Waist-to-hip ratio, body mass index, and subsequent kidney disease and death
Waist-to-hip ratio, body mass index, and subsequent kidney disease and death
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DOI：
10.1053/j.ajkd.2008.02.363
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发表时间：
2008-07-01
影响因子：
13.2
通讯作者：
Weiner, Daniel E.
中科院分区：
文献类型：
--
作者：
Elsayed, Essam F.;Sarnak, Mark J.;Weiner, Daniel E.
背景：慢性肾病（CKD）和肥胖是重要的公共卫生问题。研究设计：队列研究。设置和参与者：从社区动脉粥样硬化风险研究和心血管健康研究中汇总的个体患者数据。预测因素：腰臀比（WHR），体重指数（BMI）。结果和测量：CKD事件定义为血清肌酐水平升高大于0.4 mg/dL，男性基线肌酐水平≤ 1.4 mg/dL，女性基线肌酐水平≤ 1.2 mg/dL，最终肌酐水平大于这些水平，在单独分析中，估计肾小球滤过率（eGFR）降低15 mL/min/1.73 m（2）或更大，基线eGFR为60 mL/min/1.73 m（2）或更大，最终eGFR小于60 mL/min/1.73 m（2）。多变量logistic回归分析确定腰臀比、体重指数和预后之间的关系。结果：在13，324名受试者中，男性的平均腰臀比为0.96，女性为0.89，男性和女性的平均BMI均为27.2 kg/m2。在9.3年期间，基于肌酐的模型中有300例患者（2.3%），基于eGFR的模型中有710例患者（5.5%）发生CKD。在肌酐模型中，腰臀比每增加一个标准差，发生CKD的风险就增加（比值比，1.22; 95%置信区间[CI]，1.05 - 1.43）和复合结局（风险比，1.12; 95%CI，1.06 - 1.18），而BMI的每一个SD增加与CKD无关（比值比，1.05; 95%CI，0.93至1.20），并显示对复合结局具有保护作用（风险比，0.94; 95%CI，0.90至0.99）。基于eGFR的模型的结果相似。局限性：肌酐的单一测量，没有蛋白尿数据。结论：WHR，而不是BMI，与CKD的发病率和死亡率相关。CKD风险评估应使用WHIR而不是BMI作为肥胖的拟人化指标。
Background: Chronic kidney disease (CKD) and obesity are important public health concerns. We examined the association between anthropomorphic measures and incident CKD and mortality.Study Design: Cohort study.Setting & Participants: Individual patient data pooled from the Atherosclerosis Risk in Communities Study and the Cardiovascular Health Study.Predictors: Waist-to-hip ratio (WHR), body mass index (BMI).Outcomes & Measurements: Incident CKD defined as serum creatinine level increase greater than 0.4 mg/dL with baseline creatinine level of 1.4 mg/dL or less in men and 1.2 mg/dL or less in women and final creatinine level greater than these levels, and, in separate analyses, estimated glomerular filtration rate (eGFR) decrease of 15 mL/min/1.73 m(2) or greater with baseline eGFR of 60 mL/min/1.73 m(2) or greater and final eGFR less than 60 mL/min/1.73 m(2). Multivariable logistic regression to determine the association between WHR, BMI, and outcomes. Cox models to evaluate a secondary composite outcome of all-cause mortality and incident CKD.Results: Of 13,324 individuals, mean WHR was 0.96 in men and 0.89 in women and mean BMI was 27.2 kg/m(2) in both men and women. During 9.3 years, 300 patients (2.3%) in creatinine-based models and 710 patients (5.5%) in eGFR-based models developed CKD. In creatinine-based models, each SD increase in WHR was associated with increased risk of incident CKD (odds ratio, 1.22; 95% confidence interval [CI], 1.05 to 1.43) and the composite outcome (hazard ratio, 1.12; 95% CI, 1.06 to 1.18), whereas each SD increase in BMI was not associated with CKD (odds ratio, 1.05; 95% CI, 0.93 to 1.20) and appeared protective for the composite outcome (hazard ratio, 0.94; 95% CI, 0.90 to 0.99). Results of eGFR-based models were similar.Limitations: Single measures of creatinine, no albuminuria data.Conclusions: WHR, but not BMI, is associated with incident CKD and mortality. Assessment of CKD risk should use WHIR rather than BMI as an anthropomorphic measure of obesity.