title: Subclinical versus overt obesity in dialysis patients: more than meets the eye.
abstract: BACKGROUND
  Obesity is an important problem in the epidemic of chronic kidney disease (CKD). Obesity is usually diagnosed by body mass index (BMI), but this metric has limitations as a measure of adiposity in CKD patients. Simple anthropometric tools, like skinfold thickness measurements, have been shown to be a better test to classify obesity among those with CKD.
  
  
  METHODS
  The prevalence of obesity was estimated by BMI (>30 kg/m(2)) and by skinfold thickness-estimated body fat (>25% in men and 35% in women) in two cohorts comprising 284 incident dialysis and 209 prevalent haemodialysis (HD) patients from Sweden. Patient characteristics were compared among individuals with differing diagnosis.
  
  
  RESULTS
  BMI obesity cut-offs misdiagnosed many patients (>50%) with excess adiposity. Obesity, estimated by BMI, was present in 9 and 10% of incident and prevalent dialysis patients, respectively. When estimated by percentage of body fat, the prevalence of obesity rose to 64 and 65%. In both cohorts, a large proportion of patients (55%) were obese in the context of a normal BMI (termed as subclinical obesity). These individuals were older, presented more co-morbidity and lower surrogates of muscle mass [handgrip strength, arm muscle circumference or insulin-growth factor (IGF)-1 levels] than those diagnosed by both methods (termed overt obesity).
  
  
  CONCLUSIONS
  A BMI of <30 kg/m(2) does not exclude the presence of excess adiposity. Subclinical obesity is a frequent condition in dialysis patients, and the clinical consequences of this finding deserve further consideration.
authors.affiliation: Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Carolina
authors.initials: C
authors.lastname: Gracia-Iguacel
authors.forename: Abdul Rashid
authors.initials: AR
authors.lastname: Qureshi
authors.forename: Carla Maria
authors.initials: CM
authors.lastname: Avesani
authors.forename: Olof
authors.initials: O
authors.lastname: Heimbürger
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Huang
authors.forename: Bengt
authors.initials: B
authors.lastname: Lindholm
authors.forename: Peter
authors.initials: P
authors.lastname: Bárány
authors.forename: Alberto
authors.initials: A
authors.lastname: Ortiz
authors.forename: Peter
authors.initials: P
authors.lastname: Stenvinkel
authors.forename: Juan Jesús
authors.initials: JJ
authors.lastname: Carrero
mesh_terms: D000273:Adipose Tissue; D050154:Adiposity; D000328:Adult; D000368:Aged; D000886:Anthropometry; D001823:Body Composition; D015992:Body Mass Index; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology* / Q000503:physiopathology; D006435:Renal Dialysis; D012885:Skinfold Thickness; D013548:Sweden / Q000453:epidemiology
keywords: anthropometrics; fatness; muscle; protein-energy wasting; sarcopenia