{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T16:19:39Z","timestamp":1789402779974,"version":"build-2803163510"},"reference-count":123,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2021,5,31]],"date-time":"2021-05-31T00:00:00Z","timestamp":1622419200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>In the general population, obesity is known to be associated with adverse outcomes, including mortality. In contrast, high body mass index (BMI) may provide a survival advantage for hemodialysis patients, which is known as the obesity paradox. Although BMI is the most commonly used measure for the assessment of obesity, it does not distinguish between fat and lean mass. Fat mass is considered to serve as an energy reserve against a catabolic condition, while the capacity to survive starvation is also thought to be dependent on its amount. Thus, fat mass is used as a nutritional marker. For example, improvement of nutritional status by nutritional intervention or initiation of hemodialysis is associated with an increase in fat mass. Several studies have shown that higher levels of fat mass were associated with better survival in hemodialysis patients. Based on body distribution, fat mass is classified into subcutaneous and visceral fat. Visceral fat is metabolically more active and associated with metabolic abnormalities and inflammation, and it is thus considered to be a risk factor for cardiovascular disease and mortality. On the other hand, subcutaneous fat has not been consistently linked to adverse phenomena and may reflect nutritional status as a type of energy storage. Visceral and subcutaneous adipose tissues have different metabolic and inflammatory characteristics and may have opposing influences on various outcomes, including mortality. Results showing an association between increased subcutaneous fat and better survival, along with other conditions, such as cancer or cirrhosis, in hemodialysis patients have been reported. This evidence suggests that fat mass distribution (i.e., visceral fat and subcutaneous fat) plays a more important role for these beneficial effects in hemodialysis patients.<\/jats:p>","DOI":"10.3390\/nu13061895","type":"journal-article","created":{"date-parts":[[2021,5,31]],"date-time":"2021-05-31T21:42:06Z","timestamp":1622497326000},"page":"1895","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Significance of Adipose Tissue Maintenance in Patients Undergoing Hemodialysis"],"prefix":"10.3390","volume":"13","author":[{"given":"Senji","family":"Okuno","sequence":"first","affiliation":[{"name":"Kidney Center, Shirasagi Hospital, 7-11-23, Kumata, Higashisumiyoshi-ku, Osaka 546-0002, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,5,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1046\/j.1525-139X.2003.16046.x","article-title":"Uremic malnutrition: New insights into an old problem","volume":"16","author":"Pupim","year":"2003","journal-title":"Semin. Dial."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1053\/ajkd.2002.31766","article-title":"What are the causes of protein-energy malnutrition in chronic renal insufficiency?","volume":"39","author":"Lindholm","year":"2002","journal-title":"Am. J. Kidney Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1899","DOI":"10.1046\/j.1523-1755.1999.00422.x","article-title":"Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure","volume":"55","author":"Stenvinkel","year":"1999","journal-title":"Kidney Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1016\/j.ajkd.2003.07.016","article-title":"Malnutrition-Inflammation complex syndrome in dialysis patients: Causes and consequences","volume":"42","author":"Ikizler","year":"2003","journal-title":"Am. J. Kidney Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1038\/sj.ki.5002585","article-title":"A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease","volume":"73","author":"Fouque","year":"2008","journal-title":"Kidney Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1038\/nature05487","article-title":"Mechanisms linking obesity with cardiovascular disease","volume":"444","author":"Gaal","year":"2006","journal-title":"Nature"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Prospective Studies Collaboration, Whitlock, G., Lewington, S., Sherliker, P., Clarke, R., Emberson, J., Halsey, J., Qizilbash, N., Collins, R., and Peto, R. (2009). Body-Mass index and cause-specific mortality in 900,000 adults: Collaborative analysis of 57 prospective studies. Lancet, 373, 1083\u20131096.","DOI":"10.1016\/S0140-6736(09)60318-4"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.pcad.2018.07.001","article-title":"Obesity paradox in advanced kidney disease: From bedside to the bench","volume":"61","author":"Naderi","year":"2018","journal-title":"Prog. Cardiovasc. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/j.pcad.2013.10.005","article-title":"Obesity paradox in end-stage kidney disease patients","volume":"56","author":"Park","year":"2014","journal-title":"Prog. Cardiovasc. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1016\/S0735-1097(01)01448-6","article-title":"The relationship between obesity and mortality in patients with heart failure","volume":"38","author":"Horwich","year":"2001","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_11","first-page":"229","article-title":"Comorbidity distribution, clinical expression and survival in COPD patients with different body mass index","volume":"1","author":"Divo","year":"2014","journal-title":"Chronic. Obstr. Pulm. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1007\/s11912-016-0539-4","article-title":"The obesity paradox in cancer: A review","volume":"18","author":"Lennon","year":"2016","journal-title":"Curr. Oncol. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1016\/j.jamda.2015.07.014","article-title":"Reverse epidemiology of traditional cardiovascular risk factors in the geriatric population","volume":"16","author":"Ahmadi","year":"2015","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1159\/000182627","article-title":"Mortality risk factors in patients treated by chronic hemodialysis. Report of the Diaphane collaborative study","volume":"31","author":"Degoulet","year":"1982","journal-title":"Nephron"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1053\/ajkd.1998.v31.pm9631845","article-title":"Simple nutritional indicators as independent predictors of mortality in hemodialysis patients","volume":"31","author":"Leavey","year":"1998","journal-title":"Am. J. Kidney Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1560","DOI":"10.1046\/j.1523-1755.1999.00389.x","article-title":"Influence of excess weight on mortality and hospital stay in 1346 hemodialysis patients","volume":"55","author":"Fleischmann","year":"1999","journal-title":"Kidney Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1093\/ajcn\/80.2.324","article-title":"Association of body size with outcomes among patients beginning dialysis","volume":"80","author":"Johansen","year":"2004","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_18","first-page":"439","article-title":"Obesity and the risk of cardiovascular and all-cause mortality in chronic kidney disease: A systematic review and meta-analysis","volume":"32","author":"Ladhani","year":"2017","journal-title":"Nephrol. Dial. Tansplant."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.ekir.2017.01.009","article-title":"The obesity paradox in kidney disease: How to reconcile it with pbesity management","volume":"2","author":"Rhee","year":"2017","journal-title":"Kidney Int. Rep."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2871","DOI":"10.1093\/ndt\/gfp168","article-title":"Is there any survival advantage of obesity in Southern European haemodialysis patient?","volume":"24","author":"Chazot","year":"2009","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1053\/j.ajkd.2005.05.020","article-title":"Association of morbid obesity and weight change over time with cardiovascular survival in hemodialysis population","volume":"46","author":"Kopple","year":"2005","journal-title":"Am. J. Kidney Dis."},{"key":"ref_22","first-page":"1549","article-title":"Association of body weight changes with mortality in incident hemodialysis patients","volume":"32","author":"Chang","year":"2017","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1310","DOI":"10.1093\/ndt\/gfv379","article-title":"Examining the robustness of the obesity paradox in maintenance hemodialysis patients: A marginal structural model analysis","volume":"31","author":"Doshi","year":"2016","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1479","DOI":"10.1681\/ASN.2015030252","article-title":"Inflammation modifies the paradoxical association between body mass index and motality in hemodialysis patients","volume":"27","author":"Stenvinkel","year":"2016","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2386","DOI":"10.1093\/ndt\/16.12.2386","article-title":"Body mass index and mortality in \u2018healthier\u2019 as compared with \u2018sicker\u2019 haemodialysis patients: Results from yhe Dialysis Outcomes and Practice Patterns Study (DOPPS)","volume":"16","author":"Leavey","year":"2001","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.2215\/CJN.10951012","article-title":"Influence of body mass index on the association of weight changes with mortality in hemodialysis patients","volume":"8","author":"Carrero","year":"2013","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1097\/MNH.0000000000000212","article-title":"The dual roles of obesity in chronic kidney disease: A review of the current literature","volume":"25","author":"Rhee","year":"2016","journal-title":"Curr. Opin. Nephrol. Hypertens."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1053\/j.ajkd.2007.06.004","article-title":"Body mass index and mortality in CKD","volume":"50","author":"Madero","year":"2007","journal-title":"Am. J. Kidney Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1053\/j.ajkd.2005.07.040","article-title":"The natural history of chronic renal failure: Results from an unselected, population-based, inception cohort in Sweden","volume":"46","author":"Evans","year":"2005","journal-title":"Am. J. Kidney Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1053\/j.ajkd.2007.02.277","article-title":"Paradoxical association between body mass index and mortality in men with CKD not yet on dialysis","volume":"49","author":"Kovesdy","year":"2007","journal-title":"Am. J. Kidney Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2088","DOI":"10.1681\/ASN.2013070754","article-title":"Association of body mass index with outcomes in patients with CKD","volume":"25","author":"Lu","year":"2014","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.1016\/j.jacc.2008.12.040","article-title":"Abdominal obesity and all-cause and cardiovascular mortality in end-stage renal disease","volume":"53","author":"Postorino","year":"2009","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1111\/sdi.12516","article-title":"Hidden obesity in dialysis patients: Clinical implications","volume":"29","author":"Abramowitz","year":"2016","journal-title":"Semin. Dial."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"ii45","DOI":"10.1093\/ndt\/gfm020","article-title":"EBPG guideline on nutrition","volume":"22","author":"Fouque","year":"2007","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1097\/MCO.0000000000000485","article-title":"How to best assess abdominal obesity","volume":"21","author":"Fang","year":"2018","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1053\/jada.2003.50024","article-title":"Comparison of three methods for the determination of body fat in patients on long-term hemodialysis therapy","volume":"103","author":"Kamimura","year":"2003","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_37","first-page":"180","article-title":"Four-Site skinfold anthropometry (FSA) versus body impedance analysis (BIA) in assessing nutritional status of patients on maintenance hemodialysis: Which method is to be preferred in routine patient care?","volume":"49","author":"Oe","year":"1998","journal-title":"Clin. Nephrol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1111\/hdi.12812","article-title":"Three compartment bioimpedance spectroscopy in the nutritional assessment and the outcome of patients with advanced or end stage kidney disease: What have we learned so far?","volume":"24","author":"Broers","year":"2020","journal-title":"Hemodial. Int."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"3548284","DOI":"10.1155\/2019\/3548284","article-title":"Assessment of body composition in health and disease using bioelectrical impedance analysis (BIA) and dual energy X-ray absorptiometry (DXA): A critical overview","volume":"2019","author":"Marra","year":"2019","journal-title":"Contrast Media Mol. Imaging"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1259\/0007-1285-65-778-895","article-title":"Impact of hydration status on body composition as measured by dual energy X-ray absorptiometry in normal volunteers and patients on haemodialysis","volume":"65","author":"Horber","year":"1992","journal-title":"Br. J. Radiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1159\/000168812","article-title":"Body composition in hemodialysis patients measured by dual-energy X-ray absorptiometry","volume":"15","author":"Stenver","year":"1995","journal-title":"Am. J. Nephrol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1053\/ajkd.1998.v31.pm9531182","article-title":"Serum leptin level and its relationship with body composition in hemodialysis patients","volume":"31","author":"Nishizawa","year":"1998","journal-title":"Am. J. Kidney Dis."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1038\/ijo.2016.50","article-title":"Correlation of visceral adipose tissue measured by Lunar Prodigy dual X-ray absorptiometry with MRI and CT in older men","volume":"40","author":"Cheung","year":"2016","journal-title":"Int. J. Obes."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1681\/ASN.2007090983","article-title":"Resolved: Being fat is good for dialysis patients: The Godzilla effect: Pro","volume":"19","author":"Ikizler","year":"2008","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1016\/0024-3205(91)90292-J","article-title":"Preferential loss of body fat during starvation in dietary obese rats","volume":"49","author":"Hill","year":"1991","journal-title":"Life Sci."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1053\/j.jrn.2018.05.002","article-title":"Diagnostic usefulness of the protein energy wasting score in prevalent hemodialysis patients","volume":"28","author":"Monzon","year":"2018","journal-title":"J. Ren Nutr."},{"key":"ref_47","first-page":"141","article-title":"Protein-Energy wasting syndrome in advanced chronic kidney disease: Prevalence and specific clinical characteristics","volume":"38","author":"Garcia","year":"2018","journal-title":"Nefrologia"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1053\/ajkd.2002.33921","article-title":"Validity of subjective global assessment as a nutritional marker in end-stage renal disease","volume":"40","author":"Cooper","year":"2002","journal-title":"Am. J. Kidney Dis."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"2238","DOI":"10.1046\/j.1523-1755.2002.00658.x","article-title":"Mortality risk in hemodialysis patients and changes in nutritional indicators: DOPPS","volume":"62","author":"Pieer","year":"2002","journal-title":"Kidney Int."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1732","DOI":"10.1093\/ndt\/14.7.1732","article-title":"A modified quantitative subjective global assessment of nutrition for dialysis patients","volume":"14","author":"Kleiner","year":"1999","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1053\/j.jrn.2015.05.003","article-title":"Can bioimpedance measurements of lean and fat tissue mass replace subjective global assessments in peritoneal dialysis patients?","volume":"25","author":"Paudel","year":"2015","journal-title":"J. Ren. Nutr."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1053\/j.jrn.2017.11.002","article-title":"Prevalence and risk of protein-energy wasting assessed by subjective global assessment in older adults with advanced chronic kidney disease: Results from EQUAL study","volume":"28","author":"Windahl","year":"2018","journal-title":"J. Ren. Nutr."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1053\/ajkd.2001.29222","article-title":"A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients","volume":"38","author":"Kopple","year":"2001","journal-title":"Am. J. Kidney Dis."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1093\/ndt\/gfu380","article-title":"Diagnostic validation and prognostic significance of the malnutrition-inflammation score in nondialyzed chronic kidney disease patients","volume":"30","author":"Amparo","year":"2015","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1053\/j.ajkd.2008.09.018","article-title":"Association of malnutrition-inflammation score with quality of life and mortality in hemodialysis patients: A 5-year prospective cohort study","volume":"53","author":"Rambod","year":"2009","journal-title":"Am. J. Kidney Dis."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"596","DOI":"10.21037\/apm.2019.10.12","article-title":"Association of the malnutrition-inflammation score with anthropometry and body composition measurements in patients with chronic kidney disease","volume":"8","author":"Wang","year":"2019","journal-title":"Ann. Palliat. Med."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1053\/j.jrn.2018.02.004","article-title":"Bioimpedance spectroscopy as a practical tool for the early detection aprevention of protein-energy wasting in hemodialysis patients","volume":"28","author":"Perez","year":"2018","journal-title":"J. Ren. Nutr."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1038\/ki.2013.147","article-title":"Prevention and treatment of protein energy wasting in chronic kidney disease patients: A consensus statement by the International society of Renal Nutrition and Metabolism","volume":"84","author":"Ikizler","year":"2013","journal-title":"Kidney Int."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"3149","DOI":"10.1681\/ASN.2006040413","article-title":"Intradialytic oral nutrition improves protein homeostasis in chronic hemodialysis patients with deranged nutritional status","volume":"17","author":"Pupim","year":"2006","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"2902","DOI":"10.1093\/ndt\/gfn131","article-title":"Use of a renal-specific oral supplement by haemodialysis patients with low protein intake does not increase the need for phosphate binders and may prevent a decline in nutritional status and quality of life","volume":"23","author":"Fouque","year":"2008","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.clnesp.2017.04.003","article-title":"Effect of intradialytic protein-rich meal intake in nutritional and body composition parameters on hemodialysis patients","volume":"20","author":"Caetano","year":"2017","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1712","DOI":"10.1093\/ndt\/gfw297","article-title":"The effect of resistance exercise and oral nutritional supplementation during hemodialysis on indicators of nutritional status and quality of life","volume":"31","year":"2016","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1053\/j.ajkd.2013.08.007","article-title":"Oral intradialytic nutritional supplement use and mortality in hemodialysis patients","volume":"63","author":"Weiner","year":"2014","journal-title":"Am. J. Kidney Dis."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1053\/j.ajkd.2012.04.019","article-title":"Outcomes associated with intradialytic oral nutritional supplements in patients undergoing maintenance hemodialysis: A quality improvement report","volume":"60","author":"Lacson","year":"2012","journal-title":"Am. J. Kidney Dis."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"2260","DOI":"10.1046\/j.1523-1755.1999.00768.x","article-title":"Rise in serum albumin and creatinine in the first half year on hemodialysis","volume":"56","author":"Goldwasser","year":"1999","journal-title":"Kidney Int."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1921","DOI":"10.1681\/ASN.V1291921","article-title":"Increasing body fat mass in the first year of hemodialysis","volume":"12","author":"Ishimura","year":"2001","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1053\/j.jrn.2015.10.001","article-title":"Longitudinal changes in body composition in patients after initiation of hemodialysis therapy: Results from an international cohort","volume":"26","author":"Marcelli","year":"2016","journal-title":"J. Ren. Nutr."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Keane, D., Gardiner, C., Lindley, E., Lines, S., Woodrow, G., and Wright, M. (2016). Changes in body composition in the two years after initiation of haemodialysis: A retrospective cohort study. Nutrients, 8.","DOI":"10.3390\/nu8110702"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"S137","DOI":"10.1053\/ajkd.2003.50103","article-title":"Body fat mass in hemodialysis patients","volume":"41","author":"Ishimura","year":"2003","journal-title":"Am. J. Kidney Dis."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/j.biopha.2005.04.002","article-title":"C-Reactive protein is a significant predictor of decrease in fat mass in hemodialysis patients","volume":"59","author":"Fujino","year":"2005","journal-title":"Biomed. Pharmacother."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1046\/j.1523-1755.1998.00812.x","article-title":"Factor predicting malnutrition in hemodialysis patients: A cross-sectional study","volume":"53","author":"Qureshi","year":"1998","journal-title":"Kidney Int."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"S208","DOI":"10.1053\/ajkd.2001.27448","article-title":"Changes in body fat mass in male hemodialysis patient: A comparison between diabetics and nondiabetics","volume":"38","author":"Okuno","year":"2001","journal-title":"Am. J. Kidney Dis."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1038\/oby.2004.131","article-title":"Body fat and fat-free mass and all-cause mortality","volume":"12","author":"Bigaard","year":"2004","journal-title":"Obes. Res."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1038\/sj.ki.5000331","article-title":"Body fat mass and lean mass as predictors of survival in hemodialysis patients","volume":"70","author":"Kakiya","year":"2006","journal-title":"Kidney Int."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1093\/ajcn\/86.3.633","article-title":"Obese sarcopenia in patients with end-stage renal disease is associated with inflammation and increased mortality","volume":"86","author":"Honda","year":"2007","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Yajima, T., Arao, M., Yajima, K., Takahashi, H., and Yasuda, K. (2019). The association of fat tissue and muscle mass indices with all-cause motality in patients undergoing hemodialysis. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0211988"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.3945\/ajcn.2010.29188","article-title":"Survival predictability of lean and fat mass in men and women undergoing maintenance hemodialysis","volume":"92","author":"Noori","year":"2010","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.2215\/CJN.08550814","article-title":"Body composition and survival in dialysis patients: Results from an international cohort study","volume":"10","author":"Marcelli","year":"2015","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1053\/j.jrn.2015.10.005","article-title":"Body composition and mortality predictors in hemodialysis patients","volume":"26","author":"Caetano","year":"2016","journal-title":"J. Ren. Nutr."},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Duong, T.V., Wong, T.C., Chen, H.H., Chen, T.H., Hsu, Y.H., Peng, S.J., Kuo, K.L., Liu, H.C., Lin, E.T., and Yang, S.H. (2019). Impact of percent body fat on all-cause mortality among adequate dialysis patients with and without insulin resistance: A multi-center prospective cohort study. Nutrients, 11.","DOI":"10.3390\/nu11061304"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.biopha.2006.04.001","article-title":"Annual fat mass change is a significant predictor of mortality in female hemodialysis patients","volume":"60","author":"Fujino","year":"2006","journal-title":"Biomed. Pharmacother."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1093\/ajcn\/83.2.202","article-title":"Association of body fat and its changes over time with quality life and prospective mortality in hemodialysis patients","volume":"83","author":"Kuwae","year":"2006","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"4022","DOI":"10.1172\/JCI129191","article-title":"Contribution of adipogenesis to healthy adipose tissue expansion in obesity","volume":"129","author":"Vishvanath","year":"2019","journal-title":"J. Clin. Investig."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1161\/01.RES.0000163635.62927.34","article-title":"Adipose tissue, inflammation, and cardiovascular disease","volume":"96","author":"Berg","year":"2005","journal-title":"Circ. Res."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1161\/CIRCULATIONAHA.106.675355","article-title":"Abdominal visceral and subcutaneous adipose tissue compartments: Association with metabolic risk factors in the Framingham Heart Study","volume":"116","author":"Fox","year":"2007","journal-title":"Circulation"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1152\/japplphysiol.00627.2006","article-title":"Sarcopenic obesity and inflammation in the InCHIANTI study","volume":"102","author":"Schrager","year":"2007","journal-title":"J. Appl. Physiol."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1093\/gerona\/gls077","article-title":"Total and abdominal adiposity are associated with inflammation in older adults using a factor analysis approach","volume":"67","author":"Brinkley","year":"2012","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1681\/ASN.2013040330","article-title":"Obesity in CKD\u2014What should nephrologists know?","volume":"24","author":"Stenvinkel","year":"2013","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1053\/j.ajkd.2017.06.028","article-title":"Association of body mass index and body fat with markers of inflammation and nutrition among patients receiving hemodialysis","volume":"70","author":"Delgado","year":"2017","journal-title":"Am. J. Kidney Dis."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1053\/j.ajkd.2005.06.014","article-title":"Association of metabolic syndrome with inflammation in CKD: Results from the Third National Health and Nutrition Examination Survey (NHANES III)","volume":"46","author":"Beddhu","year":"2005","journal-title":"Am. J. Kidney Dis."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"c283","DOI":"10.1159\/000328931","article-title":"Relationship between fat mass and serum high-sensitivity C-reactive protein levels in prevalent hemodialysis patients","volume":"119","author":"Ishimura","year":"2011","journal-title":"Nephron. Clin. Pract."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1093\/ajcn\/80.5.1222","article-title":"Truncal fat mass as a contributor to inflammation in end-stage renal disease","volume":"80","author":"Axelsson","year":"2004","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1053\/j.jrn.2009.04.002","article-title":"Relationship between adiposity and cardiovascular risk factors in prevalent hemodialysis patients","volume":"19","author":"Kaysen","year":"2009","journal-title":"J. Ren. Nutr."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1291\/hypres.31.83","article-title":"Relationship between abdominal fat accumulation and insulin resistance in hemodialysis patients","volume":"31","author":"Gohda","year":"2008","journal-title":"Hypertens. Res."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"2933","DOI":"10.1161\/CIRCULATIONAHA.106.673756","article-title":"Body fat distribution and risk of coronary heart disease in men and women in the European Prospective Investigation Into Cancer and Nutrition in Norfolk cohort: A population-based prospective study","volume":"116","author":"Canoy","year":"2007","journal-title":"Circulation"},{"key":"ref_96","first-page":"268","article-title":"Body composition in chronic kidney disease","volume":"24","author":"Johansen","year":"2015","journal-title":"Curr. Opin. Nephrol. Hypertens."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"3689","DOI":"10.1093\/ndt\/gfr057","article-title":"Abdominal obesity is the most significant metabolic syndrome component predictive of cardiovascular events in chronic hemodialysis patients","volume":"26","author":"Wu","year":"2011","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1111\/sdi.12834","article-title":"The obesity paradox: A further consideration in dialysis patients","volume":"32","author":"Kittiskulnam","year":"2019","journal-title":"Semin. Dial."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1053\/j.ajkd.2008.02.004","article-title":"Waist circumference and visceral fat in CKD: A cross-sectional study","volume":"52","author":"Sanches","year":"2008","journal-title":"Am. J. Kidney Dis."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1053\/j.ajkd.2008.04.002","article-title":"Waist-To-Hip ratio and body mass index as risk factors for cardiovascular events in CKD","volume":"52","author":"Elsayed","year":"2008","journal-title":"Am. J. Kidney Dis."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"367","DOI":"10.2174\/1573399810602040367","article-title":"Metabolic obesity: The paradox between visceral and subcutaneous fat","volume":"2","author":"Hamdy","year":"2006","journal-title":"Curr. Diabetes Rev."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"E1756","DOI":"10.1210\/jc.2011-0615","article-title":"Preferential fat deposition in subcutaneous versus visceral depots is associated with insulin sensitivity","volume":"96","author":"McLaughlin","year":"2011","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"1626","DOI":"10.1161\/01.CIR.0000057974.74060.68","article-title":"Peripheral adiposity exhibits an independent dominant antiatherogenic effect in elderly women","volume":"107","author":"Tanko","year":"2003","journal-title":"Circulation"},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"1587","DOI":"10.1007\/s00125-015-3583-y","article-title":"Subcutaneous fat transplantation alleviates diet-induced glucose intolerance and inflammation in mice","volume":"58","author":"Hocking","year":"2015","journal-title":"Diabetologia"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1053\/j.ajkd.2008.02.363","article-title":"Waist to hip ratio, body mass index and subsequent kidney disease and death","volume":"52","author":"Elsayed","year":"2008","journal-title":"Am. J. Kidney Dis."},{"key":"ref_106","doi-asserted-by":"crossref","unstructured":"Leitzmann, M.F., Moore, S.C., Koster, A., Harris, T.B., Park, Y., Hollenbeck, A., and Schatzkin, A. (2011). Waist circumference as compared with body-mass index in predicting mortality from specific causes. PLoS ONE, 6.","DOI":"10.1371\/journal.pone.0018582"},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1038\/oby.2002.50","article-title":"A prospective study of adiposity and all-cause mortality: The Malmo diet and cancer study","volume":"10","author":"Lahmann","year":"2002","journal-title":"Obes. Res."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"2232","DOI":"10.1038\/oby.2009.115","article-title":"BMI, waist circumference, and mortality according to health status in the older adult population of Spain","volume":"17","author":"Banegas","year":"2009","journal-title":"Obesity"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"2644","DOI":"10.1111\/j.1600-6143.2010.03330.x","article-title":"Body mass index, waist circumference and mortality in kidney transplant recipients","volume":"10","author":"Kovesdy","year":"2010","journal-title":"Am. J. Transplant."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1053\/j.jrn.2020.08.009","article-title":"Visceral fat area is better predictor than coronary artery calcification score for cardiovascular outcome and all-cause death in patients on hemodialysis","volume":"31","author":"Xuong","year":"2021","journal-title":"J. Ren. Nutr."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1159\/000358335","article-title":"Visceral fat is an independent risk factor for cardiovascular mortality in hemodialysis patients","volume":"39","author":"Okamoto","year":"2014","journal-title":"Am. J. Nephrol."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1053\/j.ajkd.2011.02.390","article-title":"Association of waist circumference and body mass index with all-cause mortality in CKD: The REGARDS (Reasons for Geographic and Racial Differences in Stroke) study","volume":"58","author":"Kramer","year":"2011","journal-title":"Am. J. Kidney Dis."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1111\/dom.13050","article-title":"Body fat distribution is more predictive of all-cause mortality than overall adiposity","volume":"20","author":"Lee","year":"2018","journal-title":"Diabetes Obes. Metab."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"1906","DOI":"10.1158\/0008-5472.CAN-17-3287","article-title":"The importance of body composition in explaining the overweight paradox in cancer","volume":"78","author":"Caan","year":"2018","journal-title":"Cancer Res."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1111\/apt.15927","article-title":"Review article: Prognostic significance of body composition abnormalities in patients with cirrhosis","volume":"52","author":"Ebadi","year":"2020","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1038\/bjc.2017.149","article-title":"Subcutaneous adiposity is an independent predictor of motality in cancer patient","volume":"117","author":"Ebadi","year":"2017","journal-title":"Br. J. Cancer"},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"2570","DOI":"10.1016\/j.ejca.2015.07.042","article-title":"High subcutaneous adipose tissue predicts the prognosis in metastatic castration-resistant prostate cancer patients in post chemotherapy setting","volume":"51","author":"Antoun","year":"2015","journal-title":"Eur. J. Cancer"},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1038\/ki.2009.524","article-title":"Both low muscle mass and low fat are associated with higher all-cause mortality in hemodialysis patients","volume":"77","author":"Huang","year":"2010","journal-title":"Kidney Int."},{"key":"ref_119","first-page":"E971","article-title":"Production of soluble tumor necrosis factor receptors by human subcutaneous adipose tissue in vivo","volume":"277","author":"Goodrick","year":"1999","journal-title":"Am. J. Physiol."},{"key":"ref_120","doi-asserted-by":"crossref","unstructured":"Khoramipour, K., Chamari, K., Hekmatikar, A.A., Ziyaiyan, A., Taherkhani, S., Elguindy, N.M., and Bragazzi, N.L. (2021). Adiponectin: Structure, physiological functions, role in diabetes, and effects on nutrition. Nutrients, 13.","DOI":"10.3390\/nu13041180"},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1111\/j.0894-0959.2004.17311.x","article-title":"The body mass index paradox and an obesity, inflammation, and atherosclerosis syndrome in chronic kidney disease","volume":"17","author":"Beddhu","year":"2004","journal-title":"Semin. Dial."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"461S","DOI":"10.1093\/ajcn\/83.2.461S","article-title":"Obesity and the role of adipose tissue in inflammation and metabolism","volume":"83","author":"Greenberg","year":"2006","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1098\/rspb.2003.2341","article-title":"Reductions in total body fat decrease humoral immunity","volume":"270","author":"Demas","year":"2003","journal-title":"Proc. Biol. Sci."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/6\/1895\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:09:29Z","timestamp":1760162969000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/6\/1895"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,31]]},"references-count":123,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,6]]}},"alternative-id":["nu13061895"],"URL":"https:\/\/doi.org\/10.3390\/nu13061895","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,31]]}}}