Comparison between Different Measures of Body Fat with Kidney Function Decline and Incident CKD
Comparison between Different Measures of Body Fat with Kidney Function Decline and Incident CKD
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DOI：
10.2215/cjn.07010716
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发表时间：
2017-06-01
影响因子：
9.8
通讯作者：
Sarnak, Mark
中科院分区：
文献类型：
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作者：
Madero, Magdalena;Katz, Ronit;Sarnak, Mark
背景和目的虽然人体脂肪测量与CKD的发展有关，但它们可能无法区分各种形式的脂肪，因此可能不如计算机断层扫描（CT）测量准确。我们在健康老龄化和身体组成研究中比较了CT和肥胖的人体测量测量与肾脏预后的关系。设计，设置，参与者和测量参与者从1997年3月到1998年7月被招募。CT测量包括内脏腹部脂肪（VAT）、皮下脂肪组织（SAT）和肌间脂肪面积（IMAT），而人体测量包括腰围（WC）和体重指数（BMI）。肾脏结局包括肾功能（KF）下降（随访3年或10年eGFR(cys)c下降30%）或CKD事件（随访eGFR(cys)c 60 ml/min / 1.73 m2）。使用多变量logistic回归模型和泊松回归模型分别评估与KF下降和肾脏疾病发生率的关系。我们还通过将暴露措施纳入同一模型来评估暴露措施之间的独立关联。结果共纳入受试者2489人。平均年龄74±3岁，49%为男性，39%为黑人，59%为高血压，15%为糖尿病。17%的人群发生KF下降，而17%的高危人群也发生CKD事件。在连续模型中，SAT、VAT、IMAT、BMI和WC（每SD增加）均与KF下降显著相关。在KF下降方面，VAT和CKD之间存在显著的交互作用（P=0.01）。只有VAT、BMI和WC与CKD的发生有关。当其他暴露变量包括在同一模型中时，只有VAT仍然是CKD事件的重要风险因素。当使用第3年和第10年的肌酐值来估计eGFR的变化时，肥胖和肾脏结局之间没有任何关联。结论：体脂的人体测量值似乎与CT测量值提供了老年人KF下降风险的一致估计。
Background and objectives Although anthropometric measures of body fat are associated with development of CKD, they may not be able to distinguish between various forms of fat and therefore may be less accurate than computed tomography (CT) measures. We compared the association of CT and anthropometric measures of obesity with kidney outcomes in the Health Aging and Body Composition Study.Design, setting, participants, & measurements Participants were recruited from March of 1997 through July of 1998. CT measures included visceral abdominal fat (VAT), subcutaneous adipose tissue (SAT), and intermuscular fat area (IMAT), whereas anthropometric measures included waist circumference (WC) and body mass index (BMI). Kidney outcomes included kidney function (KF) decline (30% decrease in eGFR(cys)c in follow-up at either year 3 or 10) or incident CKD (follow-up eGFR(cys)c 60 ml/min per 1.73 m2). Multivariable logistic regression models and Poisson regression models were used to evaluate the association with decline in KF and incident kidney disease, respectively. We also assessed for the independent associations among the exposure measures by including them in the same model.Results Two-thousand four-hundred and eighty-nine individuals were included. Mean age was 74 +/- 3 years, 49% were men, 39% were black, 59% were hypertensive, and 15% were diabetic. KF decline occurred in 17% of the population, whereas incident CKD also occurred in 17% of those at risk. In continuous models, SAT, VAT, IMAT, BMI, and WC (per SD increase) were all significantly associated with KF decline. There was a significant interaction between VAT and CKD with regard to KF decline (P=0.01). Only VAT, BMI, and WC were associated with incident CKD. Only VAT remained a significant risk factor for incident CKD when other exposure variables were included in the same model. There was no association between any measure of obesity and kidney outcomes when creatinine values at years 3 and 10 were used to estimate changes in eGFR.Conclusions Anthropometric measures of body fat appear to provide as consistent estimates of KF decline risk as CT measures in elders.