Overweight, obesity, and the development of stage 3 CKD: The Framingham Heart Study
Overweight, obesity, and the development of stage 3 CKD: The Framingham Heart Study
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DOI：
10.1053/j.ajkd.2008.03.003
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发表时间：
2008-07-01
影响因子：
13.2
通讯作者：
Fox, Caroline S.
中科院分区：
文献类型：
--
作者：
Foster, Meredith C.;Hwang, Shih-Jen;Fox, Caroline S.
背景资料：关于体重指数（BMI）和慢性肾脏病（CKD）之间的关联程度，先前的研究得出了相互矛盾的结果。研究设计：前瞻性队列研究。（n = 2，676; 52%为女性;平均年龄43岁）基线时无3期CKD，参加了第2个检查周期（1978-1981年）和7（1998-2001）。预测因素：BMI。结果：3期CKD（女性估计肾小球滤过率< 59 mL/min/1.73 m2，男性< 64 mL/min/1.73 m2）。年龄、性别和多变量校正（糖尿病、收缩压、高血压治疗、当前吸烟状况，和高密度脂蛋白胆固醇水平）逻辑回归模型来检验基线BMI与发生3期CKD和发生试纸蛋白尿之间的关系。结果：在基线时，36%的样本超重，12%肥胖; 7.9%（n = 212）在18.5年的随访期间发展为3期CKD。相对于BMI正常的受试者，在年龄和性别校正模型（比值比[OR]，1.29; 95%置信区间[CI]，0.93 - 1.81; P = 0.1）或多变量模型（OR，1.06; 95% CI，0.75 - 1.50; P = 0.8）中，超重个体与3期CKD发病率之间没有关联。肥胖个体发生3期CKD的几率增加68%（OR，1.68; 95%CI，1.10 - 2.57; P = 0.02），在多变量模型中变得不显著（OR，1.09; 95%CI，0.69 - 1.73; P = 0.7）。当BMI建模为连续变量或四分位数时，观察到类似的结果。14.4%的患者发生蛋白尿;在多变量模型中，超重和肥胖个体发生蛋白尿的几率增加（OR，1.43; 95%CI，1.09 - 1.88; OR，1.56; 95%CI，1.08 - 2.26）。参与者主要是白色，这些研究结果可能不适用于不同的种族groups.Conclusions：肥胖与发展阶段3慢性肾脏病，这是不再显着调整后已知的心血管疾病的危险因素的风险增加。肥胖和3期CKD之间的关系可能通过心血管疾病风险因素介导。
Background: Prior research yielded conflicting results about the magnitude of the association between body mass index (BMI) and chronic kidney disease (CKD).Study Design: Prospective cohort study.Settings & Participants: Framingham Offspring participants (n = 2,676; 52% women; mean age, 43 years) free of stage 3 CKD at baseline who participated in examination cycles 2 (1978-1981) and 7 (1998-2001).Predictor: BMI.Outcome: Stage 3 CKD (estimated glomerular filtration rate < 59 mL/min/1.73 m(2) for women and < 64 mL/min/1.73 m(2) for men).Measurements: Age-, sex-, and multivariable-adjusted (diabetes, systolic blood pressure, hypertension treatment, current smoking status, and high-density lipoprotein cholesterol level) logistic regression models were used to examine the relationship between BMI at baseline and incident stage 3 CKD and incident dipstick proteinuria (trace or greater).Results: At baseline, 36% of the sample was overweight and 12% was obese; 7.9% (n = 212) developed stage 3 CKD during 18.5 years of follow-up. Relative to participants with normal BMI, there was no association between overweight individuals and stage 3 CKD incidence in age- and sex-adjusted models (odds ratio [OR], 1.29; 95% confidence interval [CI], 0.93 to 1.81; P = 0.1) or multivariable models (OR, 1.06; 95% CI, 0.75 to 1.50; P = 0.8). Obese individuals had a 68% increased odds of developing stage 3 CKD (OR, 1.68; 95% CI, 1.10 to 2.57; P = 0.02), which became nonsignificant in multivariable models (OR, 1.09; 95% CI, 0.69 to 1.73; P = 0.7). Similar findings were observed when BMI was modeled as a continuous variable or quartiles. Incident proteinuria occurred in 14.4%; overweight and obese individuals were at increased odds of proteinuria in multivariable models (OR, 1.43; 95% CI, 1.09 to 1.88; OR, 1.56; 95% CI, 1.08 to 2.26, respectively).Limitations: BMI is measure of generalized obesity and not abdominal obesity. Participants are predominantly white, and these findings may not apply to different ethnic groups.Conclusions: Obesity is associated with increased risk of developing stage 3 CKD, which was no longer significant after adjustment for known cardiovascular disease risk factors. The relationship between obesity and stage 3 CKD may be mediated through cardiovascular disease risk factors.