{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T05:26:41Z","timestamp":1764912401619,"version":"3.46.0"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T00:00:00Z","timestamp":1764892800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Physiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Constipation is among the most common gastrointestinal disorders among dialysis patients. Low skeletal muscle density (SMD), a marker of increased intramuscular fat infiltration in muscle, is also among the important characteristics of dialysis patients. This study aimed to assess whether a low SMD is associated with constipation in patients on maintenance dialysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 428 dialysis patients from three dialysis centers in our hospital were enrolled in this cross-sectional study. Constipation was assessed according to the Rome IV diagnostic criteria. The SMD was determined via computed tomography (CT) at the first lumbar vertebra level. Univariate and multivariate logistic regression analyses were used to explore the potential effect of SMD on constipation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The mean age of all participants was 56.09 (\u00b115.17) years. The percentage of male participants was 42.99%. In accordance with the Rome IV diagnostic criteria, the prevalence of constipation among dialysis patients was 62.62%. We found that compared with that of patients with no constipation, the SMD of patients with constipation was significantly lower [31.70 (\u00b17.33) HU vs. 38.44 (\u00b16.44) HU, P &amp;lt; 0.001]. Decreased SMD was significantly associated with constipation in dialysis patients. The association remained statistically significant even after adjusting for age, dialysis vintage, hemoglobin concentration, serum phosphate concentration and history of diabetes, skeletal muscle index and body mass index. The odds ratios were 0.26 (0.10\u20130.70), 0.25 (0.08\u20130.80) and 0.21 (0.05\u20130.80) for SMD quartile 2, quartile 3 and quartile 4, respectively (reference, quartile 1). Furthermore, the area under the curve (AUC) of the nomogram in the training group was 0.74, whereas that in the test group was 0.76.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Dialysis patients have a high prevalence of constipation. We found that a low SMD is an independent risk factor for constipation. Our findings provide a new perspective on the causes of susceptibility to constipation among dialysis patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphys.2025.1725508","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T05:13:26Z","timestamp":1764911606000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Low skeletal muscle density is a risk factor for constipation in patients on maintenance dialysis"],"prefix":"10.3389","volume":"16","author":[{"given":"Mengting","family":"Li","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qing","family":"Yin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shimei","family":"Hou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lirong","family":"Hao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianbing","family":"Hao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liuping","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"He","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qinglei","family":"Xie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2","DOI":"10.3892\/br.2020.1378","article-title":"Association between the severity of constipation and sarcopenia in elderly adults: a single-center university hospital-based, cross-sectional study","volume":"14","author":"Asaoka","year":"2021","journal-title":"Biomed. Rep."},{"key":"B2","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1080\/17474124.2020.1708718","article-title":"An approach to the diagnosis and management of rome IV functional disorders of chronic constipation","volume":"14","author":"Aziz","year":"2020","journal-title":"Expert Rev. Gastroenterol. Hepatol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1186\/s12877-016-0349-4","article-title":"Sarcopenia in daily practice: assessment and management","volume":"16","author":"Beaudart","year":"2016","journal-title":"BMC Geriatr."},{"key":"B4","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1111\/hdi.13009","article-title":"The quality of life and comfort levels of hemodialysis patients with constipation: a descriptive and cross-sectional study","volume":"26","author":"Bulbul","year":"2022","journal-title":"Hemodial. Int."},{"key":"B5","doi-asserted-by":"publisher","first-page":"428","DOI":"10.5056\/jnm23133","article-title":"Constipation in patients with chronic kidney disease","volume":"29","author":"Cha","year":"2023","journal-title":"J. Neurogastroenterol. Motil."},{"key":"B6","doi-asserted-by":"publisher","first-page":"04197","DOI":"10.7189\/jogh.14.04197","article-title":"Physical activity and constipation: a systematic review of cohort studies","volume":"14","author":"Cui","year":"2024","journal-title":"J. Glob. Health"},{"key":"B7","doi-asserted-by":"publisher","first-page":"422","DOI":"10.1080\/00365520510011641","article-title":"Effects of regular physical activity on defecation pattern in middle-aged patients complaining of chronic constipation","volume":"40","author":"De Schryver","year":"2005","journal-title":"Scand. J. Gastroenterol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"11369","DOI":"10.1038\/s41598-018-29825-5","article-title":"Skeletal muscle cutoff values for sarcopenia diagnosis using T10 to L5 measurements in a healthy US population","volume":"8","author":"Derstine","year":"2018","journal-title":"Sci. Rep."},{"key":"B9","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1002\/jcsm.13425","article-title":"Prevalence of sarcopenia in patients with chronic kidney disease: a global systematic review and meta-analysis","volume":"15","author":"Duarte","year":"2024","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1655","DOI":"10.1093\/ndt\/gft070","article-title":"Uraemic sarcopenia: etiology and implications","volume":"29","author":"Fahal","year":"2014","journal-title":"Nephrol. Dial. Transpl."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1323","DOI":"10.1016\/j.mri.2012.05.001","article-title":"3d slicer as an image computing platform for the quantitative imaging network","volume":"30","author":"Fedorov","year":"2012","journal-title":"Magn. Reson Imaging"},{"key":"B12","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1080\/00365521.2019.1568544","article-title":"Exercise therapy in patients with constipation: a systematic review and meta-analysis of randomized controlled trials","volume":"54","author":"Gao","year":"2019","journal-title":"Scand. J. Gastroenterol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1303","DOI":"10.1007\/s11357-023-00795-5","article-title":"Sex-specific alteration in human muscle transcriptome with age","volume":"45","author":"Gharpure","year":"2023","journal-title":"Geroscience"},{"key":"B14","doi-asserted-by":"publisher","first-page":"2863","DOI":"10.1002\/jcsm.13097","article-title":"The relationship between the mode of presentation, CT-derived body composition, systemic inflammatory grade and survival in colon cancer","volume":"13","author":"Golder","year":"2022","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"B15","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1111\/nep.14224","article-title":"Constipation and clinical outcomes in peritoneal dialysis: results from Thailand PDOPPS","volume":"28","author":"Halue","year":"2023","journal-title":"Nephrol. Carlt."},{"key":"B16","doi-asserted-by":"publisher","first-page":"7","DOI":"10.2169\/internalmedicine.2867-23","article-title":"Management of chronic constipation: a comprehensive review","volume":"64","author":"Hojo","year":"2025","journal-title":"Intern Med."},{"key":"B17","doi-asserted-by":"publisher","first-page":"5737","DOI":"10.21037\/qims-24-120","article-title":"Computed tomography (CT)-based skeletal muscle vertebral-related index to assess low muscle mass in patients with non-small cell lung cancer","volume":"14","author":"Huang","year":"2024","journal-title":"Quant. Imaging Med. Surg."},{"key":"B18","doi-asserted-by":"publisher","first-page":"112574","DOI":"10.1016\/j.exger.2024.112574","article-title":"Age- and sex-dependence of muscle quality: influence of intramuscular noncontractile tissues","volume":"196","author":"Ichinose","year":"2024","journal-title":"Exp. Gerontol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"738","DOI":"10.1007\/s12664-023-01363-7","article-title":"Occasional constipation-understanding a common but overlooked problem","volume":"42","author":"Jain","year":"2023","journal-title":"Indian J. Gastroenterol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1931","DOI":"10.3390\/nu12071931","article-title":"Plant-dominant low-protein diet for conservative management of chronic kidney disease","volume":"12","author":"Kalantar-Zadeh","year":"2020","journal-title":"Nutrients"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1605","DOI":"10.3390\/cancers12061605","article-title":"The combination of low skeletal muscle mass and high tumor Interleukin-6 associates with decreased survival in clear cell renal cell carcinoma","volume":"12","author":"Kays","year":"2020","journal-title":"Cancers (Basel)"},{"key":"B22","doi-asserted-by":"publisher","first-page":"S20","DOI":"10.1111\/apt.17852","article-title":"Functional constipation: pathophysiology, evaluation, and management","volume":"60","author":"Kilgore","year":"2024","journal-title":"Aliment. Pharmacol. Ther."},{"key":"B23","doi-asserted-by":"publisher","first-page":"10577","DOI":"10.3748\/wjg.v20.i30.10577","article-title":"Aerobic exercise improves gastrointestinal motility in psychiatric inpatients","volume":"20","author":"Kim","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1418778","DOI":"10.3389\/fnut.2024.1418778","article-title":"Gut-muscle axis mechanism of exercise prevention of sarcopenia","volume":"11","author":"Li","year":"2024","journal-title":"Front. Nutr."},{"key":"B25","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1055\/s-2007-1021212","article-title":"Brief physical inactivity prolongs colonic transit time in elderly active men","volume":"14","author":"Liu","year":"1993","journal-title":"Int. J. Sports Med."},{"key":"B26","doi-asserted-by":"publisher","first-page":"e16652","DOI":"10.7717\/peerj.16652","article-title":"Feasibility of using chest computed tomography (CT) imaging at the first lumbar vertebra (L1) level to assess skeletal muscle mass: a retrospective study","volume":"11","author":"Liu","year":"2023","journal-title":"PeerJ"},{"key":"B27","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1097\/MPG.0000000000001651","article-title":"Severe sarcopenia and increased fat stores in pediatric patients with liver, kidney, or intestine failure","volume":"65","author":"Mangus","year":"2017","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"B28","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1007\/s11912-022-01267-3","article-title":"The underestimated and overlooked burden of diarrhea and constipation in cancer patients","volume":"24","author":"Moschen","year":"2022","journal-title":"Curr. Oncol. Rep."},{"key":"B29","doi-asserted-by":"publisher","first-page":"476","DOI":"10.3350\/cmh.2020.0192","article-title":"Sarcopenia and blood myokine levels as prognostic biomarkers in patients with liver cirrhosis or hepatocellular carcinoma","volume":"26","author":"Oh","year":"2020","journal-title":"Clin. Mol. Hepatol."},{"key":"B30","doi-asserted-by":"publisher","first-page":"155","DOI":"10.23876\/j.krcp.24.174","article-title":"Constipation and risk of death and cardiovascular events in patients on hemodialysis","volume":"44","author":"Park","year":"2025","journal-title":"Kidney Res. Clin. Pract."},{"key":"B31","doi-asserted-by":"publisher","first-page":"216","DOI":"10.3747\/pdi.2013.00217","article-title":"Peritoneal protein clearance rather than faster transport status determines outcomes in peritoneal dialysis patients","volume":"35","author":"Rajakaruna","year":"2015","journal-title":"Perit. Dial. Int."},{"key":"B32","doi-asserted-by":"publisher","first-page":"S14","DOI":"10.1053\/j.gastro.2003.10.013","article-title":"Pathophysiology of adult fecal incontinence","volume":"126","author":"Rao","year":"2004","journal-title":"Gastroenterology"},{"key":"B33","doi-asserted-by":"publisher","first-page":"2353","DOI":"10.1007\/s00520-018-4051-2","article-title":"Enhancing evaluation of sarcopenia in patients with non-small cell lung cancer (NSCLC) by assessing skeletal muscle index (SMI) at the first lumbar (L1) level on routine chest computed tomography (CT)","volume":"26","author":"Recio-Boiles","year":"2018","journal-title":"Support Care Cancer"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1347","DOI":"10.1007\/s40620-020-00840-y","article-title":"Sarcopenia in chronic kidney disease: what have we learned so far?","volume":"34","author":"Sabatino","year":"2021","journal-title":"J. Nephrol."},{"key":"B35","doi-asserted-by":"publisher","first-page":"182","DOI":"10.5152\/tjg.2023.22148","article-title":"Dyssynergic defecation: a comprehensive review on diagnosis and management","volume":"34","author":"Sadeghi","year":"2023","journal-title":"Turk J. Gastroenterol."},{"key":"B36","doi-asserted-by":"publisher","first-page":"480","DOI":"10.1038\/nrneph.2010.84","article-title":"Gastrointestinal disorders and renal failure: exploring the connection","volume":"6","author":"Shirazian","year":"2010","journal-title":"Nat. Rev. Nephrol."},{"key":"B37","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1016\/j.jesf.2021.02.001","article-title":"Effects of core strengthening exercise on colon transit time in young adult women","volume":"19","author":"Song","year":"2021","journal-title":"J. Exerc Sci. Fit."},{"key":"B38","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1002\/ehf2.12237","article-title":"Muscle wasting and sarcopenia in heart failure and beyond: update 2017","volume":"4","author":"Springer","year":"2017","journal-title":"Esc. Heart Fail"},{"key":"B39","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1046\/j.1525-139x.2002.00083.x","article-title":"Inflammation in end-stage renal disease: sources, consequences, and therapy","volume":"15","author":"Stenvinkel","year":"2002","journal-title":"Semin. Dial."},{"key":"B40","doi-asserted-by":"publisher","first-page":"1248","DOI":"10.1681\/ASN.2016060656","article-title":"Constipation and incident CKD","volume":"28","author":"Sumida","year":"2017","journal-title":"J. Am. Soc. Nephrol."},{"key":"B41","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1016\/j.ekir.2019.11.002","article-title":"Constipation in CKD","volume":"5","author":"Sumida","year":"","journal-title":"Kidney Int. Rep."},{"key":"B42","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1016\/j.atherosclerosis.2018.12.021","article-title":"Constipation and risk of death and cardiovascular events","volume":"281","author":"Sumida","year":"","journal-title":"Atherosclerosis"},{"key":"B43","doi-asserted-by":"publisher","first-page":"950","DOI":"10.1681\/ASN.2020081120","article-title":"Laxative use and risk of dyskalemia in patients with advanced CKD transitioning to dialysis","volume":"32","author":"Sumida","year":"2021","journal-title":"J. Am. Soc. Nephrol."},{"key":"B44","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1007\/s11255-021-03089-x","article-title":"The role of CT-scan assessment of muscle mass in predicting postoperative surgical complications after renal transplantation","volume":"54","author":"Tabourin","year":"2022","journal-title":"Int. Urol. Nephrol."},{"key":"B45","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1002\/jcsm.13400","article-title":"Skeletal muscle atrophy in clinical and preclinical models of chronic kidney disease: a systematic review and meta-analysis","volume":"15","author":"Troutman","year":"2024","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"B46","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1007\/s11357-016-9921-2","article-title":"Effects of age and sex on neuromuscular-mechanical determinants of muscle strength","volume":"38","author":"Wu","year":"2016","journal-title":"Age (Dordr)."},{"key":"B47","doi-asserted-by":"publisher","first-page":"942","DOI":"10.1001\/jamasurg.2020.2497","article-title":"Association of low muscle mass and low muscle radiodensity with morbidity and mortality for Colon cancer surgery","volume":"155","author":"Xiao","year":"2020","journal-title":"JAMA Surg."},{"key":"B48","doi-asserted-by":"publisher","first-page":"1292","DOI":"10.1053\/ajkd.2002.33407","article-title":"Prevalence of constipation in continuous ambulatory peritoneal dialysis patients and comparison with hemodialysis patients","volume":"39","author":"Yasuda","year":"2002","journal-title":"Am. J. Kidney Dis."},{"key":"B49","doi-asserted-by":"publisher","first-page":"998","DOI":"10.1007\/s00330-014-3110-4","article-title":"Assessment of sarcopenia and changes in body composition after neoadjuvant chemotherapy and associations with clinical outcomes in oesophageal cancer","volume":"24","author":"Yip","year":"2014","journal-title":"Eur. Radiol."},{"key":"B50","doi-asserted-by":"publisher","first-page":"2001","DOI":"10.1007\/s40520-019-01385-2","article-title":"Characterization of the gut microbiota in frail elderly patients","volume":"32","author":"Zhang","year":"2020","journal-title":"Aging Clin. Exp. Res."}],"container-title":["Frontiers in Physiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2025.1725508\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T05:13:27Z","timestamp":1764911607000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2025.1725508\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,5]]},"references-count":50,"alternative-id":["10.3389\/fphys.2025.1725508"],"URL":"https:\/\/doi.org\/10.3389\/fphys.2025.1725508","relation":{},"ISSN":["1664-042X"],"issn-type":[{"value":"1664-042X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,5]]},"article-number":"1725508"}}