KRONİK BÖBREK HASTALIĞINDAN KORUNMADA VE KRONİK BÖBREK HASTALIĞINDA OBEZİTENİN DEĞERLENDİRİLMESİ

Obezite kronik bo brek hastalığ ı (KBH) ğelişmesinde ve bo brek yetmezliğ i proğresyonunda başlıca risk fakto rlerindendir. KBH'da fazla kilo ve obezite sıklıkla ğo ru lmektedir. KBH'nın o nlenmesinde ve aynı zamanda KBH'lı hastaların rutin takipleri sırasında morbidite ve mortalite risklerini belirlemede antropometrik o lçu mlerinin takip edilmesi o nemlidir. Beslenme kılavuzlarında, KBH'da başlıca ğo zo nu nde bulundurulan nu trisyonel değ erlendirme beden kitle endeksi (BKİ )'dir. KBH'da obezitenin optimum o lçu mu bilinmemektedir. Genellikle klinik uyğulamada obezite o lçu m yo ntemi olarak BKİ değ erlendirilmektedir. Artmış BKİ ğenel yağ lanmayı yansıtmaktadır, adipoz dokularla kas ku tlesini ayırt etmemektedir. Çoğ u KBH hastasının yaşlı ve kas ku tlesinin azalmış olması BKİ ile ilğili zorluklardır, sıvı hacmi BKİ hesaplamasını etkiler, BKİ 'yi arttırır. Deri kıvrım kalınlıkları (DKK) subkutan yağ ı o lçer, viseral yağ da oluşan değ işikliklere karşı hassas değ ildir. Bel çevresi ve bel/kalça oranı (BKO) abdominal yağ lanmayı o lçmek için kullanılan yo ntemlerdir. BKO, bel çevresine ğo re kas ve kemik kaybından daha az etkilenmektedir. KBH'da BKİ ve bel çevresi birlikte kullanılırsa abdominal yağ ın daha doğ ru değ erlendirilebileceğ i ileri su ru lmektedir. Bel çevresi, BKO, DKK KBH'da obeziteyi değ erlendirmede, bel çevresi ve BKO mortalite riskini belirlemede BKİ'dan daha ğu çlu belirteçlerdir. DKK, bel çevresi, BKO vu cut yağ ını o lçmede BKİ 'den daha ğu çlu belirteçler olarak ğo ru nmektedir, bu o lçu mlerin KBH'da obeziteyi değ erlendirmede BKİ 'den daha ğu çlu olduğ unu ispatlamak için klinik pratikte daha fazla çalışmaya ihtiyaç vardır

ASSESSMENT OFOBESITY INTHE PREVENTION OFCHRONIC KIDNEY DISEASE AND CHRONIC KIDNEY DISEASE

Obesity is one of the major risk factors for developinğ chronic kidney disease (CKD) and proğression of renal failure. Overweiğht and obesity are frequently seen in CKD. İn CKD both for prevention and also to determine the risk of morbidity and mortality durinğ routine follow-up anthropometric measurements are important. Body mass index (BMİ) is considered a mainstay for nutritional assessment in ğuidelines on nutrition in CKD. Optimum measurement of obesity in CKD is unknown. Obesity is frequently evaluated by BMİ in clinical practice. İncreased BMİ reflects total body fat, does not distinğuish between muscle mass and adipose tissue. İn the majority of CKD pattents, advanced ağe and decreased muscle massa re difficulties for BMİ, fluid volume İnfluences BMİ calculation. Skinfold anthropometry only measures subcutaneous fat and is not sensitive to the chanğes in visseral fat. Waist circumference (WC) and waist-to-hip ratio (WHR) are widely used as measures of abdominal adiposity. WHR is less influenced by muscle and bone mass than BMİ. İn CKD, the we of BMİ and WC toğether are recommended in order to beter assess abdominal fat. WC, WHR in CKD are better predictors than BMİ in predictinğ the risk of mortality. Skinfold thickness, WC, WHR seems to be better predictors than BMİ to measure body fat. However, more research is needed to prove that these metrics are better predictors of obesity than BMİ

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