{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T09:08:38Z","timestamp":1789117718169,"version":"build-2803163510"},"reference-count":32,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antioxidants"],"abstract":"<jats:p>Background: Endotoxemia and oxidative stress may contribute to adverse body-composition changes in patients receiving maintenance hemodialysis, but their relationships with adiposity and muscularity remain incompletely defined. We investigated whether the concentrations of circulating lipopolysaccharide (LPS), soluble NOX2-derived peptide (sNox2-dp), and hydrogen peroxide (H2O2) showed differential associations with bioimpedance-derived body-composition compartments and explored their relationships with normalized protein catabolic rate (nPCR), a surrogate of protein intake. Methods: In this observational, cross-sectional study, adult patients receiving maintenance hemodialysis were enrolled at a single center. Serum LPS and sNox2-dp and H2O2 concentrations were measured before dialysis. Body composition was assessed by bioimpedance analysis; fat mass (FM) was used as an index of adiposity, whereas intracellular water indexed to height squared (ICW\/h2) was used as a proxy of muscularity. Associations were examined using Spearman correlation and multivariable linear regression adjusted for age, sex, and nPCR. Results: A total of 58 participants were included with a median age of 73 years; 64% were male and mean body mass index was 24.6 \u00b1 4.2 kg\/m2. LPS correlated with sNox2-dp (rho = 0.420, p = 0.001), whereas sNox2-dp correlated with H2O2 (rho = 0.352, p = 0.007); the LPS\u2013H2O2 association was borderline (rho = 0.259, p = 0.050). sNox2-dp correlated positively with fat-free mass, total body water, ICW, and ICW\/h2, whereas LPS correlated with FM (rho = 0.305, p = 0.023). Participants with nPCR &gt; 0.89 g\/kg\/day had higher LPS concentrations than those with lower nPCR (p = 0.015), and nPCR correlated with ICW\/h2 (rho = 0.36, p = 0.007). In multivariable analysis, LPS remained independently associated with FM (\u03b2 = 0.210, p = 0.046). nPCR was positively associated with ICW\/h2 at the threshold of statistical significance (\u03b2 = 1.393, p = 0.050), whereas sNox2-dp showed a nonsignificant positive trend (p = 0.060). Conclusions: In maintenance hemodialysis, endotoxemia and NOX2 activation showed differential associations with body composition: LPS with adiposity and sNox2-dp with muscularity. Higher nPCR was associated with both greater muscularity and higher LPS concentrations, suggesting a complex relationship between protein intake, the gut\u2013oxidative-stress axis, and body composition.<\/jats:p>","DOI":"10.3390\/antiox15091156","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T08:17:42Z","timestamp":1789114662000},"page":"1156","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Differential Associations of Lipopolysaccharide, Soluble NOX2-Derived Peptide, and Hydrogen Peroxide with Adiposity and Muscularity in Adults on Maintenance Hemodialysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8149-9154","authenticated-orcid":false,"given":"Giovanni","family":"Imbimbo","sequence":"first","affiliation":[{"name":"Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Foti","sequence":"additional","affiliation":[{"name":"Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Ammann","sequence":"additional","affiliation":[{"name":"Hemodialysis Unit, Fatebenefratelli Hospital, Isola Tiberina, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Grazia","family":"Chiappini","sequence":"additional","affiliation":[{"name":"Hemodialysis Unit, Fatebenefratelli Hospital, Isola Tiberina, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1966-5945","authenticated-orcid":false,"given":"Vittoria","family":"Cammisotto","sequence":"additional","affiliation":[{"name":"Department of Medical and Cardiovascular Sciences, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6455-4828","authenticated-orcid":false,"given":"Valentina","family":"Castellani","sequence":"additional","affiliation":[{"name":"Istituto Pasteur Italia\u2014Fondazione Cenci Bolognetti, Istituto Pasteur Italia, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2265-7455","authenticated-orcid":false,"given":"Pasquale","family":"Pignatelli","sequence":"additional","affiliation":[{"name":"Department of Medical and Cardiovascular Sciences, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6432-0236","authenticated-orcid":false,"given":"Alessio","family":"Molfino","sequence":"additional","affiliation":[{"name":"Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy"},{"name":"Department of Interdisciplinary Studies on WellBeing, Health and Environmental Sustainability (BeSSA) Sapienza University of Rome, 02100 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1765","DOI":"10.1056\/NEJMra1700312","article-title":"Nutritional Management of Chronic Kidney Disease","volume":"377","author":"Fouque","year":"2017","journal-title":"N. 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