Association of Frailty With Nutritional Status in Patients With Chronic Kidney Disease.

OBJECTIVES: Frailty is commonly observed in patients with chronic kidney disease (CKD) and is associated with adverse outcomes. Protein-energy wasting (PEW), a state of decreased body stores of protein and energy fuels, may be associated with frailty. However, few data are available on the possible association between frailty and PEW in CKD. METHODS: We examined the association between frailty and nutritional status assessed using anthropometric and body composition measurements, serum albumin, handgrip strength, the Malnutrition Inflammation Score (MIS), and dietary protein and calorie intake in a cross-sectional analysis of nondialysis patients with CKD stages 3-5. Body composition was assessed using multifrequency bioelectrical impedance. Frailty was defined as a Clinical Frailty Scale ≥4. We performed logistic regression with different nutrition assessment tools as the main predictors and age, sex, comorbidity, estimated glomerular filtration rate (eGFR), and hemoglobin as covariates. RESULTS: A total of 157 patients (93 men and 64 women; mean age 64 years; diabetes prevalence 38.9%) with CKD (eGFR 24.4 ± 13.4 mL/min/1.73 m2) were included. Overall, 29.3% of patients were frail. Patients with frailty were older and had a significantly higher fat tissue index and MIS but a significantly lower lean tissue index, eGFR, hemoglobin value, serum albumin value, handgrip strength value, and dietary protein intake. In multivariate logistic regression analyses, a higher body mass index category (odds ratio [OR], 1.54; 95% confidence interval [CI], 1.03-2.31), higher fat tissue index (OR, 1.15; 95% CI, 1.03-1.28), larger waist circumference (OR, 1.05; 95% CI, 1.01-1.09), reduced handgrip strength (OR, 2.70; 95% CI, 1.17-6.21), PEW defined by MIS ≥5 (OR, 3.49; 95% CI, 1.35-9.01), and dietary protein intake ≤0.8 g/kg/day (OR, 2.70; 95% CI, 1.18-6.19) were associated with higher odds of frailty. CONCLUSION: Frailty is associated with nutritional status in patients with CKD. A comprehensive nutrition assessment may allow the implementation of strategies to prevent or reduce frailty.

High serum adipocyte fatty acid binding protein concentration linked with increased aortic arterial stiffness in patients with type 2 diabetes.

BACKGROUND: Adipocyte fatty acid binding protein (A-FABP) is a novel adipokine that contributes to the development of metabolic disorder, type 2 diabetes mellitus (T2DM) and atherosclerosis. We determined the correlation between serum A-FABP and aortic stiffness in T2DM patients. METHODS: Fasting blood samples were obtained from 156 patients with T2DM. Serum A-FABP concentration were determined using a commercial enzyme immunoassay. Carotid-femoral pulse wave velocity (cfPWV) was measured using SphygmoCor System, and cfPWV values of >10 m/s were defined as high aortic stiffness. RESULTS: Sixty participants (38.4%) fell under the high aortic stiffness group. This group, compared to the control group, showed older age (P = .004), higher systolic blood pressure (P < .001), diastolic blood pressure (P = .027), urine albumin-to-creatinine ratio (P = .003), serum A-FABP (P < .001) and lower estimated glomerular filtration rate (P = .001). After adjusting for factors significantly associated with aortic stiffness using multivariable logistic regression analysis, serum A-FABP [OR = 1.029 (1.002-1.058), P = .039] was found to be an independent predictor of aortic stiffness in T2DM patients. CONCLUSIONS: Serum A-FABP is positively correlated with aortic arterial stiffness in patients with T2DM.

Leptin is an independent marker of metabolic syndrome in elderly adults with type 2 diabetes.

OBJECTIVE: It is well established that patients with metabolic syndrome (MetS) demonstrate elevated levels of serum leptin. The aim of this study is to identify fasting serum leptin as an independent marker of MetS in geriatric diabetic patients. MATERIALS AND METHODS: Sixty-four patients over 65 years old with type 2 diabetic mellitus (T2DM) were assessed for MetS based on the diagnostic criteria of the International Diabetes Federation. Fasting blood samples including serum leptin concentrations were obtained from the participants. Leptin levels were determined using a commercial enzyme immunoassay. RESULTS: Forty-five (70.3%) of the 64 geriatric T2DM patients enrolled in this study were found to have MetS. This group of participants compared with those in the non-MetS group had higher serum levels of leptin (P = 0.004), triglycerides (P = 0.005), fasting glucose (P = 0.049), glycated hemoglobin (P = 0.016), white blood cells (P = 0.003), C-reactive protein (CRP, P = 0.028), insulin (P < 0.001), higher homeostatic model assessment insulin resistance values (HOMA1-IR and HOMA2-IR, both P < 0.001), a higher body weight (P = 0.024), body mass index (P < 0.001), body fat mass (P < 0.001), waist circumference (P < 0.001), systolic blood pressure (BP) (P < 0.001), diastolic BP (P < 0.001), percentage of women (P = 0.011), prevalence of hypertension (P = 0.042), and a lower level of serum high-density lipoprotein cholesterol (P = 0.001). Univariate linear analysis of the clinical variables associated with the fasting serum leptin level revealed that height (P = 0.020) had a negative correlation, while body fat mass (P < 0.001) and logarithmically transformed CRP (log-CRP, P < 0.001) had positive correlations with serum leptin levels. Multivariate forward step-wise linear regression analysis of the variables significantly associated with fasting serum leptin levels showed that body fat mass (P < 0.001) and log-CRP (P = 0.001) were independent predictors of these values. CONCLUSION: Serum leptin is positively correlated with MetS. It serves as an independent marker of MetS in elderly patients with T2DM.