Objective: To explore the association between waist-to-height ratio (WHtR) and sarcopenic obesity (SO) in maintenance hemodialysis (MHD) patients with normal body mass index (BMI). Methods: A multicenter and cross-sectional study that included adult patients undergoing MHD was conducted in 20 hemodialysis centers from June 1st to August 30th, 2021. Body composition was evaluated by body composition monitor based on bioimpedance spectroscopy. According to the quartiles of WHtR, patients were divided into four groups: Q1, Q2, Q3 and Q4 group. The association of WHtR with SO was determined by multiple logistic regression models, stratified analyses, interactive analyses, and receiver operating characteristic (ROC) analyses, respectively. Results: A total of 2 207 MHD patients (1 341 males and 866 females) were included, and aged [M (Q1, Q3)] 57 (44, 68) years. The prevalence of SO was increased with increasing quartiles of WHtR [8.6% (46/533), 22.5% (141/628), 35.4% (215/608), and 44.3% (194/438) for Q1, Q2, Q3, and Q4 group, respectively]. Multivariate logistic regression analysis showed that WHtR was associated with SO. The association remained statistically significant even after adjusting for age, gender, dialysis vintage, BMI, biochemical indicators, and various medical histories. Compared with Q1 group, the odds ratios (OR) were 2.54 (95%CI: 1.69-3.83), 4.30 (95%CI: 2.88-6.42) and 5.18 (95%CI: 3.37-7.96) for Q2, Q3 and Q4 group, respectively. The interaction analysis showed that age, sex and history of diabetes had interactive roles in the association between WHtR and SO (all P<0.05). The association stably existed across subgroups, and it was more obvious in male patients, those with older age and without a history of diabetes（all P<0.05）. Furthermore, the cut-off value of WHtR identifying SO in male patients was 0.49, and the corresponding area under the curve (AUC) was 0.73 (95%CI: 0.70-0.75), with the sensitivity of 72.7% and specificity of 60.3%. In female patients, the cut-off value was 0.51, and the AUC was 0.68 (95%CI: 0.65-0.71), with the sensitivity of 70.1% and specificity of 57.8%. Conclusion: WHtR could be used as a simple index to evaluate the risk of SO in MHD patients with normal BMI.
目的： 探讨正常体质指数维持性血液透析（MHD）患者腰围身高比（WHtR）与肌少症性肥胖（SO）的关系。 方法： 多中心横断面研究。2021年6月1日至8月30日，在贵州省20家血液透析中心对正常体质指数成年MHD患者进行调查。通过基于生物电阻抗谱的身体成分监测仪评估人体成分，根据WHtR四分位数将患者分为Q1~Q4四组。通过多因素 logistic 回归模型、分层分析、交互分析及受试者工作特征（ROC）曲线分析评估正常体质指数血液透析患者WHtR与SO的相关性。 结果： 共纳入2 207例MHD患者，男1 341例，女866例，年龄［M（Q1，Q3）］为57（44，68）岁。随着WHtR四分位数增加，SO的患病率也随之升高，Q1、Q2、Q3、Q4组患者SO患病率分别为8.6%（46/533）、22.5%（141/628）、35.4%（215/608）和44.3%（194/438）。多因素logistic回归分析结果显示，在校正年龄、性别、透析时间、体质指数、生化指标和各类疾病史后，与Q1组患者相比，Q2~Q4组MHD患者的SO发生风险分别增加了1.54倍（OR=2.54，95%CI：1.69~3.83，P<0.001）、3.30倍（OR=4.30，95%CI：2.88~6.42，P<0.001）和4.18倍（OR=5.18，95%CI：3.37~7.96，P<0.001）。交互作用分析结果显示，年龄、性别和糖尿病史在WHtR与SO的关联中具有交互作用（均P<0.05）。WHtR与SO的关联在不同的亚组中稳定存在，但在男性、年龄较大、无糖尿病史的患者中更为明显（均P<0.05）。在男性患者中WHtR识别SO的ROC曲线下面积（AUC）为0.73（95%CI：0.70~0.75），cut-off值为0.49，灵敏度72.7%，特异度60.3%；在女性患者中WHtR识别SO的AUC为0.68（95%CI：0.65~0.71），cut-off值为0.51，灵敏度70.1%，特异度57.8%。 结论： WHtR可作为一种简便的指标评估正常体质指数MHD患者的SO患病风险。.