Visceral Adiposity and Physical Fitness in CKD

CKD 中的内脏肥胖和身体健康

• 批准号: 8818718
• 负责人: Sankar Dass Navaneethan
• 金额: $ 70.99万
• 依托单位: CLEVELAND CLINIC LERNER COM-CWRU
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-22 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8818718
• 关键词: Abdomen; Address; Adipose tissue; Adult; Affect; American; Area; Body Weight decreased; Body fat; Body mass index; Cardiovascular Diseases; Cardiovascular system; Cessation of life; Chronic Kidney Failure; Chronic Kidney Insufficiency; Clinic; Clinical; Cohort Studies; Data; Development; Diabetes Mellitus; Disease Progression; End stage renal failure; Enrollment; Event; Fatty acid glycerol esters; Future; Glomerular Filtration Rate; Goals; Health; Healthcare; Hospitalization; Hypertension; Image; Incidence; Inflammation; Inflammatory; Insulin Resistance; Intervention; Investigation; Kidney; Kidney Diseases; Laboratories; Life; Low Prevalence; Magnetic Resonance Imaging; Measures; Mediating; Metabolic; Methods; Modeling; Morbidity - disease rate; Obesity; Outcome; Outcome Measure; Oxidative Stress; Participant; Pathway interactions; Patient Self-Report; Patients; Pennsylvania; Physical Fitness; Physical activity; Population; Protocols documentation; Public Health; Reading; Risk; Risk Factors; Sampling; Testing; Therapeutic; Universities; Visceral; Visit; Walking; adipokines; adverse outcome; base; cardiovascular disorder risk; cardiovascular risk factor; clinical practice; cohort; diabetic; experience; fitness; frailty; mortality; muscle form; non-diabetic; patient oriented; public health relevance; stem; subcutaneous

 DESCRIPTION (provided by applicant): Obesity and chronic kidney disease (CKD) are major public health problems. Obesity independent of its relationship with diabetes and hypertension is associated with the development and progression of kidney disease. However, higher body mass index (BMI) in those with pre-existing CKD is associated with lower mortality (obesity paradox). This may be due to the inability of BMI to differentiate fat mass and muscle mass, which may have opposite relationship with cardiovascular disease and death. Body fat distribution is a major factor of metabolic health with metabolic abnormalities correlating better with visceral than subcutaneous adipose tissue. Further, higher fitness levels among those with higher BMI are associated with a lower prevalence of cardiovascular risk factors and mortality that might explain this obesity paradox. Therefore, among Chronic Renal Insufficiency Cohort (CRIC) study participants, we propose (a) to examine whether visceral adiposity is associated with a higher incidence of composite outcomes (i.e., mortality, cardiovascular events, end stage renal disease, and 50% decline in estimated glomerular filtration rate), (b) to determine if physical fitness modifies the association between adiposity and outcomes, and (c) to study whether visceral adiposity and physical fitness are associated with altered adipokine profile, inflammation, insulin resistance, and oxidative stress. We propose to enroll 526 patients with varying degrees of kidney disease from 7 clinical centers involved in the CRIC study. Visceral adiposity will be measured by magnetic resonance imaging (MRI) of the abdomen using a standard protocol, and physical fitness will be measured using a 400 m walk test during routine CRIC study visits. The imaging data will be assessed at the central reading center at the Cleveland Clinic, and samples will be analyzed at the University of Pennsylvania central core laboratory. We have assembled a well-experienced, multi-disciplinary team to address these important public health questions. Results from this study will help us understand the independent and combined effects of visceral adiposity and physical fitness on cardiovascular disease and kidney disease progression among CKD patients. This study will also highlight potential pathways that mediate the relationship between adiposity and outcomes, which will become the focus of future therapeutic investigations in CKD.

 描述(申请人提供)：肥胖和慢性肾脏疾病(CKD)是主要的公共卫生问题。肥胖与糖尿病和高血压的关系无关，它与肾脏疾病的发展和进展有关。然而，既往CKD患者的体重指数(BMI)越高，死亡率越低(肥胖悖论)。这可能是由于BMI无法区分脂肪和肌肉质量，而脂肪和肌肉质量可能与心血管疾病和死亡有相反的关系。体内脂肪分布是代谢健康的一个主要因素，代谢异常与内脏脂肪组织的相关性比皮下脂肪组织更好。此外，体重指数较高的人的健康水平越高，心血管危险因素和死亡率的患病率就越低，这可能可以解释这一肥胖悖论。因此，在慢性肾功能不全队列(CRIC)研究参与者中，我们建议(A)检查内脏肥胖是否与更高的综合结果发生率(即死亡率、心血管事件、终末期肾病和估计的肾小球滤过率下降50%)相关，(B)确定身体健康是否改变了肥胖和预后之间的关联，以及(C)研究内脏肥胖和身体健康是否与脂肪因子谱改变、炎症、胰岛素抵抗和氧化应激有关。我们建议从参与CRIC研究的7个临床中心招募526名患有不同程度肾脏疾病的患者。内脏肥胖症将通过使用标准方案的腹部磁共振成像(MRI)来测量，身体健康将在CRIC常规研究访问期间使用400米步行测试来测量。成像数据将在克利夫兰诊所的中央阅读中心进行评估，样本将在宾夕法尼亚大学中央核心实验室进行分析。我们已经组建了一支经验丰富的多学科团队来解决这些重要的公共卫生问题。这项研究的结果将帮助我们了解内脏肥胖和身体健康对CKD患者心血管疾病和肾脏疾病进展的独立和联合影响。这项研究还将强调调节肥胖症和预后之间关系的潜在途径，这将成为未来CKD治疗研究的重点。