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- Publisher
- Hindawi Publishing Corporation
- Copyright
- Copyright © 2018 Kulapong Jayanama et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
- ISSN
- 2090-0724
- eISSN
- 2090-0732
- DOI
- 10.1155/2018/4537623
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Abstract
Hindawi Journal of Nutrition and Metabolism Volume 2018, Article ID 4537623, 11 pages https://doi.org/10.1155/2018/4537623 Research Article Evaluation of Body Composition in Hemodialysis Thai Patients: Comparison between Two Models of Bioelectrical Impedance Analyzer and Dual-Energy X-Ray Absorptiometry 1 2 2 Kulapong Jayanama , Supanee Putadechakun , Praopilad Srisuwarn , 3 2 Sakda Arj-Ong Vallibhakara , Prapimporn Chattranukulchai Shantavasinkul, 4 5 2 Chanika Sritara , Surasak Kantachuvesiri, and Surat Komindr Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road $ungphayathai, Ratchathewi, Bangkok 10400, $ailand Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road $ungphayathai, Ratchathewi, Bangkok 10400, $ailand Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road $ungphayathai, Ratchathewi, Bangkok 10400, $ailand Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road $ungphayathai, Ratchathewi, Bangkok 10400, $ailand Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road $ungphayathai, Ratchathewi, Bangkok 10400, $ailand Correspondence should be addressed to Kulapong Jayanama; kulapong.jay@mahidol.ac.th and Surat Komindr; surat.kom@ mahidol.ac.th Received 30 March 2018; Revised 4 June 2018; Accepted 24 June 2018; Published 5 August 2018 Academic Editor: Michael B. Zemel Copyright © 2018 Kulapong Jayanama et al. +is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Body composition measurement is very important for early nutritional care in hemodialysis patients. Dual-energy X-ray absorptiometry (DXA) is a gold standard test, but clinically limited. Bioelectrical impedance analysis (BIA) with mul- tifrequencytechnique isapracticalandreliabletool. Objective.+iscross-sectionalstudywasaimedtocomparetheagreementof BIA with DXA in measurement of body composition in hemodialysis patients and to evaluate their associated factors. Methods. Bodycompositionwasmeasuredby2BIAmethods(InBodyS10andInBody720)andDXAafterahemodialysissession.Atotalof 69 measurements were included. Pearson’s correlation and Bland and Altman analysis were used to determine the correlation of body composition between methods and to compare the methods agreement, respectively. Results. +e correlation coefficients of body compositions were strong between DXA and InBody S10 (fat mass index (FMI): r � 0.95, fat-free mass index (FFMI): r � 0.78) and also between DXA and InBody 720 (FMI: r � 0.96, FFMI: r � 0.81). Comparing to DXA, the means of each body compositionmeasuredbyInBodyS10methodwerenotsignificantlydifferentineachgender,butdifferenceswerefoundinFM,% FM, and FMI measured by InBody 720. Conclusions. In maintenance hemodialysis patients, the measurement of body com- position with DXA and both BIA methods had highly significant correlations; practically, BIA method could be used as an instrument to follow FM and FFM and to measure the edematous stage. Further studies with large populations are warranted. As a consequence, the patients undergoing renal replacement 1. Introduction therapy of hemodialysis have been rising [2]. Regular he- +e prevalence of chronic kidney disease (CKD) in the +ai modialysiscausesthedecreaseofbothFMandFFMovertimes population becomes much higher than previously known [1]. which isindependently associatedwith a highermortality and 2 Journal of Nutrition and Metabolism Table 1: Demographic, anthropometric, and nutritional status Table2:Bodycompositionparametersofthehemodialysispatients parameters of the hemodialysis patients (mean±SD). with BIA S10, BIA 720, and DXA (mean ± SD). Characteristics Hemodialysis patients (mean±SD) DXA BIA S10 BIA 720 Male, n (%) 24 (66) Fat mass (kg) a b a,b Age (years) 59.15±10.67 Male 19.28±7.30 19.16±8.29 16.68±9.07 a b a,b BW (kg) 61.51±12.40 Female 20.33±8.94 19.88±11.32 16.40±11.28 2 a b a,b BMI (kg/m ), median Total 19.32±7.94 18.91±9.36 16.82±9.46 22.65 (19.31–25.90) (IQR) Percentage of fat mass (%) a b a,b BMI>23kg/m , n (%) 17 (47) Male 27.24±6.48 27.53±10.00 23.68±10.20 a b a,b Waist circumference (cm) 88.90±12.81 Female 34.11±8.70 33.68±11.22 29.30±11.57 a b a,b Mid-upper arm Total 29.63±7.98 29.67±10.77 25.49±10.90 28.13±4.10 circumference (cm) Fat-free mass (kg) Triceps skinfold thickness, a a 13.60 (11.45–19.20) Male 47.56±5.88 46.46±7.35 48.88±7.24 mm, median (IQR) a a Female 36.66±5.01 35.35±3.96 37.11±4.35 MIS c,d a,c a,d Total 43.77±7.63 42.6±8.29 45.08±8.48 A, n (%) 2 (5) Fat mass index (kg/m ) B, n (%) 11 (31) a b a,b Male 6.83±2.80 6.72±3.35 6.05±3.45 C, n (%) 23 (64) a b a,b Female 8.37±3.91 8.27±4.75 7.30±4.77 BIA (InBody S10) a b a,b Total 7.37±3.29 7.26±3.93 6.46±3.93 ECF (kg) 12.26±2.17 Fat-free mass index (kg/m ) ICF (kg) 19.10±4.06 a a Male 17.18±1.88 16.73±1.95 17.63±1.70 ECF/TBW 0.39±0.02 a a Female 15.10±2.42 14.50±1.52 15.19±1.80 BIA (InBody 720) e a,e a Total 16.46±2.29 15.95±2.10 16.84±2.07 ECF (kg) 13.67±2.68 ICF (kg) 21.28±3.95 BIA �bioelectrical impedance analysis; DXA �dual-energy X-ray absorp- a,b ECF/TBW 0.39±0.02 tiometry; significant difference between tools of measurement at p<0.001 in each line; significant difference between tools of measurement nPCR (g/kg) 0.91±0.20 at p � 0.014 in each line; significant difference between tools of mea- Kt/V 1.78±0.39 surement at p � 0.049 in each line; significant difference between tools of Dialysis vintage (years), 5.21 (2.22–12.74) measurement at p � 0.006 in each line. median (IQR) BIA �bioelectrical impedance analysis; BW �body weight; ECF �extracel- lularfluid;ICF �intracellularfluid;IQR �interquartilerange;MIS �Malnutrition- hemodialysis patients was found slightly higher in fat mass Inflammation Score; SD �standard deviation; TBW �total body water; nPCR �normalized protein catabolic rate. (FM) and slightly lower in fat-free mass (FFM), but signifi- cantly [12]. +e error of the BIA was found greater in patients with CKD than in healthy subjects [13]. Because of its readily accessible, low cost, and quickly assessing procedure, the BIA a tendency toward a worse quality of life [3]. +ese also in- method has become widely used in clinical practice, in sport crease the prevalence of protein-energy malnutrition [4] and medicine, and also in weight reduction programs [7, 14]. morbidity [5]. To date, none of the studies have investigated the Early detection of malnourishment and optimized nu- agreement between BIA and DXA in measurement body tritional care can improve the outcomes [6]. +erefore, the composition in hemodialysis +ai population. Due to the body composition analysis is one of the most important effect of race [15], the accuracy of BIA must be evaluated. strategies to assess and monitor the nutritional status. +e aims of the present study were to compare the agree- Searching for a practical and accurate tool for body com- ment between BIA and DXA in measurement of the body position evaluation is essential. composition and to evaluate their associated factors. Dual-energy X-ray absorptiometry (DXA), based on the signals from two energy sources to provide a three com- partmentmodelofbodycomposition,istaken placeandhas 2. Materials and Methods become a gold standard test [7]. DXA is a reproducible and reliable technique for measuring fat mass in healthy [8] as 2.1. Subjects. +is study was a cross-sectional study con- well as in hemodialysis patients [9]. Unfortunately, this ducted in the hemodialysis unit of Ramathibodi Hospital, costly device, which is nonportable and depended on pro- Mahidol University, Bangkok, +ailand. All subjects, aged ficiency, cannot be used as a practical or accessible bedside morethan18years,whohadregularlybeenonmaintenance tool. Additionally, the body compartments, in particular hemodialysis for at least 3 months prior to the study were totalbodywater(TBW)inchronichemodialysispopulation, included.+estudywasperformedduringOctober2013and are significantly altered comparing to healthy population May 2014. Patients were treated with three sessions of di- [10]. Bioelectrical impedance analysis (BIA) with multifre- alysis per week on schedule, lasting 4 hours per period. +e quency technique has been proven to be one of the most percentageofrenalreplacementtherapymethodswasfound valid methods comparing to DXA with high correlation in 53%withhemodialysisand47%withhemodiafiltration.+is the healthy population [11]. However, the estimation by the study excluded all subjects who were unstable or currently BIA analyzers compared with that measured by DXA in on medications affecting metabolic rate or admitted in the Journal of Nutrition and Metabolism 3 Male Female 40.0 40.0 30.0 30.0 20.0 20.0 10.0 10.0 r = 0.91 r = 0.95 0.0 0.0 10.0 20.0 30.0 40.0 0.0 10.0 20.0 30.0 40.0 Fat mass by DXA (kg) Fat mass by DXA (kg) (a) (b) Male Female 40.0 40.0 30.0 30.0 20.0 20.0 10.0 10.0 r = 0.91 r = 0.97 0.0 0.0 0.0 10.0 20.0 30.0 40.0 0.0 10.0 20.0 30.0 40.0 Fat mass by DXA (kg) Fat mass by DXA (kg) (c) (d) Figure1:Correlationbetweenfatmassinhemodialysispatients:(a)measuredbyDXAandBIAS10inmale,(b)measuredbyDXAandBIA S10 in female, (c) measured by DXA and BIA 720 in male, and (d) measured by DXA and BIA 720 in female. hospitalduringtheperiodofstudy.Allofthemeasurements measurements (1, 5, 50, 250, 500, and 1000kHz) and 3 dif- were done on the dialysis day. Baseline data including age, ferent frequencies of phase angle measurement (5, 50, and sex, nutritional information, education background, socio- 250kHz) at each 5 segments (right arm, left arm, trunk, right economic status, physical examinations, and anthropo- leg, and left leg). Model InBody S10 was conducted while the metricmeasurementswereperformedandcompletedbythe patient was lying supine for 15minutes on a bed with legs well-trained physician. apart and arms not touching the torso after all metals were +e protocol was approved by the Institutional Review removed.+etouchtypeelectrodeswereplacedfollowingthe Board, Faculty of Medicine, Ramathibodi Hospital, Mahidol manuscript of the model, whereas model InBody 720 was University (Approval number MURA2013/317 Ns Feb ). 1 17 performedwhilethepatientwasstandingupright:handshold Writteninformedconsentwasobtainedfromeachparticipant. the electrodes and feet on the electrodes, with 8-point tactile electrodemethod.+eoutputvaluesincludedtheintracellular fluid,extracellularfluid,FM,FFM,and%FM.Byextracellular 2.2. Measurement and Laboratory Determinations. fluid (ECF)/(TBW), edematous state was detected by the BIA Anthropometricparameters includingweight,height, andwaist method [16]. In addition, the FM index (FMI) was de- circumferenceweremeasuredtwicewithstandardtechniquesby termined by the postdialysis FM (kg) divided by the height thesameskillfulphysician.Allmeasurementswereperformedin squared (m ), and FFM index (FFMI) was determined by the the same day after the subjects had fasted for 12hours and postdialysis FFM (kg) divided by the height squared (m ). within 30minutes after termination of hemodialysis period. All DXA was performed, immediately after BIA measure- participants dressed in light clothes without shoes. Body mass ment in the same day, using the Hologic Discovery A in- index (BMI) was calculated by the postdialysis body weight strument(HologicInc.,Waltham,MA,USA).Allscanswere (kilogram (kg)) divided by the height squared (meter (m) ). performed by the same trained technician and analyzed by BIAs were measured by 2 models of multifrequency impedance analyzers (model InBody S10, Biospace Co., Ltd., thesameradiologist.+ecalibrationwasdoneeachdayprior to start of testing by the standard technique. +e assessed Seoul,Korea,andmodelInBody720BiospaceCo.,Ltd.,Seoul, Korea) which provide 6 different frequency impedance data were FM, FFM, %FM, and bone mass. Fat mass by InBody 720 (kg) Fat mass by InBody S10 (kg) Fat mass by InBody 720 (kg) Fat mass by InBody S10 (kg) 4 Journal of Nutrition and Metabolism Male Female 50.0 60.0 40.0 50.0 30.0 40.0 20.0 30.0 10.0 20.0 0.0 r = 0.79 r = 0.91 10.0 0.0 10.0 20.0 30.0 40.0 10.0 20.0 30.0 40.0 50.0 Percentage of fat mass by DXA (kg) Percentage of fat mass by DXA (kg) (a) (b) Male Female 50.0 50.0 40.0 40.0 30.0 30.0 20.0 20.0 10.0 10.0 0.0 0.0 r = 0.89 r = 0.89 0.0 10.0 20.0 30.0 40.0 10.0 20.0 30.0 40.0 50.0 Percentage of fat mass by DXA (kg) Percentage of fat mass by DXA (kg) (c) (d) Figure2:Correlationbetweenpercentagesoffatmassinhemodialysispatients:(a)measuredbyDXAandBIAS10inmale,(b)measuredby DXA and BIA S10 in female, (c) measured by DXA and BIA 720 in male, and (d) measured by DXA and BIA 720 in female. MIS (Malnutrition-Inflammation Score) is the scoring (95% limits of agreement). +e correlation between the system more comprehensive and quantitative evaluation intermethod differences and each body parameter was criteria composed of 10 components: the 7 Dialysis Mal- obtained by Pearson’s correlation coefficient (r) test. A nutrition Score components and 3 new items (body mass statistical significance was attained when a p value was less than 0.05. index (BMI), serum albumin level, and total iron-binding capacity (TIBC)) have been added. In a recent prospective study, the MIS was found to be a comprehensive scoring 3. Results system which had the significant associations with pro- spective hospitalization and mortality [17, 18]. Sixty-nine measurements were performed. A total of 66% of patients were male, and the mean age was 59.66±11.28 years, ranging from 40 to 87 years. Patient BMIs were be- 2.3. Statistical Methods. All statistical analyses were per- tween 17.41 and 35.76kg/m : 19% of them had a BMI of 2 2 formed using STATA 12.0 software (StataCorp. 2011: Stata <18.5kg/m ,and47%hadaBMIof>23kg/m .ByMIS,64% StatisticalSoftware:Release12. CollegeStation,TX:StataCorp of patients were defined as severe malnutrition. Edematous LP). Mean±standard deviation (SD) or median (interquartile state was detected by both BIA methods (ECF/TBW). +e range (IQR)) for continuous variable and frequency (%) for averages of normalized protein catabolic rate (nPCR), Kt/v, binary or categorical variable were presented. Paired t-tests and dialysis vintage were 0.91±0.20g/kg, 1.78±0.39, and were used to compare mean of FM, %FM, FFM, FMI, and 5.21 (2.22–12.74) years, respectively (Table 1). FFMI measured by BIA and DXA. +e correlation between Inbothgenders,nosignificantintermethoddifferenceof FM, %FM, FFM, FMI, and FFMI predicted by BIA and FM, %FM, FFM, FMI, and FFMI measured by InBody S10 those measured by DXA was determined by Pearson’s and DXA was found ; on the other hand, means of FM, % correlation coefficient (r). +e Bland and Altman analysis FM,andFMImeasuredbyBIA720weresignificantlyhigher [19] was used to compare the agreement between the than when measured by BIA S10 and DXA (Table 2). +e measurement techniques. +e limits of agreement between significant difference in means of FM, %FM, and FMI methods were defined as the mean difference±1.96 SD measured by all 3 methods was not observed between Percentage of fat mass by InBody Percentage of fat mass by InBody 720 (kg) S10 (kg) Percentage of fat mass by InBody Percentage of fat mass by InBody 720 (kg) S10 (kg) Journal of Nutrition and Metabolism 5 Male Female 42.0 60.0 40.0 38.0 50.0 36.0 34.0 40.0 32.0 30.0 30.0 28.0 r = 0.84 r = 0.68 30.0 35.0 40.0 45.0 50.0 55.0 60.0 30.0 35.0 40.0 45.0 50.0 Fat-free mass by DXA (kg) Fat-free mass by DXA (kg) (a) (b) Male Female 70.0 44.0 42.0 60.0 40.0 38.0 50.0 36.0 34.0 40.0 32.0 30.0 r = 0.81 30.0 r = 0.83 30.00 35.00 40.00 45.00 50.00 55.00 60.00 30.0 35.0 40.0 45.0 50.0 Fat-free mass by DXA (kg) Fat-free mass by DXA (kg) (c) (d) Figure3:Correlationbetweenfat-freemassinhemodialysispatients:(a)measuredbyDXAandBIAS10inmale,(b)measuredbyDXAand BIA S10 in female, (c) measured by DXA and BIA 720 in male, and (d) measured by DXA and BIA 720 in female. genders. Nevertheless, all methods showed significantly r � 0.25, p � 0.039; FFM: r � −0.26, p � 0.034; FFMI: higher FFM and FFMI in men (p<0.001). r � −0.27, p � 0.025), and edematous stage (%FM: r � +e correlation coefficients (r) of body compositions 0.39, p � 0.001; FFM: r � −0.32, p � 0.008; FFMI: between DXA and InBody S10 were high (FM: r � 0.93; % r � −0.32, p � 0.008), whereas the differences of FM and FM: r � 0.85; FFM: r � 0.88; FMI: r � 0.95; FFMI: r � 0.78) FFM were associated with only age (FM: r � 0.40, p � 0.001; with p<0.001. Strong correlations were also found between FMI: r � −0.39, p � 0.001) and edematous stage (FM: DXA and InBody 720 (FM: r � 0.94; %FM: r � 0.88; FFM: r � 0.39, p � 0.001; FMI: r � 0.38, p � 0.001). Nonetheless, r � 0.89; FMI: r � 0.96; FFMI: r � 0.81) with p<0.001. +e any relationship between age and edematous stage and the difference measured by BIA 720 and DXA was not observed. correlation coefficients of these measurements between DXAandbothBIAmethodsineachgenderareillustratedin Only body weight was found to have a significant association with the difference of % FM (r � 0.39, p � 0.002), FFM Figures 1–5. By Bland and Altman analysis [19], the differences of (r � −0.26, p � 0.038), FMI (r � 0.27, p � 0.034), and FM,%FM, andFMIbetween DXAandInBody S10method FFMI (r � −0.31, p � 0.016). were smaller than that between DXA and InBody 720. However, both BIA methods had wide 95% limits of 4. Discussion agreement with DXA (Table 3). +ese intermethod dif- ferences did not significantly differ between male and fe- +e deterioration of body compositions, both FM and FFM, male. +e agreements of all measures in both genders is strongly correlated with morbidity and mortality and illustrated by Bland and Altman plots also revealed the represents a poor prognostic marker [20]. Hence, early same direction: between BIA S10 and DXA (Figure 6) and nutritional care is very important to prevent this morbidity. between BIA 720 and DXA (Figure 7). With regard to the Nevertheless, the measurement of FFM, which is pre- measures between BIA S10 and DXA, the differences of % dominantly composed of muscle mass, body water, and FM, FFM, and FFMI were significantly correlated with age minerals, is affected by abnormal fluid and electrolyte dis- (%FM: r � 0.36, p � 0.002; FFM: r � −0.34, p � 0.004; tribution, and commonly observed in patients undergoing FFMI: r � −0.35, p � 0.003), body weight (%FM: renal replacement therapy. Fat-free mass by InBody 720 (kg) Fat-free mass by InBody S10 (kg) Fat-free mass by InBody 720 (kg) Fat-free mass by InBody S10 (kg) 6 Journal of Nutrition and Metabolism Male Female 20.0 20.0 15.0 15.0 10.0 10.0 5.0 5.0 0.0 r = 0.93 0.0 r = 0.96 0.0 2.5 5.0 7.5 10.0 12.5 0.0 5.0 10.0 15.0 20.0 Fat mass index by DXA (kg) Fat mass index by DXA (kg) (a) (b) Male Female 20.0 14.0 12.0 15.0 10.0 8.0 10.0 6.0 4.0 5.0 2.0 0.0 0.0 r = 0.93 r = 0.98 0.0 2.5 5.0 7.5 10.0 12.5 5.0 10.0 15.0 Fat mass index by DXA (kg) Fat mass index by DXA (kg) (c) (d) Figure 4: Correlation between fat mass index in hemodialysis patients: (a) measured by DXA and BIA S10 in male, (b) measured by DXA and BIA S10 in female, (c) measured by DXA and BIA 720 in male, and (d) measured by DXA and BIA 720 in female. In agreement with the previous reports [7, 12], the both BIA and DXA were in the same direction in this study. present study observed highly significant correlations in the FMI and FFMI may be beneficial for nutritional assessment measurement of FM and FFM between DXA and both BIA and easier recognition [23], but FM and FFM are also useful methods.+eFMmeasuredbybothBIAmethodswaslower and familiar due to the direct report from the devices. +e than the DXA, and this could be the result of edema in limitation of this study is the modest sample size. Never- hemodialysispatientsinthisstudy.+eFFMofbothgenders theless, this is the first study which compares DXA and both was underestimated by InBody S10 but overestimated by of 2 BIA methods in hemodialysis +ai patients. InBody 720. As a result of gravity, the water distribution in the supine position differs from the upright position in the edematous state, [21] and the variation of body water dis- 5. Conclusions tribution by BIA measurement of body composition is also affected by different positions [22]. All methods showed In conclusion, the present study depicted that body com- significantly higher FFM in men according to the normal position values measured by DXA and both BIA methods physiology. +e mean differences of FM, %FM, and FMI had strongly significant correlations. However, significant between DXA and InBody S10 method for both genders differences between measurement by DXA and InBody 720 weresmallandnotsignificant,whereasthemeandifferences methods were also found but not between measurement by between DXA and InBody 720 were higher. +ese results DXA and InBody S10. As a result, both BIA methods could support the idea that the measurement of FM, %FM, and be practically used as an instrument to follow FM, FFM, FFM by both BIA methods could be clinically, practically, FMI, and FFMI in the same individuals. +e body weight and reasonably used in follow-up. BIA can also measure the was an associated factor with the difference of FFM and edematous stage in this population. However, these devices FFMI when measured by DXA and both BIA methods. cannot provide the accuracy of DXA when measuring FM Notwithstanding, age and edematous stage were correlated and FFM. with the intermethod difference when measured by DXA +e results between body compositions (FM and FFM) and InBody S10. Further study with a larger number of and their calculated indices (FMI and FFMI) measured by hemodialysis +ai patients should be warranted. Fat mass index by InBody 720 (kg) Fat mass index by InBody S10 (kg) Fat mass index by InBody 720 (kg) Fat mass index by InBody S10 (kg) Journal of Nutrition and Metabolism 7 Male Female 22.0 18.0 20.0 17.0 18.0 16.0 16.0 15.0 14.0 14.0 12.0 13.0 10.0 r = 0.71 12.0 r = 0.78 12.5 15.0 17.5 20.0 22.5 12.0 14.0 16.0 18.0 20.0 Fat-free mass index by DXA (kg) Fat-free mass index by DXA (kg) (a) (b) Male Female 22.0 18.0 20.0 18.0 16.0 16.0 14.0 14.0 12.0 12.0 r = 0.64 r = 0.89 12.0 14.0 16.0 18.0 20.0 22.0 12.0 14.0 16.0 18.0 20.0 Fat-free mass index by DXA (kg) Fat-free mass index by DXA (kg) (c) (d) Figure 5: Correlation between fat-free mass index in hemodialysis patients: (a) measured by DXA and BIA S10 in male, (b) measured by DXA and BIA S10 in female, (c) measured by DXA and BIA 720 in male, and (d) measured by DXA and BIA 720 in female. Table3:Meandifferencesandlimitsofagreementforfatmass,percentageoffatmass,fat-freemass,fatmassindex,andfat-freemassindex of the hemodialysis patients with BIA S10, BIA 720, and DXA. InBody S10 versus DXA InBody 720 versus DXA Methods Mean difference±SD 95% limits of agreement Mean difference±SD 95% limits of agreement Fat mass (kg) Male −0.42±3.56 −7.40 to 6.56 −2.57±3.74 −9.90 to 4.76 Female −0.41±3.67 −7.60 to 6.78 −2.70±2.92 −8.42 to 3.02 Total −0.41±3.57 −7.42 to 6.59 −2.6±3.47 −9.41 to 4.19 Percentage of fat mass (%) Male 0.28±5.24 −9.99 to 10.55 −3.62±5.24 −13.89 to 6.65 Female −0.42±6.93 −14.00 to 13.16 −5.19±5.74 −16.44 to 6.06 Total 0.04±5.84 −11.41 to 11.48 −4.13±5.41 −14.73 to 6.48 Fat-free mass (kg) Male −1.10±4.00 −8.94 to 6.74 0.98±4.21 −7.27 to 9.23 Female −1.32±3.74 −8.65 to 6.01 0.96±2.93 −4.84 to 6.76 Total −1.17±3.88 −8.79 to 6.44 0.98±3.82 −6.51 to 8.46 Fat mass index (kg/m ) Male −0.11±1.28 −2.62 to 2.40 −0.88±1.30 −3.43 to 1.67 Female −0.10±1.52 −3.08 to 2.88 −1.06±1.16 −3.33 to 1.21 Total −0.11±1.36 −2.78 to 2.56 −0.94±1.25 −3.39 to 1.51 Fat-free mass index (kg/m ) Male −0.46±1.45 −3.30 to 2.38 0.29±1.49 −2.63 to 3.21 Female −0.60±1.56 −3.66 to 2.46 0.35±1.19 −1.98 to 3.52 Total −0.51±1.48 −3.41 to 2.39 0.31±1.39 −2.41 to 3.03 BIA �bioelectrical impedance analysis; DXA �dual-energy X-ray absorptiometry. Fat-free mass index by InBody 720 (kg) Fat-free mass index by InBody S10 (kg) Fat-free mass index by InBody 720 (kg) Fat-free mass index by InBody S10 (kg) 8 Journal of Nutrition and Metabolism –5 –5 –10 –10 –15 –15 –20 –20 –25 0 10 20 30 40 0 10 20 30 40 50 Mean of fat mass (kg) Mean of percentage of fat mass (%) (InBody S10 + DXA)/2 (InBody S10 + DXA)/2 (a) (b) 20 8 10 4 0 0 –2 –10 –4 –6 –20 –8 30 35 40 45 50 55 60 0 5 10 15 20 Mean of percentage of fat mass (%) Mean of fat mass index (kg/m ) (InBody S10 + DXA)/2 (InBody S10 + DXA)/2 (c) (d) –2 –4 –6 –8 16 18 20 10 12 14 Mean of fat-free mass index (kg/m ) (InBody S10 + DXA)/2 (e) Figure 6: +e agreement between DXA and BIA S10 in (a) fat mass, (b) percentage of fat mass, (c) fat-free mass, (d) fat mass index, and (e) fat-free mass index. Black filled-in triangles represent values of male, and black circles represent values of female. Difference of percentage of fat mass (%) Difference of fat mass (kg) (InBody S10 – DXA) (InBody S10 – DXA) Difference of fat-free mass index (kg/m ) (InBody S10 – DXA) Difference of percentage of fat mass (%) Difference of fat mass index (kg/m ) (InBody S10 – DXA) (InBody S10 – DXA) Journal of Nutrition and Metabolism 9 –5 –5 –10 –15 –10 –20 –15 –25 –30 –20 0 10 20 30 40 50 0 10 20 30 40 Mean of percentage of fat mass (%) Mean of fat mass (kg) (InBody 720 + DXA)/2 (InBody 720 + DXA)/2 (a) (b) –2 –5 –4 –10 –6 –15 –20 –8 30 35 40 45 50 55 60 0 5 10 15 20 Mean of fat-free mass (kg) Mean of fat mass index (kg/m ) (InBody 720 + DXA)/2 (InBody 720 + DXA)/2 (c) (d) –2 –4 –6 –8 12 14 16 18 20 22 Mean of fat-free mass index (kg/m ) (InBody 720 + DXA)/2 (e) Figure7:+e agreementbetweenDXA andBIA 720in(a)fat mass,(b)percentage offat mass,(c) fat-free mass,(d)fat massindex,and (e) fat-free mass index. Black filled-in triangles represent values of male, and black circles represent values of female. Abbreviations FM: Fat mass ICF: Intracellular fluid BIA: Bioelectrical impedance analysis IQR: Interquartile range BMI: Body mass index kg: Kilogram BW: Body weight m: Meter CKD: Chronic kidney disease MIS: Malnutrition-Inflammation Score DXA: Dual-energy X-ray absorptiometry nPCR: Normalized protein catabolic rate ECF: Extracellular fluid SD: Standard deviation FFM: Fat-free mass TBW: Total body water FFMI: Fat-free mass index TIBC: Total iron-binding capacity. FMI: Fat mass index Difference of fat-free mass (kg) Difference of fat mass (kg) (InBody 720 – DXA) (InBody 720 – DXA) Difference of fat-free mass index (kg/m ) (InBody 720 – DXA) Difference of fat mass index (kg/m ) Difference of percentage of fat mass (%) (InBody 720 – DXA) (InBody 720 – DXA) 10 Journal of Nutrition and Metabolism prospective mortality in hemodialysis patients,” American Data Availability Journal of Clinical Nutrition, vol. 83,no. 2, pp.202–210, 2006. +edatasetsusedand/oranalyzedduringthecurrentstudyare [4] C. M. Piratelli and R. Telarolli Junior, “Nutritional evaluation availablefromthecorrespondingauthoronreasonablerequest. of stage 5 chronic kidney disease patients on dialysis,” Sao Paulo Medical Journal, vol. 130, no. 6, pp. 392–397, 2012. [5] W. M. McClellan, C. Anson, K. Birkeli, and E. 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