Association of abdominal visceral adiposity and thigh sarcopenia with changes of arteriosclerosis in haemodialysis patients

Background. In haemodialysis (HD) patients, abdominal visceral fat is accumulated while lean body mass is decreased irrespective of their body mass indexes (BMI). However, it is poorly understood which changes of fat and muscle masses are more associated with changes of arteriosclerosis. We aimed at examining the associations of abdominal visceral fat and thigh muscle masses with markers of arteriosclerosis in chronic HD patients in a cross-sectional fashion. Patients and Methods. We measured abdominal visceral fat mass area (AVFA), abdominal subcutaneous fat mass area (ASFA), thigh muscle area (TMA) and TMA standardized for femoral shaft area (TMA/FSA) by computed tomography (CT) in 161 HD patients (age: 61 +/- 11 years, time on HD: 12 +/- 10 years, male/female = 113/48, non-diabetes/diabetes = 127/34). We also investigated carotid artery intima-media thickness (CA-IMT) using the ultrasound instrument, and brachial-ankle pulse wave velocity (baPWV), cardio-ankle vascular index (CAVI) and ankle-brachial pressure index (ABI) using the waveform device (CAVI-VaSera VS-1000). Results. AVFA was significantly and positively related to CA-IMT in both non-diabetic (r = 0.23, P < 0.05) and diabetic HD patients (r = 0.38, P < 0.05). There was a significant and positive correlation between AVFA and hs-CRP in all patients (r = 0.26, P < 0.01). ASFA was also significantly correlated with CA-IMT (r = 0.53, P < 0.01) in diabetic HD patients. TMA/SFA ratio was negatively associated with CA-IMT (r = -0.21, P < 0.05), while positively with ABI (r = 0.28, P < 0.01) in non-diabetic patients. TMA/SFA ratio was inversely related to baPWV (r = -0.41, P < 0.01) and CAVI (r = -0.41, P < 0.05) in diabetic HD patients. Multiple regression analysis revealed that AVFA was a significant determinant of CA-IMT. TMA/AFA was also significantly associated with CA-IMT, baPWV, CAVI and ABI. Conclusion. Accumulated abdominal visceral fat is associated with CA-IMT. In addition, reduced thigh muscle mass area is independently related to CA-IMT, baPWV, CAVI and ABI, suggesting that sarcopenia in the leg is closely associated with systemic changes of arteriosclerosis in HD patients.