and body cell mass; estimation of fat-free mass and body fatness can be affected by hydration status. Dual x-ray absorptiometry permits estimation of bone status and fat mass because changes in hydration status are reflected in estimates of fat-free mass. Evaluation of validity of techniques for fluid status and body composition assessment requires the use of appropriate reference methods and proper statistical procedures to examine error not only between groups but by individual. Use of body composition assessment methods together with biochemical measurements will enhance the nutritional assessment of end- stage renal disease patients on chronic hemodialysis. |
