1
|
Iqbal J, Wu HX, Nawaz MA, Jiang HL, Xu SN, Huang BL, Li L, Cai JM, Zhou HD. Risk of incident chronic kidney disease in metabolically healthy obesity and metabolically unhealthy normal weight: A systematic review and meta-analysis. Obes Rev 2024; 25:e13656. [PMID: 37904643 DOI: 10.1111/obr.13656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 09/27/2023] [Accepted: 10/03/2023] [Indexed: 11/01/2023]
Abstract
Studies have reported inconsistent results about the risk of incident chronic kidney disease (CKD) in people with metabolically healthy obesity (MHO). We designed this systematic review and meta-analysis to evaluate the risk of developing CKD in people with MHO and metabolically unhealthy normal weight (MUNW). We used a predefined search strategy to retrieve eligible studies from multiple databases up to June 20, 2022. Random-effects model meta-analyses were implied to estimate the overall hazard ratio (HR) of incident CKD in obesity phenotypes. Eight prospective cohort studies, including approximately 5 million participants with a median follow-up ranging between 3 and 14 years, were included in this meta-analysis. Compared to the metabolically healthy normal weight (MHNW), the mean differences in cardiometabolic and renal risk factors in MHO, MUNW, and metabolically unhealthy obesity (MUO) were evaluated with overall HR of 1.42, 1.49, and 1.84, respectively. Compared to MHNW, the mean estimated glomerular filtration rate (eGFR) and high-density lipoprotein (HDL) were significantly lower, and low-density lipoprotein (LDL), blood pressure, blood glucose, and triglycerides were higher in MHO and MUNW. In conclusion, MHO and MUNW are not benign conditions and pose a higher risk for incident CKD. Obesity, whether in the presence or absence of metabolic health, is a risk factor for CKD.
Collapse
Affiliation(s)
- Junaid Iqbal
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory for Metabolic Bone Diseases, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hui-Xuan Wu
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory for Metabolic Bone Diseases, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | | | - Hong-Li Jiang
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory for Metabolic Bone Diseases, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shi-Na Xu
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory for Metabolic Bone Diseases, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Bi-Ling Huang
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory for Metabolic Bone Diseases, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Long Li
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory for Metabolic Bone Diseases, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jun-Min Cai
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory for Metabolic Bone Diseases, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hou-De Zhou
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory for Metabolic Bone Diseases, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| |
Collapse
|
2
|
Yan J, Yang X, Wang J, Cai H, Che X, Ying L, Zhang T, Chen Q, Xia J, Gu L, Yuan X, Chen R, Li D, Liu Z, Dong K, He L, Zhang M, Mou S. Metabolic Risk Profile and Graft Function Deterioration 2 Years After Kidney Transplant. JAMA Netw Open 2023; 6:e2349538. [PMID: 38150251 PMCID: PMC10753396 DOI: 10.1001/jamanetworkopen.2023.49538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/07/2023] [Indexed: 12/28/2023] Open
Abstract
Importance Studies exploring the association of body weight and metabolic status with graft function deterioration (GFD) after kidney transplantation have produced inconsistent findings. Few studies have examined whether metabolically healthy overweight or obesity (MHO) may contribute to GFD. Objective To evaluate associations of overweight or obesity and metabolic disorders with GFD in recipients of kidney transplant. Design, Setting, and Participants This multicenter retrospective cohort study was conducted from January 1, 2020, through June 30, 2021, with a follow-up period of 2 years after kidney transplantation. Participants included adult recipients of cadaveric kidney transplant in 4 transplantation centers in China. Participants were classified as 4 metabolic phenotypes according to their BMI and metabolic status. Data were analyzed from July to August 2023. Exposures Overweight and obesity were characterized by body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 24 or greater. Metabolic disorder was identified by existence of a minimum of 2 of 4 conditions: hypertension, hyperglycemia, increased triglyceride, and decreased high-density lipoprotein cholesterol. Main Outcome and Measures The main outcome was GFD, defined as a decrease in estimated glomerular filtration rate of at least 25% within 6 months to 2 years after transplant. Results A total of 1260 adult recipients of cadaveric kidney transplant (mean [SD] age, 43.97 [11.51] years; 755 [59.92%] male) were included in the study, and 127 (10.08%) participants experienced the primary outcome of GFD during follow-up. After accounting for confounding factors in multivariable analyses, overweight or obesity (odds ratio [OR], 1.64; 95% CI, 1.10-2.44; P = .02) and metabolic disorder (OR, 1.71; 95% CI, 1.12-2.63; P = .01) were associated with increased risk of GFD. The MHO subgroup exhibited a greater risk for GFD (OR, 2.37; 95% CI, 1.01-5.57; P = .048) compared with participants who did not have overweight or obesity or metabolic disorder. All components of metabolic disorder, with the exception of elevated triglyceride, were associated with GFD. There was a dose-response association of number of metabolic disorder components (OR per 1 additional condition, 1.40; 95% CI, 1.20-1.63; P < .001) and BMI (OR per 1-unit increase, 1.90; 95% CI, 1.03-1.15; P = .002) with increased risk for GFD. A nonlinear association was observed between BMI and risk of GFD. Conclusions and Relevance In this cohort study of recipients of cadaveric kidney transplant, individuals with overweight or obesity or metabolic disorder had a significantly higher risk of experiencing GFD. Individuals with MHO had an elevated risk for graft function deterioration. Additional studies with larger sample size and longer follow-up are necessary to validate our findings.
Collapse
Affiliation(s)
- Jiayi Yan
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Academy of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaoqian Yang
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jieying Wang
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Clinical Research Center, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Cai
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiajing Che
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liang Ying
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianyi Zhang
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Chen
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Xia
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Leyi Gu
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaodong Yuan
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruoyang Chen
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dawei Li
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhihong Liu
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kun Dong
- Organ Transplantation Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Long He
- Organ Transplantation Center, General Hospital of Northern Theater Command, Shenyang, China
| | - Ming Zhang
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shan Mou
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Academy of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| |
Collapse
|
3
|
Lee YH, Song SH, Song SH, Shin HS, Yang J, Kim MS, Hwang HS. Clinical implications of changes in metabolic syndrome status after kidney transplantation: a nationwide prospective cohort study. Nephrol Dial Transplant 2023; 38:2743-2753. [PMID: 37243323 DOI: 10.1093/ndt/gfad115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is prevalent in patients with end-stage kidney disease, and kidney transplantation is expected to modify the metabolic status. However, whether changes in metabolic status at the time of transplantation affect recipient outcomes remains unclear. METHODS We analyzed 4187 recipients registered in a nationwide prospective cohort from 2014 to 2020. MetS was defined as the presence of three or more components of the metabolic syndrome. Patients were classified based on the pre- and post-transplant MetS status: MetS-free, MetS-developed, MetS-recovered and MetS-persistent. Study outcomes were occurrence of death-censored graft loss and a composite of cardiovascular events and death. RESULTS Among recipients without pre-transplant MetS, 19.6% (419/2135) developed post-transplant MetS, and MetS disappeared in 38.7% (794/2052) of the recipients with pre-transplant MetS. Among the four groups, the MetS-developed group showed the worst graft survival rate, and the MetS-persistent group had a poorer composite event-free survival rate. Compared with the MetS-free group, the MetS-developed group was associated with an increased risk of graft loss [adjusted hazard ratio (aHR) 2.35; 95% confidence interval (CI) 1.17-4.98] and the risk of graft loss increased with increasing numbers of dysfunctional MetS components. MetS-persistent was associated with increased risks of cardiovascular events and death (aHR 2.46; 95% CI 1.12-5.63), but changes in the number of dysfunctional MetS components was not. CONCLUSION Kidney transplantation significantly alters the metabolic status. Newly developed MetS after transplantation was associated with an increased risk of graft loss, whereas persistent MetS exposure before and after transplantation was associated with increased risks cardiovascular events and patient survival.
Collapse
Affiliation(s)
- Yu Ho Lee
- Division of Nephrology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sang Heon Song
- Department of Internal Medicine, Pusan National University Hospital, Pusan, Korea
| | - Seung Hwan Song
- Department of Surgery, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Ho Sik Shin
- Division of Nephrology, Department of Internal Medicine, Kosin University College of Medicine, Pusan, Korea
| | - Jaeseok Yang
- Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - Myoung Soo Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeon Seok Hwang
- Division of Nephrology, Department of Internal Medicine, Kyung Hee University School of Medicine, Kyung Hee University Medical Center, Seoul, Korea
| |
Collapse
|
4
|
Moeinzadeh F, Rouhani MH, Seirafian S, Vahdat S, Mortazavi M, Clark CCT, Shahdadian F. Metabolic health status and renal disorders: a cross-sectional study. Sci Rep 2023; 13:20794. [PMID: 38012254 PMCID: PMC10682426 DOI: 10.1038/s41598-023-48333-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 11/25/2023] [Indexed: 11/29/2023] Open
Abstract
Previous surveys suggests that body mass index (BMI) may be positively related to development of chronic kidney disease (CKD). However, this association might be altered by metabolic syndrome. Therefore, we aimed to evaluate the association of metabolic health status with CKD. The present cross-sectional study was carried out on 3322 representative sample of Iranian adults. Metabolic syndrome was identified based on the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) and BMI was assessed by anthropometric measurements. Estimated glomerular filtration rate (eGFR) was calculated by modification of diet in renal disease-Chronic Kidney Disease Epidemiology Collaboration (MDRD-EPI) formula. Subjects were categorized into four phenotypes: metabolically healthy normal weight (MHNW), metabolically healthy overweight and obesity (MHO), metabolically unhealthy normal weight (MUHNW), and metabolically unhealthy overweight and obesity (MUHO). Based on multivariate-adjusted models, the risk of CKD was significantly higher in MUHO compared with MHNW (OR: 1.48; p < 0.05). Although MUHNW and MUHO were associated with lower eGFR and albuminuria, the significant association was not observed in case of hematuria. Furthermore, subjects with kidney stones tended to be in MHO (OR: 1.42; p < 0.05) and MUHO phenotypes (OR: 1.64; p < 0.05), in comparison to the MHNW phenotype. The odds of kidney disorders were higher in adults with metabolic syndrome, regardless of BMI. However, this relationship might be strengthened by the concomitance of metabolic syndrome and obesity. To verify our findings, clarify the causality, and elucidate the underlying mechanisms, further research are warranted.
Collapse
Affiliation(s)
- Firouzeh Moeinzadeh
- Isfahan Kidney Diseases Research Center, Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Hossein Rouhani
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, and Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shiva Seirafian
- Isfahan Kidney Diseases Research Center, Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sahar Vahdat
- Isfahan Kidney Diseases Research Center, Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojgan Mortazavi
- Isfahan Kidney Diseases Research Center, Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Cain C T Clark
- Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5FB, UK
| | - Farnaz Shahdadian
- Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
| |
Collapse
|
5
|
Fu X, Xu Z, Tan Q, Wei W, Wang Z. Association between a high triglyceride-glucose index and chronic kidney disease in adult patients with latent autoimmune diabetes. BMC Endocr Disord 2023; 23:209. [PMID: 37770895 PMCID: PMC10540360 DOI: 10.1186/s12902-023-01465-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Insulin resistance (IR) is one of the risk factors for chronic kidney disease (CKD) and diabetes. The triglyceride-glucose (TyG) index is considered a reliable alternative marker of IR. We investigated the correlation between the TyG index and the severity of CKD in patients with latent autoimmune diabetes in adults (LADA). METHODS This cross-sectional study included 288 patients with LADA in the department of endocrinology at our hospital between January 2018 and January 2022. The TyG index was calculated as Ln [TG (mg/dl) × fasting blood glucose (FBG) (mg/dl) / 2]. All individuals were divided into either a LADA + CKD group or a LADA + non-CKD group according to the presence or absence of CKD. A correlation analysis, logistic regression analysis and receiver operating characteristics curve analysis were performed. RESULTS A total of 130 (45.1%) participants were identified as having CKD. Compared with the non-CKD group, the CKD group had a longer disease duration and a higher proportion of smokers; patients were more likely to have hypertension and higher serum creatinine, triglyceride, cholesterol, low-density lipoprotein cholesterol, FBG, uric acid estimated glomerular filtration rates (eGFR) and TyG levels as well as lower high-density lipoprotein cholesterol levels (all P < 0.05). The positive relationship between the TyG index and the urinary albumin/creatinine ratio was significant (r = 0.249, P = 0.010). There was also a significant correlation between the TyG index and the eGFR (r = - 0.211, P = 0.034) after adjusting for confounding factors. The area-under-the-curve value of the TyG index was 0.708 (95% confidence interval: 0.61-0.81, P < 0.001). CONCLUSIONS The TyG index is significantly associated with the severity of CKD in patients with LADA. This conclusion supports the clinical application of the TyG index for the assessment of kidney disease in patients with LADA.
Collapse
Affiliation(s)
- Xiuli Fu
- Department of Endocrinology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26 of Shengli Street, Jiangan District, Wuhan, 430061, China
| | - Zihui Xu
- Department of Endocrinology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26 of Shengli Street, Jiangan District, Wuhan, 430061, China
| | - Qin Tan
- Department of Endocrinology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26 of Shengli Street, Jiangan District, Wuhan, 430061, China
| | - Wei Wei
- Department of Endocrinology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26 of Shengli Street, Jiangan District, Wuhan, 430061, China
| | - Zhongjing Wang
- Department of Endocrinology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26 of Shengli Street, Jiangan District, Wuhan, 430061, China.
| |
Collapse
|
6
|
Afonso-Alí A, Porrini E, Teixido-Trujillo S, Pérez-Pérez JA, Luis-Lima S, Acosta-González NG, Sosa-Paz I, Díaz-Martín L, Rodríguez-González C, Rodríguez-Rodríguez AE. The Role of Gender Differences and Menopause in Obesity-Related Renal Disease, Renal Inflammation and Lipotoxicity. Int J Mol Sci 2023; 24:12984. [PMID: 37629165 PMCID: PMC10455320 DOI: 10.3390/ijms241612984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/08/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
The pathogenesis of obesity-related-renal disease is unknown. Menopause can promote renal disease in obese women, but this interaction is unclear. In a previous study, we observed that obese male and female mice developed albuminuria, hyperfiltration, and glomerulomegaly, and these changes were more severe in those obese ovariectomized females. In this study, we also evaluated renal inflammation and lipotoxicity in that animal model. For six months, 43 males and 36 females C57BL6/J mice were randomized to standard diet (SD) or high fat diet (HFD). A group of female animals on SD or HFD was ovariectomized to simulate menopause. We evaluated cytokines: NF-κβ p65, IL-1β, MCP-1, TNF-α, total lipid content, lipid classes, and fatty acid profile in total lipid and individual lipid classes in renal tissue and urine. We found that obese males and females showed higher NF-kβ p-65, TNF-α and MCP-1 in renal tissue, and obese females ovariectomized had higher IL-1β and TNF-α compared with not-ovariectomized. Also, obese animals showed lower proinflammatory and higher anti-inflammatory fatty acids in kidney total lipids, while obese females ovariectomized had a more exacerbated pattern. In brief, obesity induces inflammation and an unbalanced lipidic profile in renal tissue. This pattern seems to be enhanced in obesity after menopause.
Collapse
Affiliation(s)
- Aaron Afonso-Alí
- ITB (Instituto Tecnologías Biomédicas), University of La Laguna, 38200 Tenerife, Spain; (A.A.-A.); (S.T.-T.); (L.D.-M.); (C.R.-G.); (A.E.R.-R.)
| | - Esteban Porrini
- ITB (Instituto Tecnologías Biomédicas), University of La Laguna, 38200 Tenerife, Spain; (A.A.-A.); (S.T.-T.); (L.D.-M.); (C.R.-G.); (A.E.R.-R.)
- Research Unit, Hospital Universitario de Canarias, 38200 Tenerife, Spain
| | - Silvia Teixido-Trujillo
- ITB (Instituto Tecnologías Biomédicas), University of La Laguna, 38200 Tenerife, Spain; (A.A.-A.); (S.T.-T.); (L.D.-M.); (C.R.-G.); (A.E.R.-R.)
- Research Unit, Hospital Universitario de Canarias, 38200 Tenerife, Spain
| | - José Antonio Pérez-Pérez
- Department of Animal Biology, Edaphology and Geology, Faculty of Biology, University of La Laguna, 38204 Tenerife, Spain; (J.A.P.-P.); (N.G.A.-G.); (I.S.-P.)
| | - Sergio Luis-Lima
- Department of Laboratory Medicine, Complejo Hospitalario Universitario de Canarias, 38200 San Cristóbal de La Laguna, Spain;
| | - Nieves Guadalupe Acosta-González
- Department of Animal Biology, Edaphology and Geology, Faculty of Biology, University of La Laguna, 38204 Tenerife, Spain; (J.A.P.-P.); (N.G.A.-G.); (I.S.-P.)
| | - Irene Sosa-Paz
- Department of Animal Biology, Edaphology and Geology, Faculty of Biology, University of La Laguna, 38204 Tenerife, Spain; (J.A.P.-P.); (N.G.A.-G.); (I.S.-P.)
| | - Laura Díaz-Martín
- ITB (Instituto Tecnologías Biomédicas), University of La Laguna, 38200 Tenerife, Spain; (A.A.-A.); (S.T.-T.); (L.D.-M.); (C.R.-G.); (A.E.R.-R.)
- Research Unit, Hospital Universitario de Canarias, 38200 Tenerife, Spain
| | - Covadonga Rodríguez-González
- ITB (Instituto Tecnologías Biomédicas), University of La Laguna, 38200 Tenerife, Spain; (A.A.-A.); (S.T.-T.); (L.D.-M.); (C.R.-G.); (A.E.R.-R.)
- Department of Animal Biology, Edaphology and Geology, Faculty of Biology, University of La Laguna, 38204 Tenerife, Spain; (J.A.P.-P.); (N.G.A.-G.); (I.S.-P.)
| | - Ana Elena Rodríguez-Rodríguez
- ITB (Instituto Tecnologías Biomédicas), University of La Laguna, 38200 Tenerife, Spain; (A.A.-A.); (S.T.-T.); (L.D.-M.); (C.R.-G.); (A.E.R.-R.)
- Research Unit, Hospital Universitario de Canarias, 38200 Tenerife, Spain
| |
Collapse
|
7
|
Li K, Cao B, Ke J, Yang L, Zhao D. Association of Hyper-Triglyceridemic Waist Phenotype and Diabetic Vascular Complication in the Chinese Population. Diabetes Metab Syndr Obes 2023; 16:2233-2241. [PMID: 37525822 PMCID: PMC10387281 DOI: 10.2147/dmso.s416668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/22/2023] [Indexed: 08/02/2023] Open
Abstract
Background Diabetic vascular complications are the leading cause of crippling and death of diabetic patients and seriously affect patients' quality of life. It is essential to control the risk factors contributing to vascular complications in patients with Type 2 diabetes (T2DM). This study aimed to examine the association between hyper-triglyceridemic waist phenotype (HWP) and the risk of vascular complication index of diabetes in T2DM patients. Methods The participants with type 2 diabetes mellitus in this study registered at the National Metabolic Management Center (MMC) of Beijing Luhe Hospital from June 2017 to June 2021. Data were collected by trained personnel according to the protocol. The questionnaire containing information on demographic characteristics and lifestyle factors (including alcohol drinking and cigarette smoking et al) was administered by trained interviewers. Logistic regression analysis assessing the associations between the hyper-triglyceridemic waist phenotype and vascular complication index of diabetes. In addition, the subgroup analysis was performed by age, sex, HbA1c, hypertension or not, and education level. Results After data cleaning, a total of 3221 participants with T2DM were enrolled. The median (IQR) duration of diabetes was 47.00 (3.00, 125.00) months. Compared to the participants in the Normal triglycerides level and Normal waist circumference group (NTNW), those in the Elevated triglycerides level and Enlarged waist circumference group (HTGW) have a higher risk of CKD-related vascular complications; the OR of decreased estimated glomerular filtration rate (GFR) and elevated urinary albumin creatinine ratio (UACR) were 2.21 (95% CI:1.32-3.82) and 2.18 (95% CI:1.69-2.81), respectively. Moreover, compared to the participants in the NTNW group, the ORs of the decreased ankle-brachial index (ABI) and elevated Brachial-ankle pulse wave velocity (baPWV) were 2.24 (95% CI:1.38-3.80) and 1.63 (95% CI:1.28-2.06) in the HTGW group. Conclusion In summary, there was an association between hyper-triglyceridemic waist phenotype and diabetic vascular complications in the Chinese population.
Collapse
Affiliation(s)
- Kun Li
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, People’s Republic of China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing, 101149, People’s Republic of China
| | - Bin Cao
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, People’s Republic of China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing, 101149, People’s Republic of China
| | - Jing Ke
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, People’s Republic of China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing, 101149, People’s Republic of China
| | - Longyan Yang
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, People’s Republic of China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing, 101149, People’s Republic of China
| | - Dong Zhao
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, People’s Republic of China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing, 101149, People’s Republic of China
| |
Collapse
|
8
|
Stencel J, Alai HR, Dhore-Patil A, Urina-Jassir D, Le Jemtel TH. Obesity, Preserved Ejection Fraction Heart Failure, and Left Ventricular Remodeling. J Clin Med 2023; 12:jcm12093341. [PMID: 37176781 PMCID: PMC10179420 DOI: 10.3390/jcm12093341] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 04/30/2023] [Accepted: 05/06/2023] [Indexed: 05/15/2023] Open
Abstract
Owing to the overwhelming obesity epidemic, preserved ejection fraction heart failure commonly ensues in patients with severe obesity and the obese phenotype of preserved ejection fraction heart failure is now commonplace in clinical practice. Severe obesity and preserved ejection fraction heart failure share congruent cardiovascular, immune, and renal derangements that make it difficult to ascertain whether the obese phenotype of preserved ejection fraction heart failure is the convergence of two highly prevalent conditions or severe obesity enables the development and progression of the syndrome of preserved ejection fraction heart failure. Nevertheless, the obese phenotype of preserved ejection fraction heart failure provides a unique opportunity to assess whether sustained and sizeable loss of excess body weight via metabolic bariatric surgery reverses the concentric left ventricular remodeling that patients with preserved ejection fraction heart failure commonly display.
Collapse
Affiliation(s)
- Jason Stencel
- Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, Tulane University Heart and Vascular Institute, New Orleans, LA 70112, USA
| | - Hamid R Alai
- Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, Tulane University Heart and Vascular Institute, New Orleans, LA 70112, USA
- Southeast Louisiana VA Healthcare System (SLVHCS), New Orleans, LA 70119, USA
| | - Aneesh Dhore-Patil
- Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, Tulane University Heart and Vascular Institute, New Orleans, LA 70112, USA
| | - Daniela Urina-Jassir
- Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, Tulane University Heart and Vascular Institute, New Orleans, LA 70112, USA
| | - Thierry H Le Jemtel
- Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, Tulane University Heart and Vascular Institute, New Orleans, LA 70112, USA
| |
Collapse
|
9
|
Zhang H, Chen R, Xu X, Yang M, Xu W, Xiang S, Wang L, Jiang X, Hua F, Huang X. Metabolically healthy obesity is associated with higher risk of both hyperfiltration and mildly reduced estimated glomerular filtration rate: the role of serum uric acid in a cross-sectional study. J Transl Med 2023; 21:216. [PMID: 36959674 PMCID: PMC10035285 DOI: 10.1186/s12967-023-04003-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/16/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND The impact of metabolically healthy obesity (MHO) on kidney dysfunction remains debatable. Moreover, few studies have focused on the early stages of kidney dysfunction indicated by hyperfiltration and mildly reduced eGFR. Thus, we aimed to investigate the association between the MHO and early kidney dysfunction, which is represented by hyperfiltration and mildly reduced estimated glomerular filtration rate (eGFR), and to further explore whether serum uric acid affects this association. METHODS This cross-sectional study enrolled 1188 residents aged ≥ 40 years old from Yonghong Communities. Metabolically healthy phenotypes were categorized based on Adult Treatment Panel III criteria. Obesity was defined as body mass index (BMI) ≥ 25 kg/m2. Mildly reduced eGFR was defined as being in the range 60 < eGFR ≤ 90 ml/min/1.73m2. Hyperfiltration was defined as eGFR > 95th percentile after adjusting for sex, age, weight, and height. RESULTS Overall, MHO accounted for 12.8% of total participants and 24.6% of obese participants. Compared to metabolically healthy non-obesity (MHNO), MHO was significantly associated with an increased risk of mildly reduced eGFR (odds ratio [OR] = 1.85, 95% confidence interval [CI] 1.13-3.01) and hyperfiltration (OR = 2.28, 95% CI 1.03-5.09). However, upon further adjusting for uric acid, the association between the MHO phenotype and mildly reduced eGFR was reduced to null. Compared with MHNO/non-hyperuricemia, MHO/non-hyperuricemia was associated with an increased risk of mildly reduced eGFR (OR = 2.04, 95% CI 1.17-3.58), whereas MHO/hyperuricemia was associated with an observably increased risk (OR = 3.07, 95% CI 1.34-7.01). CONCLUSIONS MHO was associated with an increased risk of early kidney dysfunction, and the serum uric acid partially mediated this association. Further prospective studies are warranted to clarify the causality.
Collapse
Affiliation(s)
- Hong Zhang
- Department of Endocrine and Metabolic Diseases, The First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, 185 Juqianjie Road, Changzhou, 213000, Jiangsu, China
| | - Rui Chen
- Department of Endocrine and Metabolic Diseases, The First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, 185 Juqianjie Road, Changzhou, 213000, Jiangsu, China
| | - Xiaohong Xu
- Department of Nephrology, Nanjing Drum Tower Hospital Group Suqian Hospital, Suqian, 223800, Jiangsu, China
- Department of Nephrology, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, 223800, Jiangsu, China
| | - Minxing Yang
- Department of Endocrine and Metabolic Diseases, The First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, 185 Juqianjie Road, Changzhou, 213000, Jiangsu, China
| | - Wenrong Xu
- Department of Immunization Program, Liangxi District Center for Disease Control and Prevention, Wuxi, 214000, Jiangsu, China
| | - Shoukui Xiang
- Department of Endocrine and Metabolic Diseases, The First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, 185 Juqianjie Road, Changzhou, 213000, Jiangsu, China
| | - Long Wang
- Department of Endocrine and Metabolic Diseases, The First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, 185 Juqianjie Road, Changzhou, 213000, Jiangsu, China
| | - Xiaohong Jiang
- Department of Endocrine and Metabolic Diseases, The First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, 185 Juqianjie Road, Changzhou, 213000, Jiangsu, China
| | - Fei Hua
- Department of Endocrine and Metabolic Diseases, The First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, 185 Juqianjie Road, Changzhou, 213000, Jiangsu, China.
| | - Xiaolin Huang
- Department of Endocrine and Metabolic Diseases, The First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, 185 Juqianjie Road, Changzhou, 213000, Jiangsu, China.
| |
Collapse
|
10
|
Kanbay M, Copur S, Siriopol D, Yildiz AB, Berkkan M, Tuttle KR, Zoccali C. The risk for chronic kidney disease in metabolically healthy obese patients: A systematic review and meta-analysis. Eur J Clin Invest 2023; 53:e13878. [PMID: 36120818 DOI: 10.1111/eci.13878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/30/2022] [Accepted: 09/15/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with obesity and metabolic syndrome. Nevertheless, the association of CKD with phenotype referred as metabolically healthy obese or overweight is unclear. In this this systematic review and meta-analysis, we investigate the relationships between obesity and CKD independent of metabolic syndrome by appraising published evidence in studies focusing on metabolically healthy obese people. MATERIALS AND METHODS We performed a literature search through three databases Embase (Elsevier), the Cochrane Central Register of Controlled Trials (Wiley) and PubMed/Medline Web of Science up to March 2022 with the following terms: "chronic kidney disease", "kidney function", "obesity", "metabolic syndrome", "metabolically healthy obesity", "metabolically healthy overweight". Metabolically unhealthy was defined an individual having at least 3 of the following: abdominal obesity, high blood pressure, hypertriglyceridemia, low HDL cholesterol and hyperglycaemia. We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for reporting. Prospective, retrospective, randomized and nonrandomized studies fitting the search criteria were included in our results. RESULTS Our final analysis included 16 studies with a total number of 4.965.285 participants. There is considerable heterogeneity in terms of study design, participant characteristics and number of participants across individual studies. In comparison to healthy normal weight patients, the risk was progressively higher in overweight (RR 1.29, 95% CI 1.27 to 1.32, p < 0.001) and obese patients (RR 1.47, 95% CI 1.31 to 1.65, p < 0.001). CONCLUSION Metabolically healthy overweight and obese individuals have higher risk of CKD compared to individuals without weight excess.
Collapse
Affiliation(s)
- Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey
| | - Sidar Copur
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Dimitrie Siriopol
- Department of Nephrology, "Saint John the New" County Hospital, Suceava, Romania.,"Stefan cel Mare" University, Suceava, Romania
| | - Abdullah B Yildiz
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Metehan Berkkan
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Kathherine R Tuttle
- Division of Nephrology, University of Washington, Seattle, Washington, USA.,Providence Medical Research Center, Providence Health Care, Spokane, Washington, USA
| | - Carmine Zoccali
- Renal Research Institute, New York, New York, USA.,Associazione Ipertensione, Nefrologia e Trapianto Renale (IPNET) c/o Nefrologia, Reggio Calabria, Italy
| |
Collapse
|
11
|
Wu Z, Yu S, Zhang H, Guo Z, Zheng Y, Xu Z, Li Z, Liu X, Li X, Chen S, Zhang J, Tao L, Guo X. Combined evaluation of arterial stiffness, glycemic control and hypertension for macrovascular complications in type 2 diabetes. Cardiovasc Diabetol 2022; 21:262. [PMID: 36443820 PMCID: PMC9706858 DOI: 10.1186/s12933-022-01696-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Arterial stiffness, glycemic control and blood pressure are risk factors of macrovascular complications in type 2 diabetes. This study aimed to investigate the combined association of arterial stiffness, glycemic control and hypertension status with the occurrence of diabetic macrovascular complication. METHODS A total of 1870 patients of diabetes were enrolled from Beijing Health Management Cohort between 2008 and 2018 as baseline, and then followed for macrovascular complication onset. We proposed a composite risk score (0-4) by arterial stiffness severity, pool glycemic control and hypertension status. Cox model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI). RESULTS The mean age (SD) of this population was 59.90 (12.29) years. During a median follow-up of 4.0 years, 359 (19.2%) patients developed macrovascular complication. Compared to the normal arterial stiffness and good glycemic control group, patients with severe arterial stiffness and pool glycemic control had the highest risk of macrovascular complications (HR: 2.73; 95% CI: 1.42-5.25). Similarly, those of severe arterial stiffness and hypertension had the highest risk (HR: 2.69; 95% CI: 1.61-4.50). Patients of the composite score > 2 had a significantly increased risk of macrovascular complication. CONCLUSION This study suggested the clinical importance of combined evaluation of arterial stiffness, glycemic control and hypertension status for the risk stratification and management of macrovascular complication of type 2 diabetes.
Collapse
Affiliation(s)
- Zhiyuan Wu
- grid.24696.3f0000 0004 0369 153XBeijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmen Street, Beijing, 100069 China ,grid.1038.a0000 0004 0389 4302Centre for Precision Health, Edith Cowan University, Perth, Australia
| | - Siqi Yu
- grid.24696.3f0000 0004 0369 153XBeijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmen Street, Beijing, 100069 China
| | - Haiping Zhang
- grid.24696.3f0000 0004 0369 153XBeijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmen Street, Beijing, 100069 China
| | - Zheng Guo
- grid.1038.a0000 0004 0389 4302Centre for Precision Health, Edith Cowan University, Perth, Australia
| | - Yulu Zheng
- grid.1038.a0000 0004 0389 4302Centre for Precision Health, Edith Cowan University, Perth, Australia
| | - Zongkai Xu
- grid.24696.3f0000 0004 0369 153XBeijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmen Street, Beijing, 100069 China
| | - Zhiwei Li
- grid.24696.3f0000 0004 0369 153XBeijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmen Street, Beijing, 100069 China
| | - Xiangtong Liu
- grid.24696.3f0000 0004 0369 153XBeijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmen Street, Beijing, 100069 China
| | - Xia Li
- grid.1018.80000 0001 2342 0938Department of Mathematics and Statistics, La Trobe University, Melbourne, Australia
| | - Shuo Chen
- Beijing Physical Examination Center, Beijing, China
| | - Jingbo Zhang
- Beijing Physical Examination Center, Beijing, China
| | - Lixin Tao
- grid.24696.3f0000 0004 0369 153XBeijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmen Street, Beijing, 100069 China
| | - Xiuhua Guo
- grid.24696.3f0000 0004 0369 153XBeijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmen Street, Beijing, 100069 China
| |
Collapse
|
12
|
Novel Insights in the Physiopathology and Management of Obesity-Related Kidney Disease. Nutrients 2022; 14:nu14193937. [PMID: 36235590 PMCID: PMC9572176 DOI: 10.3390/nu14193937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 11/30/2022] Open
Abstract
Obesity is recognized as an independent risk factor for the development of kidney disease, which has led to the designation of obesity-related glomerulopathy (ORG). Common renal features observed in this condition include glomerular hypertrophy, glomerulosclerosis, haemodynamic changes and glomerular filtration barrier defects. Additionally, and although less studied, obesity-related kidney disease also involves alterations in renal tubules, including tubule hypertrophy, lipid deposition and tubulointerstitial fibrosis. Although not completely understood, the harmful effects of obesity on the kidney may be mediated by different mechanisms, with alterations in adipose tissue probably playing an important role. An increase in visceral adipose tissue has classically been associated with the development of kidney damage, however, recent studies point to adipose tissue surrounding the kidney, and specifically to the fat within the renal sinus, as potentially involved in the development of ORG. In addition, new strategies for the treatment of patients with obesity-related kidney disease are focusing on the management of obesity. In this regard, some non-invasive options, such as glucagon-like peptide-1 (GLP-1) receptor agonists or sodium–glucose cotransporter-2 (SGLT2) inhibitors, are being considered for application in the clinic, not only for patients with diabetic kidney disease but as a novel pharmacological strategy for patients with ORG. In addition, bariatric surgery stands as one of the most effective options, not only for weight loss but also for the improvement of kidney outcomes in obese patients with chronic kidney disease.
Collapse
|
13
|
Yu M, Zhang S, Wang L, Feng H, Li X, Wu J, Yuan J. Association of Metabolically Healthy Obesity and Glomerular Filtration Rate among Male Steelworkers in North China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11764. [PMID: 36142036 PMCID: PMC9517549 DOI: 10.3390/ijerph191811764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
This study aims to investigate the association between metabolically healthy obesity (MHO) and the early stages of renal dysfunction and whether systemic inflammation affects the study's outcome. Male steelworkers in northern China were investigated in this cross-sectional survey (n = 6309). A decrease in estimated glomerular filtration rate (eGFR) was used as the primary outcome, which was defined as an eGFR of ≤89 mL/min/1.73 m2. A BMI ≥ 25 kg/m2 was used to determine obesity. In the definition of metabolic health, the absence of metabolic syndrome components is considered metabolically healthy. An assessment of inflammation was carried out using a surrogate marker called high-sensitivity C-reactive protein (hs-CRP). The adjusted odds ratio (OR) and confidence intervals (CIs) were estimated using the multivariable logistic regression model. After adjusting for hs-CRP, MHO (OR = 1.97; 95% CI: 1.21 to 3.21) was significantly associated with decreased eGFR compared to metabolically healthy non-obesity (MHNO). With the MHNO/hs-CRP ≤ 0.01 mg/dL group as a reference, the OR was 2.17 (95% CI: 1.17 to 4.02) for decreased eGFR in the group with MHO/hs-CRP > 0.01 mg/dL. MHO is associated with renal dysfunction at an early stage. To some degree, this risk can be explained by the level of inflammation.
Collapse
Affiliation(s)
- Miao Yu
- Department of Epidemiology and Health Statistics, School of Public Health, North China University of Science and Technology, Tangshan 063210, China
| | - Shengkui Zhang
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical, Beijing 100005, China
| | - Lihua Wang
- Department of Epidemiology and Health Statistics, School of Public Health, North China University of Science and Technology, Tangshan 063210, China
| | - Hongman Feng
- Department of Epidemiology and Health Statistics, School of Public Health, North China University of Science and Technology, Tangshan 063210, China
| | - Xiaoming Li
- Department of Epidemiology and Health Statistics, School of Public Health, North China University of Science and Technology, Tangshan 063210, China
| | - Jianhui Wu
- Department of Epidemiology and Health Statistics, School of Public Health, North China University of Science and Technology, Tangshan 063210, China
| | - Juxiang Yuan
- Department of Epidemiology and Health Statistics, School of Public Health, North China University of Science and Technology, Tangshan 063210, China
| |
Collapse
|
14
|
Kuma A, Kato A. Lifestyle-Related Risk Factors for the Incidence and Progression of Chronic Kidney Disease in the Healthy Young and Middle-Aged Population. Nutrients 2022; 14:nu14183787. [PMID: 36145162 PMCID: PMC9506421 DOI: 10.3390/nu14183787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/10/2022] [Accepted: 09/11/2022] [Indexed: 11/16/2022] Open
Abstract
The prevalence of chronic kidney disease (CKD) increased by 88% from 1990 to 2016. Age of onset of lifestyle-related diseases (such as hypertension, diabetes mellitus, obesity, dyslipidemia, and hyperuricemia), which are risk factors for incident CKD, is lower now compared with the past. Thus, we aimed to evaluate the risk factors for the incidence and progression of CKD in the young and middle-aged population. There are differences in the risk for CKD among the young, middle-aged, and elderly populations. We aimed to assess obesity (which is basic component of metabolic syndrome), waist circumference, and abdominal adiposity, which are predictive factors of CKD in the younger population. Furthermore, we described the management and clinical evidence of hypertension, diabetes mellitus, dyslipidemia, and hyperuricemia for young and middle-aged patients, along with diet management and nutrients associated with kidney function. Kidney function in the young and middle-aged population is mostly normal, and they are considered a low-risk group for incident CKD. Thus, we expect this review to be useful in reducing the prevalence of CKD.
Collapse
Affiliation(s)
- Akihiro Kuma
- Kidney Center, Hospital of the University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8556, Fukuoka, Japan
| | - Akihiko Kato
- Blood Purification Unit, Hamamatsu University Hospital, 1-20-1 Handayama, Higashi-ku, Hamamatsu 431-3125, Shizuoka, Japan
- Correspondence:
| |
Collapse
|
15
|
Xuan Y, Gao P, Shen Y, Wang S, Gu X, Tang D, Wang X, Zhu F, Lu L, Chen L. Association of hypertriglyceridemic waist phenotype with non-alcoholic fatty liver disease: a cross-sectional study in a Chinese population. Hormones (Athens) 2022; 21:437-446. [PMID: 35597838 DOI: 10.1007/s42000-022-00374-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/29/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The aim of this study was to determine the association between hypertriglyceridemic waist (HTGW) phenotype and non-alcoholic fatty liver disease (NAFLD) in a middle- to older-aged Chinese population. METHODS In this cross-sectional study, a total of 9015 participants (age 40-79 years) were recruited and grouped into four phenotypes, as follows: NWNT: normal waist-normal triglyceride; NWET: normal waist-elevated triglycerides; EWNT: elevated waist-normal triglycerides; and hypertriglyceridemic waist (HTGW). Logistic regression analysis was carried out to assess the associations between HTGW phenotype and NAFLD. Receiver-operating characteristic (ROC) curves were drawn to evaluate the utility of waist circumference-triglyceride index (WTI) as a reference factor for screening for NAFLD. RESULTS HTGW phenotype had a higher prevalence of NAFLD (53.3%), diabetes (19.6%), and hypertension (79.8%) than the other three subgroups. After adjusting for age, sex, and BMI, HTGW phenotype was associated with NAFLD (odds ratio (OR) 6.12; 95% confidence interval (CI) 5.11-7.32). Further adjusted for potential confounders, the HTGW phenotype was still significantly associated with NAFLD (adjusted OR 5.18; 95% CI 4.30-6.23) regardless of gender. The subgroup analyses generally revealed similar associations across all subgroups. ROC curve analysis showed that when the maximum area under the curve was 0.748, the WTI was 90.1, and the corresponding sensitivity and specificity were 90.6 and 59.5%, respectively. CONCLUSIONS HTGW phenotype is strongly associated with NAFLD and can be used as a reference factor for NAFLD screening.
Collapse
Affiliation(s)
- Yan Xuan
- Institute and Department of Endocrinology, Shanghai Ruijin Hospital, Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ping Gao
- Institute and Department of Endocrinology, Shanghai Ruijin Hospital, Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Shen
- Institute and Department of Endocrinology, Shanghai Ruijin Hospital, Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sujie Wang
- Institute and Department of Endocrinology, Shanghai Ruijin Hospital, Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xi Gu
- Institute and Department of Endocrinology, Shanghai Ruijin Hospital, Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dou Tang
- Institute and Department of Endocrinology, Shanghai Ruijin Hospital, Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xun Wang
- Institute and Department of Endocrinology, Shanghai Ruijin Hospital, Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - FanFan Zhu
- Institute and Department of Endocrinology, Shanghai Ruijin Hospital, Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Leiqun Lu
- Institute and Department of Endocrinology, Shanghai Ruijin Hospital, Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Ling Chen
- Institute and Department of Endocrinology, Shanghai Ruijin Hospital, Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| |
Collapse
|
16
|
Wu Z, Yu S, Zhu Q, Li Z, Zhang H, Kang X, Xu Z, Miao X, Liu X, Li X, Zhang J, Wang W, Tao L, Guo X. Association of baseline and cumulative remnant cholesterol with incidence of diabetic nephropathy: A longitudinal cohort study. Diabetes Res Clin Pract 2022; 191:110079. [PMID: 36099974 DOI: 10.1016/j.diabres.2022.110079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/01/2022] [Accepted: 09/05/2022] [Indexed: 11/03/2022]
Abstract
AIMS To evaluate the longitudinal association of remnant cholesterol with the incidence of diabetic nephropathy using a Chinese diabetes cohort. METHODS We included 4237 individuals with type 2 diabetes during 2013-2014 from Beijing Health Management Cohort. Remnant cholesterol was defined by Martin-Hopkins equation. Diabetic nephropathy was confirmed by urine albumin/creatinine ratio and estimated glomerular filtration rate. We calculated the hazard ratio (HR) and 95% confidence interval (CI) for incident diabetic nephropathy using adjusted Cox proportional hazards regression. RESULTS The median [IQR] age was 55 [48, 64] years, and 3 256 (76.8 %) were men. During follow-up, 248 (5.9 %) participants developed diabetic nephropathy. One-SD increase of baseline and average cumulative remnant cholesterol were significantly associated with an increased risk of diabetic nephropathy, and the adjusted HRs were 1.208 (95 % CI: 1.098-1.329) and 1.216 (95 % CI: 1.102-1.341), respectively. Individuals in the highest tertile of baseline and average cumulative remnant cholesterol had a 82.3 % and 87.6 % excess risk of diabetic nephropathy, compared with those in the lowest. CONCLUSION Remnant cholesterol is independently associated with incident diabetic nephropathy in type 2 diabetes.
Collapse
Affiliation(s)
- Zhiyuan Wu
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China; Centre for Precision Health, Edith Cowan University, Perth, Australia.
| | - Siqi Yu
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China.
| | - Qian Zhu
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China.
| | - Zhiwei Li
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Haiping Zhang
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | | | - Zongkai Xu
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Xinlei Miao
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Xiangtong Liu
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Xia Li
- Department of Mathematics and Statistics, La Trobe University, Melbourne, Australia.
| | - Jingbo Zhang
- Beijing Physical Examination Center, Beijing, China
| | - Wei Wang
- Centre for Precision Health, Edith Cowan University, Perth, Australia.
| | - Lixin Tao
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China.
| | - Xiuhua Guo
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China; Centre for Precision Health, Edith Cowan University, Perth, Australia.
| |
Collapse
|
17
|
Pathogenesis, Murine Models, and Clinical Implications of Metabolically Healthy Obesity. Int J Mol Sci 2022; 23:ijms23179614. [PMID: 36077011 PMCID: PMC9455655 DOI: 10.3390/ijms23179614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
Although obesity is commonly associated with numerous cardiometabolic pathologies, some people with obesity are resistant to detrimental effects of excess body fat, which constitutes a condition called “metabolically healthy obesity” (MHO). Metabolic features of MHO that distinguish it from metabolically unhealthy obesity (MUO) include differences in the fat distribution, adipokine types, and levels of chronic inflammation. Murine models are available that mimic the phenotype of human MHO, with increased adiposity but preserved insulin sensitivity. Clinically, there is no established definition of MHO yet. Despite the lack of a uniform definition, most studies describe MHO as a particular case of obesity with no or only one metabolic syndrome components and lower levels of insulin resistance or inflammatory markers. Another clinical viewpoint is the dynamic and changing nature of MHO, which substantially impacts the clinical outcome. In this review, we explore the pathophysiology and some murine models of MHO. The definition, variability, and clinical implications of the MHO phenotype are also discussed. Understanding the characteristics that differentiate people with MHO from those with MUO can lead to new insights into the mechanisms behind obesity-related metabolic derangements and diseases.
Collapse
|
18
|
Jam SA, Moloudpour B, Najafi F, Darbandi M, Pasdar Y. Metabolic obesity phenotypes and chronic kidney disease: a cross-sectional study from the RaNCD cohort study. BMC Nephrol 2022; 23:233. [PMID: 35778682 PMCID: PMC9248132 DOI: 10.1186/s12882-022-02858-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 06/21/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Investigating the effect of metabolic disorders on chronic kidney disease (CKD) in the presence or the absence of obesity is of great importance. This study aimed to examine the independent and joint relationships of obesity and metabolic syndrome (MetS) with CKD. METHODS : The present study was performed on 9,762 participants from the baseline phase of the Ravansar non- communicable diseases (RaNCD) study. Thereafter, the CKD was estimated by glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) equation. All the included participants were categorized into the following four phenotypes: metabolically healthy non-overweight/obesity (MHNO), metabolically unhealthy non-overweight/obesity (MUNO), metabolically healthy overweight/obesity (MHO), and metabolically unhealthy overweight/obesity (MUO). Finally, Logistic regression analysis was used to estimate the odds ratio (ORs). RESULTS The mean age of the included participants was 47.33 ± 8.27 years old, %48.16 (4,701) of whom were men. As well, 1,058(10.84%) participants had CKD (eGFR less than 60 ml/min/1.73m2). The overweight/obesity was not significantly associated with odds of CKD. The odds of CKD in male subjects with MetS was 1.48 times higher than non-MetS ones (95% CI: 1.10, 2.01). After adjusting the confounders, the odds of CKD were 1.54 times (95% CI: 1.12, 2.11) higher in the MUNO and 2.22 times (95% CI: 1.44, 3.41) higher in the MUO compared to MHNO phenotype in male subjects. The odds of CKD in the MUNO and MUO was 1.31 times (95% CI: 1.10, 1.60) and 1.23 times (95% CI: 1.01, 1.54) higher than MHNO phenotype in female subjects, respectively. CONCLUSION The odds of CKD were higher in MUNO and MUO phenotypes. Therefore, lifestyle modification is recommended to control normal weight and healthy metabolism.
Collapse
Affiliation(s)
- Samira Arbabi Jam
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Behrooz Moloudpour
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farid Najafi
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mitra Darbandi
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yahya Pasdar
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
- Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| |
Collapse
|
19
|
Chu SC, Wang PH, Lu KY, Ko CC, She YH, Lee CC, Wu IW, Sun CY, Hsu HJ, Pan HC. Relationships Between Metabolic Body Composition Status and Rapid Kidney Function Decline in a Community-Based Population: A Prospective Observational Study. Front Public Health 2022; 10:895787. [PMID: 35719641 PMCID: PMC9204180 DOI: 10.3389/fpubh.2022.895787] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/16/2022] [Indexed: 12/23/2022] Open
Abstract
Obesity and metabolic syndrome are strong risk factors for incident chronic kidney disease (CKD). However, the predictive accuracy of metabolic body composition status (MBCS), which combines the status of obesity and metabolic syndrome, for rapid kidney function decline (RKFD) is unclear. The aim of this study was to investigate the relationship between MBCS and RKFD in a healthy population in a prospective community-based cohort study. In the current study, we followed changes in renal function in 731 people residing in northern Taiwan for 5 years. The participants were divided into four groups according to their MBCS, including metabolically healthy normal weight (MHNW), metabolically healthy overweight (MHOW), metabolically unhealthy normal weight (MUNW), and metabolically unhealthy overweight (MUOW). We evaluated traditional risk factors for CKD and metabolic profiles. The primary outcome was RKFD, which was defined as a 15% decline in estimated glomerular filtration rate (eGFR) within the first 4 years, and a reduction in eGFR which did not improve in the 5th year. During the study period, a total of 731 participants were enrolled. The incidence of RKFD was 17.1% (125/731). Multiple Cox logistic regression hazard analysis revealed that age, cerebrovascular accident, eGFR, urine albumin-to-creatinine ratio, use of painkillers, depressive mood, MUNW and MUOW were independent predictors of RKFD. After adjusting for age, sex, eGFR and total cholesterol, the participants with MUNW and MUOW had higher hazard ratios (HRs) for RKFD [HR: 2.19, 95% confidence interval (CI): 1.22–3.95 for MUNW; HR: 1.86, 95% CI: 1.21–2.87 for MUOW] than those with MHNW. Similar results were also observed in subgroup analysis of those aged above 65 years. On the basis of the results of this study, we conclude that MBCS was independently associated with RKFD, especially in the older adults. On the basis of our results, we suggest that MUNW and MUOW should be considered as risk factors for RKFD.
Collapse
Affiliation(s)
- Shao-Chi Chu
- Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Po-Hsi Wang
- Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Kuan-Ying Lu
- Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chia-Chun Ko
- Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yun-Hsuan She
- Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chin-Chan Lee
- Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - I-Wen Wu
- Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chiao-Yin Sun
- Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Heng-Jung Hsu
- Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Heng-Chih Pan
- Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- *Correspondence: Heng-Chih Pan
| |
Collapse
|
20
|
Alagh AR, Shukla S, Acharya S, Vagha S, Dhingra L. Evaluation of microalbuminuria in obesity phenotypes. J Family Community Med 2022; 29:162-167. [PMID: 35754751 PMCID: PMC9221229 DOI: 10.4103/jfcm.jfcm_57_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 04/13/2022] [Accepted: 04/25/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND: Obesity is a universal health issue of the present time. Nearly 2 billion people were estimated to be either overweight or obese in 2020, with nearly 3.4 million deaths worldwide. Proteinuria is now widely known to be a significant predictor of renal pathologies including end-stage renal disease. This study aimed to assess the relationship between the presence of microalbuminuria (MA) in obese individuals. MATERIALS AND METHODS: This cross-sectional study was conducted among patients attending the outpatient department of Jawaharlal Nehru Medical College and Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha. From the subjects meeting the study criteria, selected 150 individuals with BMI ≥ 25 that formed the obese group. Obese individuals were further subdivided as metabolic healthy obese (MHO) and metabolic abnormal obese (MAO) based on metablic syndrome criteria. From the non-obese patients (BMI≤25), one age and gender matched control was selected for each obese subject. All subjects were tested for MA by dipstick method. Data was analyzed using SPSS and Chi-square test was performed to test for statistical significance. RESULTS: The study reflected the association of MA in the groups studied. The metabolic abnormal obese group was noted as having the highest percentage of positive cases (53.7%) of MA, followed by the MHO group (31.3%). A significant association of prevalence of MA was seen in MHO and MAO obese individuals (P < 0.001). MA was present in the urine samples of 26 (31.3%) obese subjects in the MHO group, 36 (53.7%) in the MAO group, and 8 (5.3%) in the control population. CONCLUSION: Both MHO and MAO subgroups of obese individuals showed higher proportion of MA indicating adverse renal function. Therefore, primary prophylactic measures such as health education and lifestyle modification should be promoted for the obese to reduce their body weight and thereby possibly reduce the risk of future obesity-related renal complications.
Collapse
Affiliation(s)
- Arzoo R Alagh
- Department of Pathology, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India
| | - Samarth Shukla
- Department of Pathology, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India
| | - Sourya Acharya
- Department of Medicine, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India
| | - Sunita Vagha
- Department of Pathology, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India
| | | |
Collapse
|
21
|
Hamzeh B, Pasdar Y, Moradi S, Darbandi M, Rahmani N, Shakiba E, Najafi F. Metabolically healthy versus unhealthy obese phenotypes in relation to hypertension incidence; a prospective cohort study. BMC Cardiovasc Disord 2022; 22:106. [PMID: 35287586 PMCID: PMC8922873 DOI: 10.1186/s12872-022-02553-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 03/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Although obesity increases the risk of hypertension, the effect of obesity based on metabolic status on the incidence of hypertension is not known. This study aimed to determine the association between obesity phenotypes including metabolically unhealthy obesity (MUO) and metabolically healthy obesity (MHO) and the risk of hypertension incidence. Methods We conducted a prospective cohort study on 6747 adults aged 35–65 from Ravansar non-communicable diseases (RaNCD) study. Obesity was defined as body mass index above 30 kg/m2 and metabolically unhealthy was considered at least two metabolic disorders based on the International Diabetes Federation criteria. Obesity phenotypes were categorized into four groups including MUO, MHO, metabolically unhealthy non obesity (MUNO), and metabolically healthy non obesity (MHNO). Cox proportional hazards regression models were applied to analyze associations with hypertension incidence. Results The MHO (HR: 1.37; 95% CI: 1.03–1.86) and MUO phenotypes (HR: 2.44; 95% CI: 1.81–3.29) were associated with higher hypertension risk compared to MHNO. In addition, MUNO phenotype was significantly associated with risk of hypertension incidence (HR: 1.65; 95% CI: 1.29–2.14). Conclusions Both metabolically healthy and unhealthy obesity increased the risk of hypertension incidence. However, the increase in metabolically unhealthy phenotype was higher.
Collapse
Affiliation(s)
- Behrooz Hamzeh
- Health Education and Promotion, Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yahya Pasdar
- Department of Nutrition Sciences, Research Center for Environmental Determinants of Health (RCEDH), Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shima Moradi
- Department of Nutrition Sciences, Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Mitra Darbandi
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Negin Rahmani
- Julius Maximillian University of Wuerzburg, Wuerzburg, Germany
| | - Ebrahim Shakiba
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Farid Najafi
- Epidemiology, School of Public Health, Communing Developmental and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| |
Collapse
|
22
|
Wu Z, Yu S, Kang X, Liu Y, Xu Z, Li Z, Wang J, Miao X, Liu X, Li X, Zhang J, Wang W, Tao L, Guo X. Association of visceral adiposity index with incident nephropathy and retinopathy: a cohort study in the diabetic population. Cardiovasc Diabetol 2022; 21:32. [PMID: 35209907 PMCID: PMC8876445 DOI: 10.1186/s12933-022-01464-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background The association between visceral adiposity index (VAI) and diabetic complications has been reported in cross-sectional studies, while the effect of VAI on complication development remains unclear. This study aims to evaluate the longitudinal association of VAI and Chinese VAI (CVAI) with the incidence of diabetic nephropathy and retinopathy using a Chinese cohort. Methods A total of 8 948 participants with type 2 diabetes from Beijing Health Management Cohort were enrolled during 2013–2014, and followed until December 31, 2019. Nephropathy was confirmed by urine albumin/creatinine ratio and estimated glomerular filtration rate; retinopathy was diagnosed using fundus photograph. Results The mean (SD) age was 53.35 (14.66) years, and 6 154 (68.8%) were men. During a median follow-up of 4.82 years, 467 participants developed nephropathy and 90 participants developed retinopathy. One-SD increase in VAI and CVAI levels were significantly associated with an increased risk of nephropathy, and the adjusted hazard ratios (HR) were 1.127 (95% CI 1.050–1.210) and 1.165 (95% CI 1.003–1.353), respectively. On contrary, VAI and CVAI level were not associated with retinopathy after adjusting confounding factors. Conclusion VAI and CVAI are independently associated with the development of nephropathy, but not retinopathy in Chinese adults with diabetes. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01464-1.
Collapse
Affiliation(s)
- Zhiyuan Wu
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmen Street, Beijing, 100069, China.,Centre for Precision Health, Edith Cowan University, Perth, Australia
| | - Siqi Yu
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmen Street, Beijing, 100069, China
| | | | - Yue Liu
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmen Street, Beijing, 100069, China
| | - Zongkai Xu
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmen Street, Beijing, 100069, China
| | - Zhiwei Li
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmen Street, Beijing, 100069, China
| | - Jinqi Wang
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmen Street, Beijing, 100069, China
| | - Xinlei Miao
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmen Street, Beijing, 100069, China
| | - Xiangtong Liu
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmen Street, Beijing, 100069, China
| | - Xia Li
- Department of Mathematics and Statistics, La Trobe University, Melbourne, Australia
| | - Jingbo Zhang
- Beijing Physical Examination Center, Beijing, China
| | - Wei Wang
- Centre for Precision Health, Edith Cowan University, Perth, Australia
| | - Lixin Tao
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmen Street, Beijing, 100069, China.
| | - Xiuhua Guo
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmen Street, Beijing, 100069, China. .,Centre for Precision Health, Edith Cowan University, Perth, Australia.
| |
Collapse
|
23
|
Kuma A, Mafune K, Uchino B, Ochiai Y, Enta K, Kato A. Development of chronic kidney disease influenced by serum urate and body mass index based on young-to-middle-aged Japanese men: a propensity score-matched cohort study. BMJ Open 2022; 12:e049540. [PMID: 35131815 PMCID: PMC8823083 DOI: 10.1136/bmjopen-2021-049540] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To investigate the association between serum uric acid (SUA) level and body mass index (BMI) on the development of chronic kidney disease (CKD) in working men aged 20-60 years. DESIGN Retrospective cohort study. SETTING Data from employees' annual health check-ups were collected from two companies in 2009 and 2014. PARTICIPANTS A total of 16 708 working men were recruited. We excluded participants with missing essential data (N=7801), who had basal estimated glomerular filtration rate (eGFR) <60.0 mL/min/1.73 m2 and/or proteinuria (N=698) or with the absence of follow-up data (N=2). PRIMARY OUTCOME eGFR <60 mL/min/1.73 m2 and/or proteinuria (≥1+) in 2014 (defined as incident CKD). RESULTS The cut-off values of SUA for incident CKD were 6.6 mg/dL in both young (20-39 years old) and middle-aged (40-60 years old) men analysed by receiver operator characteristics. ORs for incident CKD were assessed on propensity score-matched (1:1) cohorts. In young participants (N=1938), after propensity score matching, a coexistence of high-level SUA (≥6.6 mg/dL) and overweight (BMI ≥25 kg/m2) was a significant risk factor of incident CKD (OR=2.18, 95% CI 1.10 to 4.31, p=0.025), but high-level SUA was not an independent risk factor without overweight status (p=0.174). In middle-aged participants (N=2944) after propensity score matching, high-level SUA was a significant risk factor of incident CKD both with or without overweight (OR=1.44, 95% CI 1.02 to 2.04, p=0.037; OR=1.32, 95% CI 1.01 to 1.73, p=0.041, respectively). CONCLUSION These findings suggest that high-level SUA is strongly associated with incident CKD in overweight young adult men.
Collapse
Affiliation(s)
- Akihiro Kuma
- Kidney Centre, Hospital of the University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
- Blood Purification Unit, Hamamatsu University Hospital, Hamamatsu, Shizuoka, Japan
| | - Kosuke Mafune
- Department of Mental Health, Institution of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Bungo Uchino
- Health Promotion Centre, Yamaha Motor Co Ltd, Iwata, Shizuoka, Japan
| | - Yoko Ochiai
- Health Promotion Centre, Yamaha Motor Co Ltd, Iwata, Shizuoka, Japan
| | - Kazuhiko Enta
- Health Care Centre, Central Japan Railway Company, Nagoya, Aichi, Japan
| | - Akihiko Kato
- Blood Purification Unit, Hamamatsu University Hospital, Hamamatsu, Shizuoka, Japan
| |
Collapse
|
24
|
Xuan Y, Shen Y, Wang S, Gao P, Gu X, Tang D, Wang X, Zhu F, Lu L, Chen L. The association of hypertriglyceridemic waist phenotype with hypertension: A cross-sectional study in a Chinese middle aged-old population. J Clin Hypertens (Greenwich) 2022; 24:191-199. [PMID: 35083845 PMCID: PMC8845473 DOI: 10.1111/jch.14424] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/08/2021] [Accepted: 12/21/2021] [Indexed: 12/28/2022]
Abstract
The present study aimed to evaluate the relationship between the hypertriglyceridemic waist (HTGW) phenotype and hypertension. We undertook a cross‐sectional study with a sample of 9015 adults from China. The HTGW phenotype was defined as elevated waist circumference (WC) and elevated triglyceride (TG) concentration. Logistic regression analysis was used to evaluate the association between the HTGW phenotype and hypertension. The prevalence of hypertension was significantly higher in individuals with the HTGW phenotype, than in those with the normal waist normal triglyceride (NWNT) phenotype (89.9% vs 75.3%, respectively, P < .001). After adjusting for age, sex, BMI, current smoker, and current alcohol consumption, the HTGW phenotype was associated with hypertension (Odds Ratio (OR)1.53; 95% CI 1.25–1.87). After further adjustment for potential confounders, the HTGW phenotype was still significantly associated with hypertension (adjusted OR1.28; 95% CI 1.04‐1.58) regardless of sex. The subgroup analyses generally revealed similar associations across all subgroups. This study indicated that the HTGW phenotype was strongly associated with hypertension, and blood pressure should be clinically monitored in individuals with the HTGW phenotype. We suggested a combined use of hypertriglyceridemia waist phenotype in identifying participants who are at high risk of hypertension.
Collapse
Affiliation(s)
- Yan Xuan
- Institute and Department of Endocrinology, Shanghai Jiaotong University of medicine Affiliated to Ruijin Hospital Luwan Branch, Shanghai, China
| | - Ying Shen
- Institute and Department of Endocrinology, Shanghai Jiaotong University of medicine Affiliated to Ruijin Hospital Luwan Branch, Shanghai, China
| | - Sujie Wang
- Institute and Department of Endocrinology, Shanghai Jiaotong University of medicine Affiliated to Ruijin Hospital Luwan Branch, Shanghai, China
| | - Ping Gao
- Institute and Department of Endocrinology, Shanghai Jiaotong University of medicine Affiliated to Ruijin Hospital Luwan Branch, Shanghai, China
| | - Xi Gu
- Institute and Department of Endocrinology, Shanghai Jiaotong University of medicine Affiliated to Ruijin Hospital Luwan Branch, Shanghai, China
| | - Dou Tang
- Institute and Department of Endocrinology, Shanghai Jiaotong University of medicine Affiliated to Ruijin Hospital Luwan Branch, Shanghai, China
| | - Xun Wang
- Institute and Department of Endocrinology, Shanghai Jiaotong University of medicine Affiliated to Ruijin Hospital Luwan Branch, Shanghai, China
| | - Fanfan Zhu
- Institute and Department of Endocrinology, Shanghai Jiaotong University of medicine Affiliated to Ruijin Hospital Luwan Branch, Shanghai, China
| | - Leiqun Lu
- Institute and Department of Endocrinology, Shanghai Jiaotong University of medicine Affiliated to Ruijin Hospital Luwan Branch, Shanghai, China
| | - Ling Chen
- Institute and Department of Endocrinology, Shanghai Jiaotong University of medicine Affiliated to Ruijin Hospital Luwan Branch, Shanghai, China
| |
Collapse
|
25
|
Xuan Y, Zhang W, Wang Y, Wang B, Chen Y, Xia F, Zhang K, Li Q, Wang N, Lu Y. The Association Between Hypertriglyceridemic-Waist Phenotype and Chronic Kidney Disease in Patients with Type 2 Diabetes: A Cross-Sectional METAL Study. Diabetes Metab Syndr Obes 2022; 15:1885-1895. [PMID: 35757194 PMCID: PMC9231417 DOI: 10.2147/dmso.s359742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/11/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The aim of this study was measuring the association between the hypertriglyceridemic-waist (HTGW) phenotype and chronic kidney disease in a large type 2 diabetes population. METHODS A total of 4254 diabetic patients from the cross-sectional Environmental Pollutant Exposure and Metabolic Diseases in Shanghai (METAL) study were enrolled. The hypertriglyceridemic-waist (HTGW) phenotype was defined as the presence of an elevated waist circumference (WC) and elevated triglyceride (TG) concentration. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2 or urinary albumin creatinine ratio (uACR) more than 30 mg/g. Linear and multiple logistic regression models were used for measuring the association between HTGW phenotype and chronic kidney disease. RESULTS The prevalence of CKD was 29% and 35.8% in total participants and participants with HTGW phenotype, respectively. Subjects in the HTGW phenotype group were more likely to have CKD (OR 1.47, 95% CI: 1.11, 1.95) compared with subjects in the normal waist circumference and normal triglycerides (NTNW) group. HTGW phenotype was both associated with the increasing risk of decreased eGFR (OR 1.31, 95% CI: 1.02, 1.75) and elevated uACR (OR 1.57, 95% CI: 1.18, 2.11). Furthermore, the stratified analysis showed that the strongest positive association between HTGW phenotype and CKD presence was found in the subgroup of presence of hypertension. The associations were all fully adjusted for age, sex, BMI, current smoking, current drinking and other confounding factors. CONCLUSION Our study suggested a positive association between the HTGW phenotype and CKD in Chinese type 2 diabetes patients. Further prospective studies are needed to confirm our findings and to investigate the underlying biological mechanisms.
Collapse
Affiliation(s)
- Yan Xuan
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Department of Endocrinology, Luwan Branch, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200020, People’s Republic of China
| | - Wen Zhang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Yuying Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Bin Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Yi Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Fangzhen Xia
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Kun Zhang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Qing Li
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Ningjian Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Yingli Lu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Correspondence: Yingli Lu, Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, People’s Republic of China, Tel +86-13636352507, Fax +86-21-63136856, Email
| |
Collapse
|
26
|
Rinne AG, Sorensen CA, Lima SL, Gil MG, Mena NN, Martín LD, Ramírez A, Morales A, Vega N, Gallego E, Izquierdo EM, Cabello E, Rodríguez AER, González JP, Escamilla B, Cruz C, Tamajón LP, Ramírez AT, Gaspari F, Ortiz A, Porrini E. OUP accepted manuscript. Clin Kidney J 2022; 15:885-894. [PMID: 35498883 PMCID: PMC9050540 DOI: 10.1093/ckj/sfab220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Indexed: 11/22/2022] Open
Abstract
Background In living kidney transplantation there are two different individuals, a healthy donor and a renal transplant recipient. This is an excellent human model to study factors that influence kidney function in the context of reduced renal mass and the adaptation of two comparable kidneys to different metabolic demands. Methods We analyzed the changes in measured glomerular filtration rate (GFR, iohexol) from pretransplantation to 12 months after transplantation in 30 donor–recipient pairs. Each donor was compared with his/her recipient. We defined a priori three different groups based on GFR differences at 12 months: donor > recipient (Group A; 78 ± 8 versus 57 ± 8 mL/min), donor < recipient (Group B; 65 ± 11 versus 79 ± 11 mL/min) and donor ≈ recipient (Group C; 66 ± 7 versus 67 ± 7 mL/min). Other factors like donor/recipient mismatches in body mass index (BMI), surface area and gender were evaluated. Results In Group A donors were mostly male and recipients were female (75% each). Donors had a higher baseline weight than their recipients. During follow-up, weight remained stable in donors but increased 7% in recipients. In Group B donors were mostly female (60%) and recipients male. At baseline, donors had a lower weight than recipients. At 12 months, weight was stable in donors but increased in recipients. In Group C donors were mostly (75%) female and recipients male. At baseline, donors had a higher BMI than their recipients. At 12 months, BMI was stable in donors but increased 14% in recipients. In multivariable analysis, higher GFR at 12 months was associated with higher baseline weight and GFR in donors and with male gender and higher baseline weight in recipients. Conclusions Kidneys from living donors are more ‘plastic’ than originally thought and respond to metabolic demands and weight changes of their new host. These changes should be taken into account when assessing GFR outcomes in this population.
Collapse
Affiliation(s)
- Ana González Rinne
- Department of Nephrology, University Hospital of the Canary Islands, Tenerife, Spain
| | | | - Sergio Luis Lima
- IIS-Fundación Jiménez Diaz, Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Marta Gómez Gil
- Radiology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - Natalia Negrín Mena
- Research Unit Department, Unidad de Investigación Clínica y Ensayos Clínicos, Hospital Universitario de Canarias, Tenerife, Spain
- LFR Laboratorio de Función Renal, Universidad de La Laguna, Tenerife, Spain
| | - Laura Díaz Martín
- Research Unit Department, Unidad de Investigación Clínica y Ensayos Clínicos, Hospital Universitario de Canarias, Tenerife, Spain
- LFR Laboratorio de Función Renal, Universidad de La Laguna, Tenerife, Spain
| | - Ana Ramírez
- Nephrology Department, Hospital Universitario Insular, Las Palmas de Gran Canaria, Spain
| | - Adelaida Morales
- Nephrology Department, Hospital General de Lanzarote, Arrecife, Spain
| | - Nicanor Vega
- Nephrology Department, Hospital Universitario Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Eduardo Gallego
- Nephrology Department, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
| | | | - Elisa Cabello
- Nephrology Department, Hospital General de La Palma, Santa Cruz de La Palma, Spain
| | | | | | - Beatriz Escamilla
- Department of Nephrology, University Hospital of the Canary Islands, Tenerife, Spain
| | - Coriolano Cruz
- Research Unit Department, Unidad de Investigación Clínica y Ensayos Clínicos, Hospital Universitario de Canarias, Tenerife, Spain
- LFR Laboratorio de Función Renal, Universidad de La Laguna, Tenerife, Spain
| | - Lourdes Pérez Tamajón
- Department of Nephrology, University Hospital of the Canary Islands, Tenerife, Spain
| | - Armando Torres Ramírez
- Department of Nephrology, University Hospital of the Canary Islands, Tenerife, Spain
- Internal Medicine Department, Universidad de La Laguna, ITB Instituto de Tecnologías Biomédicas, Tenerife, Spain
| | - Flavio Gaspari
- LFR Laboratorio de Función Renal, Universidad de La Laguna, Tenerife, Spain
| | - Alberto Ortiz
- IIS-Fundación Jiménez Diaz, Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Red de Investigación Renal, Instituto Carlos III-FEDER, Madrid, Spain
| | | |
Collapse
|
27
|
Han KY, Gu J, Wang Z, Liu J, Zou S, Yang CX, Liu D, Xu Y. Association Between METS-IR and Prehypertension or Hypertension Among Normoglycemia Subjects in Japan: A Retrospective Study. Front Endocrinol (Lausanne) 2022; 13:851338. [PMID: 35370984 PMCID: PMC8971288 DOI: 10.3389/fendo.2022.851338] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 02/21/2022] [Indexed: 12/19/2022] Open
Abstract
AIM Our study aimed to investigate the association between the novel non-insulin-based metabolic score for insulin resistance (METS-IR) index and pre-hypertension (HTN) or HTN in normoglycemia Japanese participants. METHODS The NAGALA medical examination program at Murakami Memorial Hospital in Gifu, Japan was found in 1994. 15,453 participants enrolled in this program from 2004 to 2015 was included in this retrospective study to explore the association between the METS-IR index and pre-HTN or HTN. Covariates included serum biomarkers and clinicodemographic characteristics. Logistic regression was applied to explore the association between METS-IR level and pre-HTN or HTN. RESULTS This study includes a total of 15453 participants. The prevalence rates of pre-HTN and HTN were 28.55% (4412/15453) and 6.23% (962/15453), respectively. Adjusted for confounding factors in the multivariable logistic regression analysis models, when METS-IR was used as a categorical variable, high METS-IR was significantly associated with both pre-HTN (adjusted odds ratio (OR) = 1.95, 95% confidence interval (CI): 1.61-2.36) and HTN (adjusted OR = 2.12, 95% CI: 1.44-3.11). When METS-IR was used as a continuous variable, each 1 unit increase in METS-IR was associated with a 7% increase in the prevalence of pre-HTN (adjusted OR = 1.07, 95% CI: 1.06-1.08) and with a 13% increase in the prevalence of HTN (adjusted OR = 1.13, 95% CI: 1.10-1.16). Stratified analyses indicated a positive correlation between METS-IR and pre-HTN or HTN in normoglycemia subjects with different characteristics. CONCLUSIONS METS-IR levels are significantly associated with pre-HTN or HTN in normoglycemia individuals in Gifu, Japan. METS-IR may be used as a monitoring indicator for the development of HTN primary prevention and management strategies in the future, but it still needs more research to confirm.
Collapse
Affiliation(s)
- Kai-Yue Han
- Department of Cardiology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Jianing Gu
- Department of Cardiology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Zhangsheng Wang
- Department of Cardiology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Jie Liu
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Su Zou
- Department of Cardiology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Chen-Xi Yang
- Department of Cardiology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Dan Liu
- Department of Cardiology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Yingjia Xu
- Department of Cardiology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
- *Correspondence: Yingjia Xu,
| |
Collapse
|
28
|
Kotsis V, Martinez F, Trakatelli C, Redon J. Impact of Obesity in Kidney Diseases. Nutrients 2021; 13:nu13124482. [PMID: 34960033 PMCID: PMC8703549 DOI: 10.3390/nu13124482] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/10/2021] [Accepted: 12/10/2021] [Indexed: 01/14/2023] Open
Abstract
The clinical consequences of obesity on the kidneys, with or without metabolic abnormalities, involve both renal function and structures. The mechanisms linking obesity and renal damage are well understood, including several effector mechanisms with interconnected pathways. Higher prevalence of urinary albumin excretion, sub-nephrotic syndrome, nephrolithiasis, increased risk of developing CKD, and progression to ESKD have been identified as being associated with obesity and having a relevant clinical impact. Moreover, renal replacement therapy and kidney transplantation are also influenced by obesity. Losing weight is key in limiting the impact that obesity produces on the kidneys by reducing albuminuria/proteinuria, declining rate of eGFR deterioration, delaying the development of CKD and ESKD, and improving the outcome of a renal transplant. Weight reduction may also contribute to appropriate control of cardiometabolic risk factors such as hypertension, metabolic syndrome, diabetes, and dyslipidemia which may be protective not only in renal damage but also cardiovascular disease. Lifestyle changes, some drugs, and bariatric surgery have demonstrated the benefits.
Collapse
Affiliation(s)
- Vasilios Kotsis
- 3rd Department of Internal Medicine, Hypertension-24h ABPM ESH Center of Excellence, Papageorgiou Hospital, Aristotle University of Thessaloniki, 564 29 Pavlos Melas, Greece; (V.K.); (C.T.)
| | - Fernando Martinez
- Internal Medicine Hospital Clínico de Valencia, 46010 Valencia, Spain;
| | - Christina Trakatelli
- 3rd Department of Internal Medicine, Hypertension-24h ABPM ESH Center of Excellence, Papageorgiou Hospital, Aristotle University of Thessaloniki, 564 29 Pavlos Melas, Greece; (V.K.); (C.T.)
| | - Josep Redon
- Internal Medicine Hospital Clínico de Valencia, 46010 Valencia, Spain;
- Cardiovascular and Renal Research Group, INCLIVA Research Institute, University of Valencia, 46010 Valencia, Spain
- CIBERObn Carlos III Institute, 28029 Madrid, Spain
- Correspondence:
| |
Collapse
|
29
|
Cao X, Yang B, Zhou J. Scoring model to predict risk of chronic kidney disease in Chinese health screening examinees with type 2 diabetes. Int Urol Nephrol 2021; 54:1629-1639. [PMID: 34724145 PMCID: PMC9184348 DOI: 10.1007/s11255-021-03045-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/24/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE As health screening continues to increase in China, there is an opportunity to integrate a large number of demographic as well as subjective and objective clinical data into risk prediction modeling. The aim of this study was to develop and validate a prediction model for chronic kidney disease (CKD) in Chinese health screening examinees with type 2 diabetes mellitus (T2DM). METHODS We conducted a retrospective cohort study consisting of 2051 Chinese T2DM patients between 35 and 78 years old who were enrolled in the XY3CKD Follow-up Program between 2009 and 2010. All participants were randomly assigned into a derivation set or a validation set at a 2:1 ratio. Cox proportional hazards regression model was selected for the analysis of risk factors for the development of the proposed risk model of CKD. We established a prediction model with a scoring system following the steps proposed by the Framingham Heart Study. RESULTS The mean follow-up was 8.52 years, with a total of 315 (23.20%) and 189 (27.27%) incident CKD cases in the derivation set and validation set, respectively. We identified the following risk factors: age, gender, body mass index, duration of type 2 diabetes, variation of fasting blood glucose, stroke, and hypertension. The points were summed to obtain individual scores (from 0 to 15). The areas under the curve of 3-, 5- and 10-year CKD risks were 0.843, 0.799 and 0.780 in the derivation set and 0.871, 0.803 and 0.785 in the validation set, respectively. CONCLUSIONS The proposed scoring system is a promising tool for further application of assisting Chinese medical staff for early prevention of T2DM complications among health screening examinees.
Collapse
Affiliation(s)
- Xia Cao
- Department of Health Management, Health Management Research Center of Central South University, The Third Xiangya Hospital, Central South University, Changsha, 410013 Hunan Province China
| | - Binfang Yang
- Department of Health Management, Health Management Research Center of Central South University, The Third Xiangya Hospital, Central South University, Changsha, 410013 Hunan Province China
| | - Jiansong Zhou
- Department of Psychiatry & Mental Health Institute, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province China
| |
Collapse
|
30
|
Ciardullo S, Ballabeni C, Trevisan R, Perseghin G. Metabolic Syndrome, and Not Obesity, Is Associated with Chronic Kidney Disease. Am J Nephrol 2021; 52:666-672. [PMID: 34569517 DOI: 10.1159/000518111] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/24/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Obese (OB) patients are at increased risk of chronic kidney disease, but it is still unclear whether this can be attributed to obesity per se or to the associated metabolic derangements. The aim of this study was to evaluate the relative impact of obesity and metabolic syndrome (MS) on kidney disease. METHODS This is a cross-sectional study based on data obtained in the 2005-2016 cycles of the National Health and Nutrition Examination Survey. We included all adult participants with available data on body mass index, estimated glomerular filtration rate (eGFR), urine albumin to creatinine ratio (UACR), and each of the MS components. Primary outcomes were eGFR <60 mL/min, UACR ≥30 mg/g, or a combination of the two. RESULTS The studied population comprised 12,335 participants. OB participants without MS (OB+ MS-) were younger and more commonly female. After adjustment for potential confounders, compared with OB- MS- participants, an increased prevalence of albuminuria and reduced eGFR were present in both OB- MS+ groups and the OB+ MS+ groups, but not in the OB+ MS- groups. When each of the MS components was evaluated separately, elevated blood pressure and low high-density lipoprotein cholesterol were associated with both UACR and reduced eGFR, while elevated blood glucose and triglycerides were only associated with UACR. Waist circumference was not associated with any of the renal outcomes. DISCUSSION/CONCLUSION This large cross-sectional study suggests that MS and not obesity is associated with kidney damage and that the OB+ MS- phenotype does not seem to carry an increased risk of kidney disease.
Collapse
Affiliation(s)
- Stefano Ciardullo
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | | | - Roberto Trevisan
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
- Endocrinology and Diabetes Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Gianluca Perseghin
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| |
Collapse
|
31
|
Rodríguez-Rodríguez AE, Donate-Correa J, Luis-Lima S, Díaz-Martín L, Rodríguez-González C, Pérez-Pérez JA, Acosta-González NG, Fumero C, Navarro-Díaz M, López-Álvarez D, Villacampa-Jiménez J, Navarro-González JA, Ortiz A, Porrini E. Obesity and metabolic syndrome induce hyperfiltration, glomerulomegaly, and albuminuria in obese ovariectomized female mice and obese male mice. Menopause 2021; 28:1296-1306. [PMID: 34581293 DOI: 10.1097/gme.0000000000001842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Obese patients with metabolic syndrome have a high risk of chronic kidney disease. The prevalence of obesity, metabolic syndrome, and insulin resistance increase in women after menopause, as does the risk of chronic kidney disease. This may indicate an interaction between obesity, metabolic syndrome, and menopause in the induction of renal damage. However, the pathogenesis of kidney disease in postmenopausal obese women is poorly understood. METHODS We investigated the interaction of an obesogenic diet and menopause on renal dysfunction in ovariectomized and non-ovariectomized lean (n = 8 and 17) and obese (n = 12 and 20) female mice. Obese (n = 12) and lean (n = 10) male mice were also studied. Glucose metabolism, insulin resistance, and kidney function were evaluated with gold standards procedures. Changes in kidney histology and lipid deposition were analyzed. Females had a lower number of glomeruli than males at baseline. RESULTS Only female ovariectomized obese animals developed insulin resistance, hyperglycemia, and kidney damage, evidenced as glomerulomegaly, glomerular hyperfiltration, and increased urinary albumin excretion, despite a similar increase in weight than obese non-ovariectomized female mice. Male obese mice developed hyperglycemia, insulin resistance, and hyperfiltration without major renal histological changes. Males on high fat diet showed higher renal lipid content and females on high fat diet (ovariectomized or non-ovariectomized) showed higher total cholesterol content than males. CONCLUSIONS In mice, there is a clear interplay between obesity, metabolic syndrome, and menopause in the induction of kidney damage.
Collapse
Affiliation(s)
- Ana Elena Rodríguez-Rodríguez
- Research Unit, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
- Fundacion General de la Universidad, University of La Laguna, Tenerife, Spain
| | - Javier Donate-Correa
- Research Unit, Hospital Universitario de Nuestra Señora de La Candelaria, La Laguna, Tenerife, Spain
- GEENDIAB (Grupo Español para el Estudio de la Nefropatía Diabética), Sociedad Española de Nefrología, Santander, Spain
| | - Sergio Luis-Lima
- Department of Nephology and Hypertension, IIS-Fundación Jimenez Díaz, UAM, Madrid, Spain
| | - Laura Díaz-Martín
- Research Unit, Hospital Universitario de Canarias, FIISC (Fundación Canaria Investigación Sanitaria de Canarias), La Laguna, Tenerife, Spain
| | | | | | | | - Cecilia Fumero
- Research Unit, Hospital Universitario de Canarias, FIISC (Fundación Canaria Investigación Sanitaria de Canarias), La Laguna, Tenerife, Spain
| | | | | | | | | | - Alberto Ortiz
- GEENDIAB (Grupo Español para el Estudio de la Nefropatía Diabética), Sociedad Española de Nefrología, Santander, Spain
- Department of Nephology and Hypertension, IIS-Fundación Jimenez Díaz, UAM, Madrid, Spain
| | - Esteban Porrini
- Research Unit, Hospital Universitario de Canarias, University of La Laguna, Faculty of Medicine, Tenerife, Spain
- ITB (Instituto Tecnologías Biomédicas), University of La Laguna, Tenerife, Spain
| |
Collapse
|
32
|
Hashimoto Y, Hamaguchi M, Okamura T, Nakanishi N, Obora A, Kojima T, Fukui M. Metabolic associated fatty liver disease is a risk factor for chronic kidney disease. J Diabetes Investig 2021; 13:308-316. [PMID: 34561962 PMCID: PMC8847128 DOI: 10.1111/jdi.13678] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/13/2021] [Accepted: 09/21/2021] [Indexed: 12/13/2022] Open
Abstract
Background and Aims To clarify the relationship between metabolic dysfunction‐associated fatty liver disease (MAFLD) and chronic kidney disease (CKD). Methods The participants were divided into four groups by the presence or absence of fatty liver disease (FLD) and metabolic dysfunction (MD). MAFLD was defined as having both FLD and MD, whereas CKD was defined as having an estimated glomerular filtration rate of <60 mL/min/1.73 m2 and/or proteinuria. Results In this cross‐sectional study of 27,371 participants, the proportions of those in the non‐FLD without MD, non‐FLD with MD, FLD without MD, and MAFLD groups were 48.7, 28.2, 2.3, and 20.8%, respectively. Compared with non‐FLD without MD, MAFLD was associated with the risk of CKD (adjusted odds ratio 1.83 [1.66–2.01], P < 0.001), whereas FLD without MD was not (1.02 [0.79–1.33], P = 0.868). Moreover, compared with FLD without MD, MAFLD was associated with the risk of CKD (1.19 [1.09–1.31], P < 0.001). In this retrospective cohort study, 16,938 of 27,371 participants underwent a median 4.6 (2.0–8.1) years follow‐up, and incident data of non‐FLD without MD, non‐FLD with MD, FLD without MD, and MAFLD were 21.0, 31.1, 26.1, and 31.1 cases per 1,000 person‐years, respectively. Compared with the non‐FLD without MD, MAFLD was associated with the risk of incident CKD (adjusted hazard ratio 1.24 [1.14–1.36], P < 0.001), whereas FLD without MD was not (1.11 [0.85–1.41], P = 0.433). Conclusions MAFLD was associated with a risk of CKD, whereas FLD without MD was not a risk for CKD.
Collapse
Affiliation(s)
- Yoshitaka Hashimoto
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masahide Hamaguchi
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takuro Okamura
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Naoko Nakanishi
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akihiro Obora
- Department of Gastroenterology, Asahi University Hospital, Gifu, Japan
| | - Takao Kojima
- Department of Gastroenterology, Asahi University Hospital, Gifu, Japan
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| |
Collapse
|
33
|
Mun KH. Association Between Serum Albumin Levels and Obesity and Risk of Developing Chronic Kidney Disease Using Data from the Korean Multi-Rural Communities Cohort (MRCohort) Population Database. Med Sci Monit 2021; 27:e933840. [PMID: 34398870 PMCID: PMC8378222 DOI: 10.12659/msm.933840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background The Multi-Rural Communities Cohort (MRCohort) was established as part of the Korean Genome and Epidemiology Study, which identified risk factors for cardiovascular diseases in the population between January 2005 and December 2011. This was a prospective study, aimed to investigate the association between serum albumin levels and the risk of developing chronic kidney disease (CKD) in obese patients using data from the MRCohort population database. Material/Methods For analysis, we selected a total of 9695 people from the MRCohort from 2004 to 2013: 3105 people from Goryeong, 3183 from Yangpyeong, and 3407 from Namwon, without previous history of myocardial infarction, cerebrovascular disease, cancer, and CKD, or missing values on confounders. As a result, 2300 metabolically healthy participants were studied as a whole, and then by body mass index of >23 kg/m2. The groups were divided into 4 subgroups by albumin quartiles, and the effects of albumin levels compared to the lowest quartile were studied by Cox proportional hazard analysis, after adjusting for potential confounders. Results The results showed that the highest quartile of albumin, compared to the lowest quartile, was a protective factor of CKD development only in the overweight and obese group with adjusted hazard ratio (HR)=0.38 (95% confidence interval (CI) 0.16–0.95, p<0.05). In the normal-weight group, results were insignificant, with adjusted HR=0.54 (95% CI 0.24–1.25, not significant). Conclusions Data from the Korean MRCohort population database showed that obesity and increased serum albumin levels were protective factors for the development of CKD.
Collapse
Affiliation(s)
- Kwang Ho Mun
- Department of Infectious Disease Research, Armed Forces Medical Research Institute, Daejeon, South Korea
| |
Collapse
|
34
|
Wang J, Niratharakumar K, Gokhale K, Tahrani AA, Taverner T, Thomas GN, Dasgupta I. Obesity Without Metabolic Abnormality and Incident CKD: A Population-Based British Cohort Study. Am J Kidney Dis 2021; 79:24-35.e1. [PMID: 34146618 DOI: 10.1053/j.ajkd.2021.05.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/27/2021] [Indexed: 12/29/2022]
Abstract
RATIONALE & OBJECTIVE Metabolically healthy obesity (obesity without any metabolic abnormality) is not considered to be associated with increased risk of morbidity and mortality. We examined and quantified the association between metabolically healthy overweight/obesity and the risk of incident chronic kidney disease (CKD) in a British primary care population. STUDY DESIGN Retrospective population-based cohort study. SETTING & PARTICIPANTS 4,447,955 of the 5,182,908 adults in The Health Improvement Network (THIN) database (United Kingdom, 1995-2015) with a recorded body mass index (BMI) at the time of registration date who were free of CKD and cardiovascular disease. EXPOSURE 11 body size phenotypes were created, defined by BMI categories (underweight, normal weight, overweight, and obesity) and 3 metabolic abnormalities (diabetes, hypertension, and dyslipidemia). OUTCOME Incident CKD defined as a recorded code for kidney replacement therapy, a recorded diagnosis of CKD, or by an estimated glomerular filtration rate of<60mL/min/1.73m2 for≥90 days, or a urinary albumin-creatinine ratio>3mg/mmol for≥90 days. RESULTS Of the 4.5 million individuals, 1,040,921 (23.4%) and 588,909 (13.2%) had metabolically healthy overweight and metabolically healthy obesity, respectively. During a mean follow-up interval of 5.4±4.3 (SD) years, compared with individuals with a metabolically healthy normal weight (n=1,656,231), there was a higher risk of incident CKD among those who had metabolically healthy overweight (adjusted HR, 1.30 [95% CI, 1.28-1.33]) and metabolically healthy obesity (adjusted HR, 1.66 [95% CI, 1.62-1.70]). The association was stronger in those younger than 65 years of age. In all BMI categories, there was greater risk of incident CKD with a greater number of metabolic abnormalities in a graded manner. LIMITATIONS Potential misclassification of metabolic status due to delayed diagnosis and residual confounding due to unmeasured factors. CONCLUSIONS Overweight and obesity without metabolic abnormality are associated with a higher risk of incident CKD compared with those with normal body weight and no metabolic abnormality.
Collapse
Affiliation(s)
- Jingya Wang
- Institute of Applied Health Research, University of Birmingham, United Kingdom
| | | | - Krishna Gokhale
- Institute of Applied Health Research, University of Birmingham, United Kingdom
| | - Abd A Tahrani
- Institute of Applied Health Research, University of Birmingham, United Kingdom; Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Tom Taverner
- Institute of Applied Health Research, University of Birmingham, United Kingdom
| | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, United Kingdom.
| | - Indranil Dasgupta
- Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom
| |
Collapse
|
35
|
Martin-Taboada M, Vila-Bedmar R, Medina-Gómez G. From Obesity to Chronic Kidney Disease: How Can Adipose Tissue Affect Renal Function? Nephron Clin Pract 2021; 145:609-613. [PMID: 33882488 DOI: 10.1159/000515418] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/17/2021] [Indexed: 11/19/2022] Open
Abstract
Obesity is directly associated with an increased risk of developing CKD, regardless of other comorbid conditions. Although the molecular mechanisms that link both diseases are not well established, the role of adipose tissue (AT) is becoming increasingly important in obesity-associated kidney damage. In the context of obesity, lipotoxicity and the alteration of AT secretion profile promote inflammation, oxidative stress, and fibrosis in the kidney, which ultimately leads to impaired renal function. Different studies have highlighted the importance of body weight loss in the improvement of renal function markers. In this regard, bariatric surgery, rather than low-calorie diets, has been accepted as the most effective option to lose weight. In fact, a significant reduction in proteinuria and hyperfiltration has been observed in association with surgically induced weight loss. Detection of early signs of kidney dysfunction in patients with obesity has not been accomplished yet, though. Therefore, understanding the harmful effects within the adipo-renal axis is essential to prevent the progression to the irreversible renal insufficiency. MicroRNAs have recently been described as important modulators of normal kidney function. Some of these microRNAs could be potential early markers of kidney damage, which would help with the diagnosis and the prevention of CKD.
Collapse
Affiliation(s)
- Marina Martin-Taboada
- Departamento de Ciencias Básicas de la Salud, Área de Bioquímica y Biología Molecular, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain
| | - Rocío Vila-Bedmar
- Departamento de Ciencias Básicas de la Salud, Área de Bioquímica y Biología Molecular, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain
| | - Gema Medina-Gómez
- Departamento de Ciencias Básicas de la Salud, Área de Bioquímica y Biología Molecular, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain
| |
Collapse
|
36
|
Hasegawa Y, Takahashi F, Hashimoto Y, Munekawa C, Hosomi Y, Okamura T, Okada H, Senmaru T, Nakanishi N, Majima S, Ushigome E, Hamaguchi M, Yamazaki M, Fukui M. Effect of COVID-19 Pandemic on the Change in Skeletal Muscle Mass in Older Patients with Type 2 Diabetes: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084188. [PMID: 33920957 PMCID: PMC8071268 DOI: 10.3390/ijerph18084188] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/08/2021] [Accepted: 04/14/2021] [Indexed: 02/07/2023]
Abstract
Background: The aim of this study was to investigate the effect of the coronavirus disease (COVID-19) pandemic restrictions on the change in muscle mass in older patients with type 2 diabetes (T2D), who were not infected with COVID-19. Methods: In this retrospective cohort study, data were obtained from outpatients who underwent bioelectrical impedance analysis at least twice before April 2020 and at least once thereafter. Skeletal muscle mass index (SMI, kg/m2) was calculated as appendicular muscle mass (kg) divided by height squared (m2). Change in SMI (kg/m2/year) was calculated as (follow-up SMI-baseline SMI/follow-up period). The differences between the changes in SMI before and after the start of the COVID-19 pandemic were evaluated using paired t test. Results: This study recruited 56 patients, with a mean (SD) age of 75.2 (7.1) years. SMI changed from 6.7 (0.9) to 6.8 (0.9) kg/m2 before the COVID-19 pandemic, whereas SMI changed from 6.8 (0.9) to 6.6 (0.9) kg/m2 after the start of the COVID-19 pandemic. SMI decreased after the start of the COVID-19 pandemic compared with before the pandemic (-0.117 (0.240) vs. 0.005 (0.289) kg/m2/year, p = 0.049). This decrease was observed in men (-0.159 (0.257) vs. 0.031 (0.325) kg/m2/year, p = 0.038), patients with poor glycemic control (-0.170 (0.264) vs. 0.031 (0.285) kg/m2/year, p = 0.042), and those with a long diabetes duration (-0.153 (0.229) vs. 0.082 (0.291) kg/m2, p = 0.049). Conclusions: The COVID-19 pandemic restrictions caused muscle mass loss in older patents with T2D. Actions, including recommendation of exercise and adequate diet intake, are needed to prevent loss of muscle mass.
Collapse
|
37
|
Bennouar S, Bachir Cherif A, Temmar M, Fauvel JP, Bouafia MT, Abdi S. Combined effect of obesity and metabolic profile on glomerular dysfunction in hypertensive subjects. Nephrology (Carlton) 2021; 26:578-585. [PMID: 33634933 DOI: 10.1111/nep.13868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/07/2021] [Accepted: 02/19/2021] [Indexed: 11/26/2022]
Abstract
AIM The aim of this study is to explore the individual and combined effects of obesity and metabolic profile on the impairment of glomerular function among hypertensive subjects. METHODS This is a cross-sectional study enrolling 499 hypertensive subjects. Based on body mass index values and metabolic profile, they were assigned to one of four metabolic phenotype groups: MHNO: metabolically healthy non-obese, MHO: metabolically healthy but obese, MUHNO: metabolically unhealthy but non-obese, and MUHO: metabolically unhealthy and obese. The effect of the interaction between obesity and metabolic profile was tested on an additive scale, for both microalbuminuria and reduced estimated glomerular filtration rate (eGFR). RESULTS After adjustment for confounding factors, the highest risk of both microalbuminuria and decreased eGFR was found among patients of the MUHO group (OR = 6.0 [2.13], p < 0.0001, OR = 5.4 [1.26], p = 0.03, respectively). Analysis of the additive interaction indicates that 51% and 53% of the risk of microalbuminuria and its combination with low eGFR respectively is explained by the co-occurrence of obesity and metabolic disorder. The mechanism of this interaction is synergistic (synergy index = 2.6, [1.5.3]). CONCLUSION The decline of glomerular function in hypertensive subjects is significantly exacerbated by the interaction between obesity and metabolic disorders. The management of such high-risk subjects requires, in addition to the therapeutic regimen, an adequate dietary and physical program in order to preserve glomerular function.
Collapse
Affiliation(s)
- Salam Bennouar
- Central Laboratory of Clinical Biology, University Hospital Center of Blida, Blida, Algeria
| | - Abdelghani Bachir Cherif
- Department of Internal Medicine and Cardiology, University Hospital Center of Blida, Blida, Algeria
| | - Mohamed Temmar
- Department of Internal Medicine and Cardiology, University Hospital Center of Blida, Blida, Algeria
| | - Jean-Pierre Fauvel
- Department of Nephrology-Hypertension, Claude Bernard University, Lyon, France
| | - Mohamed Tahar Bouafia
- Department of Internal Medicine and Cardiology, University Hospital Center of Blida, Blida, Algeria
| | - Samia Abdi
- Central Laboratory of Clinical Biology, University Hospital Center of Blida, Blida, Algeria
| |
Collapse
|
38
|
Sandino J, Luzardo L, Morales E, Praga M. Which Patients with Obesity Are at Risk for Renal Disease? Nephron Clin Pract 2021; 145:595-603. [PMID: 33677441 DOI: 10.1159/000513868] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/16/2020] [Indexed: 11/19/2022] Open
Abstract
Obesity-related glomerulopathy (ORG) is an increasingly recognized cause of end-stage kidney disease. The most common clinical presentation is a slowly increasing nonnephrotic proteinuria that is followed by a progressive decline of kidney function. Key histological findings are glomerulomegaly and lesions of focal and segmental glomerulosclerosis. A central pathogenic mechanism is the increased sodium reabsorption by proximal tubules that typically accompanies obesity. This causes a decrease in the offer of sodium to the macula densa in the distal nephron, which results in a vasodilation of afferent glomerular arterioles and glomerular hyperfiltration. From a clinical point of view, it is essential to differentiate focal segmental glomerulosclerosis secondary to obesity from primary glomerular processes, which requires a careful differential diagnosis. Diet-induced weight loss, bariatric surgery, and renin-angiotensin blockers are the fundamental therapeutic measures in ORG. The recently developed sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 agonist represent a significant advance in renal protection and will probably improve clinical kidney outcomes in ORG.
Collapse
Affiliation(s)
- Justo Sandino
- Department of Nephrology, University Hospital "12 de Octubre", Madrid, Spain
| | - Leonella Luzardo
- Nephrology Center, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Enrique Morales
- Department of Nephrology, University Hospital "12 de Octubre", Madrid, Spain, .,Research Institute of University Hospital "12 de Octubre" (imas12), Madrid, Spain, .,Department of Medicine, Complutense University of Madrid, Madrid, Spain,
| | - Manuel Praga
- Department of Nephrology, University Hospital "12 de Octubre", Madrid, Spain.,Research Institute of University Hospital "12 de Octubre" (imas12), Madrid, Spain.,Department of Medicine, Complutense University of Madrid, Madrid, Spain
| |
Collapse
|
39
|
Pinto KRD, Feckinghaus CM, Hirakata VN. Obesity as a predictive factor for chronic kidney disease in adults: systematic review and meta-analysis. ACTA ACUST UNITED AC 2021; 54:e10022. [PMID: 33656052 PMCID: PMC7917711 DOI: 10.1590/1414-431x202010022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 11/12/2020] [Indexed: 01/08/2023]
Abstract
Chronic kidney disease (CKD) is one of the main chronic diseases affecting the world population due to its high prevalence and increasing morbidity. Similarly, obesity gained the interest of the scientific community as it directly or indirectly increases mortality from cardiovascular causes, and its prevalence characterizes a pandemic. The objective of this study was to investigate obesity measured by body mass index as a predictor for end-stage renal disease in the general adult population. A systematic review and meta-analysis was carried out by searching 10 databases for prospective or retrospective cohort studies, with no restrictions on the language of publication, including adults with obesity without previous renal disease and who evolved to CKD (diagnosed by estimated glomerular filtration rate below 60 mL&mac_middot;min-1&mac_middot;(1.73 m2)-1 over the follow-up period. The R software and Meta package were used for data analysis. After removing duplicates, 5431 studies were submitted to the steps of the systematic review, and 21 articles were included in the data analysis. In total, 3,504,303 patients, 521,216 with obesity, and an average follow-up time of 9.86 years were included. The relative risk of obese people for developing CKD in the random effects model was 1.81 (95%CI: 1.52-2.16). The evidence found in this meta-analysis confirmed that obese people are at higher risk of developing CKD that the non-obese population (1.81 times higher), with obesity being a priority risk factor in preventive actions.
Collapse
Affiliation(s)
- K R D Pinto
- Complexo Hospital de Clínicas da Universidade Federal do Paraná, Universidade Federal do Paraná, Curitiba, PR, Brasil
| | - C M Feckinghaus
- Complexo Hospital de Clínicas da Universidade Federal do Paraná, Universidade Federal do Paraná, Curitiba, PR, Brasil
| | - V N Hirakata
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| |
Collapse
|
40
|
Adair KE, von Waaden N, Rafalski M, Hess BW, Weaver SP, Bowden RG. Metabolic Phenotypes and Chronic Kidney Disease: A Cross-Sectional Assessment of Patients from a Large Federally Qualified Health Center. Life (Basel) 2021; 11:life11020175. [PMID: 33672432 PMCID: PMC7926935 DOI: 10.3390/life11020175] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/19/2021] [Accepted: 02/20/2021] [Indexed: 01/10/2023] Open
Abstract
The purpose of this study is to determine if renal function varies by metabolic phenotype. A total of 9599 patients from a large Federally Qualified Health Center (FQHC) were included in the analysis. Metabolic health was classified as the absence of metabolic abnormalities defined by the National Cholesterol Education Program Adult Treatment Panel III criteria, excluding waist circumference. Obesity was defined as body mass index >30 kg/m2 and renal health as an estimated glomerular filtration rate (eGFR) >60 mL/min/1.73 m2. Linear and logistic regressions were used to analyze the data. The metabolically healthy overweight (MHO) phenotype had the highest eGFR (104.86 ± 28.76 mL/min/1.72 m2) and lowest unadjusted odds of chronic kidney disease (CKD) (OR = 0.46, 95%CI = 0.168, 1.267, p = 0.133), while the metabolically unhealthy normal weight (MUN) phenotype demonstrated the lowest eGFR (91.34 ± 33.28 mL/min/1.72 m2) and the highest unadjusted odds of CKD (OR = 3.63, p < 0.0001). After controlling for age, sex, and smoking status, the metabolically unhealthy obese (MUO) (OR = 1.80, 95%CI = 1.08, 3.00, p = 0.024) was the only phenotype with significantly higher odds of CKD as compared to the reference. We demonstrate that the metabolically unhealthy phenotypes have the highest odds of CKD compared to metabolically healthy individuals.
Collapse
Affiliation(s)
- Kathleen E. Adair
- Department of Health, Human Performance, and Recreation, Baylor University, Waco, TX 76798, USA;
- Correspondence: (K.E.A.); (R.G.B.); Tel.: +1-254-710-6111 (R.G.B.)
| | - Nicholas von Waaden
- Department of Health, Human Performance, and Recreation, Baylor University, Waco, TX 76798, USA;
| | - Matthew Rafalski
- Family Health Center, Waco, TX 76707, USA; (M.R.); (B.W.H.); (S.P.W.)
| | - Burritt W. Hess
- Family Health Center, Waco, TX 76707, USA; (M.R.); (B.W.H.); (S.P.W.)
| | - Sally P. Weaver
- Family Health Center, Waco, TX 76707, USA; (M.R.); (B.W.H.); (S.P.W.)
| | - Rodney G. Bowden
- Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76798, USA
- Correspondence: (K.E.A.); (R.G.B.); Tel.: +1-254-710-6111 (R.G.B.)
| |
Collapse
|
41
|
Lee HJ, Mariappan MM, Norton L, Bakewell T, Feliers D, Oh SB, Donati A, Rubannelsonkumar CS, Venkatachalam MA, Harris SE, Rubera I, Tauc M, Ghosh Choudhury G, Kahn CR, Sharma K, DeFronzo RA, Kasinath BS. Proximal tubular epithelial insulin receptor mediates high-fat diet-induced kidney injury. JCI Insight 2021; 6:143619. [PMID: 33400689 PMCID: PMC7934847 DOI: 10.1172/jci.insight.143619] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/29/2020] [Indexed: 01/04/2023] Open
Abstract
The role of insulin receptor (IR) activated by hyperinsulinemia in obesity-induced kidney injury is not well understood. We hypothesized that activation of kidney proximal tubule epithelial IR contributes to obesity-induced kidney injury. We administered normal-fat diet (NFD) or high-fat diet (HFD) to control and kidney proximal tubule IR–knockout (KPTIRKO) mice for 4 months. Renal cortical IR expression was decreased by 60% in male and female KPTIRKO mice. Baseline serum glucose, serum creatinine, and the ratio of urinary albumin to creatinine (ACR) were similar in KPTIRKO mice compared to those of controls. On HFD, weight gain and increase in serum cholesterol were similar in control and KPTIRKO mice; blood glucose did not change. HFD increased the following parameters in the male control mice: renal cortical contents of phosphorylated IR and Akt, matrix proteins, urinary ACR, urinary kidney injury molecule-1–to-creatinine ratio, and systolic blood pressure. Renal cortical generation of hydrogen sulfide was reduced in HFD-fed male control mice. All of these parameters were ameliorated in male KPTIRKO mice. Interestingly, female mice were resistant to HFD-induced kidney injury in both genotypes. We conclude that HFD-induced kidney injury requires renal proximal tubule IR activation in male mice.
Collapse
Affiliation(s)
- Hak Joo Lee
- Center for Renal Medicine, Division of Nephrology
| | | | - Luke Norton
- Division of Diabetes, Department of Medicine
| | | | | | - Sae Byeol Oh
- Center for Renal Medicine, Division of Nephrology
| | | | | | | | - Stephen E Harris
- Department of Periodontics, University of Texas Health, San Antonio, Texas, USA
| | - Isabelle Rubera
- Universite Cote d'Azur, CNRS - UMR-7370, Laboratoire de Physiomédecine Moléculaire, Nice, France
| | - Michel Tauc
- Universite Cote d'Azur, CNRS - UMR-7370, Laboratoire de Physiomédecine Moléculaire, Nice, France
| | - Goutam Ghosh Choudhury
- Center for Renal Medicine, Division of Nephrology.,VA Research and.,Geriatric Research, Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - C Ronald Kahn
- Joslin Diabetes Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Kumar Sharma
- Center for Renal Medicine, Division of Nephrology.,VA Research and
| | | | - Balakuntalam S Kasinath
- Center for Renal Medicine, Division of Nephrology.,VA Research and.,Geriatric Research, Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas, USA
| |
Collapse
|
42
|
Cai XT, Ji LW, Liu SS, Wang MR, Heizhati M, Li NF. Derivation and Validation of a Prediction Model for Predicting the 5-Year Incidence of Type 2 Diabetes in Non-Obese Adults: A Population-Based Cohort Study. Diabetes Metab Syndr Obes 2021; 14:2087-2101. [PMID: 34007195 PMCID: PMC8123981 DOI: 10.2147/dmso.s304994] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/28/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The aim of this study was to derivate and validate a nomogram based on independent predictors to better evaluate the 5-year risk of T2D in non-obese adults. PATIENTS AND METHODS This is a historical cohort study from a collection of databases that included 12,940 non-obese participants without diabetes at baseline. All participants were randomised to a derivation cohort (n = 9651) and a validation cohort (n = 3289). In the derivation cohort, the least absolute shrinkage and selection operator (LASSO) regression model was used to determine the optimal risk factors for T2D. Multivariate Cox regression analysis was used to establish the nomogram of T2D prediction. The receiver operating characteristic (ROC) curve, C-index, calibration curve, and decision curve analysis were performed by 1000 bootstrap resamplings to evaluate the discrimination ability, calibration, and clinical practicability of the nomogram. RESULTS After LASSO regression analysis of the derivation cohort, it was found that age, fatty liver, γ-glutamyltranspeptidase, triglycerides, glycosylated hemoglobin A1c and fasting plasma glucose were risk predictors, which were integrated into the nomogram. The C-index of derivation cohort and validation cohort were 0.906 [95% confidence interval (CI), 0.878-0.934] and 0.837 (95% CI, 0.760-0.914), respectively. The AUC of 5-year T2D risk in the derivation cohort and validation cohort was 0.916 (95% CI, 0.889-0.943) and 0.829 (95% CI, 0.753-0.905), respectively. The calibration curve indicated that the predicted probability of nomogram is in good agreement with the actual probability. The decision curve analysis demonstrated that the predicted nomogram was clinically useful. CONCLUSION Our nomogram can be used as a reasonable, affordable, simple, and widely implemented tool to predict the 5-year risk of T2D in non-obese adults. With this model, early identification of high-risk individuals is helpful to timely intervene and reduce the risk of T2D in non-obese adults.
Collapse
Affiliation(s)
- Xin-Tian Cai
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, People’s Republic of China
| | - Li-Wei Ji
- Laboratory of Mitochondrial and Metabolism, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, People’s Republic of China
| | - Sha-Sha Liu
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, People’s Republic of China
| | - Meng-Ru Wang
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, People’s Republic of China
| | - Mulalibieke Heizhati
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, People’s Republic of China
| | - Nan-Fang Li
- Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, People’s Republic of China
- Correspondence: Nan-Fang Li Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, Xinjiang, People’s Republic of ChinaTel +86 991 8564818 Email
| |
Collapse
|
43
|
Zou S, Yang C, Shen R, Wei X, Gong J, Pan Y, Lv Y, Xu Y. Association Between the Triglyceride-Glucose Index and the Incidence of Diabetes in People With Different Phenotypes of Obesity: A Retrospective Study. Front Endocrinol (Lausanne) 2021; 12:784616. [PMID: 34956095 PMCID: PMC8695922 DOI: 10.3389/fendo.2021.784616] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/10/2021] [Indexed: 12/14/2022] Open
Abstract
AIM We aimed to examine the relationship between the Triglyceride-glucose (TyG) index and the incidence of type 2 diabetes in people with different phenotypes of obesity. METHODS From May 1, 1994 to December 31, 2016, 15,464 participants were enrolled in the medical examination program at the Murakami Memorial Hospital to determine the relationship between the TyG index and the incidence of type 2 diabetes in people with different phenotypes of obesity after 5.38 years of follow-up. RESULTS Besides triglycerides, HbA1c%, and FPG, the incidence of type 2 diabetes was found to be significantly associated with the TyG index (p <0.001), age (p <0.001), BMI (p = 0.033), current smoker (p <0.001), and fatty liver (p <0.001). In participants with visceral fat obesity and/or ectopic fat obesity and normal BMI, the TyG index was significantly associated with the incidence of type 2 diabetes after adjusting for confounding factors. In patients with BMI ≥25 mg/m2, although there was a trend of the relationship between the TyG index and the incidence of type 2 diabetes, the relationship was no longer positive. CONCLUSION In participants with obesity involving visceral fat obesity and/or fatty liver and normal BMI which is not a measure of body fat distribution, there was a significant association between the TyG index and incidence of T2DM.
Collapse
|
44
|
Wang Y, Sun B, Sheng LT, Pan XF, Zhou Y, Zhu J, Li X, Yang K, Guo K, Zhang X, He M, Yang H, Wu T, Pan A. Association between weight status, metabolic syndrome, and chronic kidney disease among middle-aged and elderly Chinese. Nutr Metab Cardiovasc Dis 2020; 30:2017-2026. [PMID: 32826134 DOI: 10.1016/j.numecd.2020.06.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS Obesity often initiates or coexists with certain metabolic abnormalities. This study sought to examine the independent and joint relations of weight and metabolic syndrome (MetS) with incident chronic kidney disease (CKD) among Chinese elderly people. METHODS AND RESULTS A total of 15,229 participants (mean age: 62.8 years) from the Dongfeng-Tongji cohort with complete baseline questionnaire and medical examination data were followed from 2008 to 2010 to 2013. All participants were categorized into four phenotypes: metabolically healthy non-overweight/obesity (MHNO), metabolically healthy overweight/obesity (MHO), metabolically unhealthy non-overweight/obesity (MUNO), metabolically unhealthy overweight/obesity (MUO). Multivariable-adjusted logistic regression models were applied to estimate the odds ratios (ORs) and confidence intervals (CIs) of four phenotypes with the risk of incident CKD, which was defined as estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2. A total of 1151 CKD cases were identified during a mean of 4.6-year follow-up. After adjusting for potential confounders, both overweight/obesity and MetS were associated with higher risk of CKD, and the ORs (95% CI) were 1.32 (1.15-1.52) and 1.50 (1.31-1.73), respectively. The risk of CKD was progressively higher in MHO (1.31, 1.09-1.57), MUNO (1.54, 1.22-1.93), and MUO (2.05, 1.73-2.42) as compared with MHNO phenotype, without significant multiplicative interaction between overweight/obesity and MetS (Pinteraction = 0.906). These associations were slightly stronger among those aged >60 years or with baseline diabetes. CONCLUSION Both overweight/obesity and MetS were associated with an increased risk of CKD. It is worth noting that MHO and MUNO also have an elevated risk. Maintaining both normal weight and healthy metabolic profile is recommended.
Collapse
Affiliation(s)
- Yi Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, PR China
| | - Bin Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, PR China
| | - Li-Ting Sheng
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, PR China
| | - Xiong-Fei Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, PR China; Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yanfeng Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, PR China
| | - Jiang Zhu
- Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan, Hubei Province, 442000, PR China
| | - Xiulou Li
- Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan, Hubei Province, 442000, PR China
| | - Kun Yang
- Department of Endocrinology, Affiliated Dongfeng Hospital, Hubei University of Medicine, Shiyan, Hubei Province, 442000, PR China
| | - Kunquan Guo
- Department of Endocrinology, Affiliated Dongfeng Hospital, Hubei University of Medicine, Shiyan, Hubei Province, 442000, PR China
| | - Xiaomin Zhang
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, PR China; Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, PR China
| | - Meian He
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, PR China; Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, PR China
| | - Handong Yang
- Sinopharm Dongfeng General Hospital, Hubei University of Medicine, Shiyan, Hubei Province, 442000, PR China
| | - Tangchun Wu
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, PR China; Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, PR China
| | - An Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, PR China.
| |
Collapse
|
45
|
Sponholtz TR, van den Heuvel ER, Xanthakis V, Vasan RS. Association of Variability in Body Mass Index and Metabolic Health With Cardiometabolic Disease Risk. J Am Heart Assoc 2020; 8:e010793. [PMID: 31025893 PMCID: PMC6509716 DOI: 10.1161/jaha.118.010793] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Metabolic syndrome is associated with high risk of cardiovascular disease, although risk may differ according to the specific conditions present and variability in those conditions. Methods and Results We defined obesity (body mass index [BMI] ≥30 kg/m2) and metabolic health (<2 nonobesity National Cholesterol Education Program Adult Treatment Panel III conditions) among 3632 Framingham Heart Study offspring cohort participants (mean age, 50.8 years; 53.8% women) who were followed up from 1987 to 2014. We defined participants whose variance independent of the mean for a metabolic syndrome-associated measure was in the top quintile as being "variable" for that measure. Variable metabolic health was defined as ≥2 variable nonobesity metabolic syndrome components. We investigated the interaction between obesity and metabolic health in their associations with cardiometabolic disease and cardiovascular disease using Cox proportional hazards regression. In addition, we estimated the associations of BMI variability and variable metabolic health with study outcomes within categories of obesity and metabolic health status, respectively. We observed 567 incident obesity (41 439 person-years), 771 incident metabolically unhealthy state (25 765 person-years), 272 incident diabetes mellitus (56 233 person-years), 503 incident hypertension (12 957 person-years), 589 cardiovascular disease (60 300 person-years), and 195 chronic kidney disease (47 370 person-years) events on follow-up. Obesity and being metabolically unhealthy were independently and positively associated with all outcomes. BMI variability, compared with stable BMI, was associated with 163%, 67%, 58%, and 74% higher risks of having obesity, becoming metabolically unhealthy, having diabetes mellitus, and having hypertension, respectively, among nonobese participants. Variable metabolic health, compared with stable metabolic health, was associated with a 28% higher risk of cardiovascular disease, among metabolically healthy participants. Conclusions We did not observe evidence for a positive interaction between obesity and metabolic health status with regard to study outcomes. BMI and metabolic health variability are associated with adverse health outcomes.
Collapse
Affiliation(s)
- Todd R Sponholtz
- 1 The Whitaker Cardiovascular Institute Boston University School of Medicine Boston MA.,6 Section of Preventive Medicine and Epidemiology, and Cardiovascular Medicine Department of Medicine Boston University School of Medicine Boston MA
| | - Edwin R van den Heuvel
- 2 Department of Mathematics and Computer Science Eindhoven University of Technology Eindhoven The Netherlands
| | - Vanessa Xanthakis
- 3 National Heart, Lung, and Blood Institute Framingham Heart Study Framingham MA.,4 Department of Biostatistics Boston University School of Public Health Boston MA.,6 Section of Preventive Medicine and Epidemiology, and Cardiovascular Medicine Department of Medicine Boston University School of Medicine Boston MA
| | - Ramachandran S Vasan
- 3 National Heart, Lung, and Blood Institute Framingham Heart Study Framingham MA.,5 Department of Epidemiology Boston University School of Public Health Boston MA.,6 Section of Preventive Medicine and Epidemiology, and Cardiovascular Medicine Department of Medicine Boston University School of Medicine Boston MA
| |
Collapse
|
46
|
Duque AP, Rodrigues Junior LF, Mediano MFF, Tibiriça E, De Lorenzo A. Emerging concepts in metabolically healthy obesity. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2020; 10:48-61. [PMID: 32685263 PMCID: PMC7364278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/15/2020] [Indexed: 06/11/2023]
Abstract
Obesity is a major risk factor for noncommunicable diseases that is responsible for more than 70% of early deaths in the world. In the 1980's decade, some studies started to describe a "benign" obesity phenotype, named "metabolically healthy obesity" (MHO), which represents obesity without comorbidities such as hypertension, cardiovascular diseases, insulin resistance, diabetes, dyslipidemia or metabolic syndrome. However, it is still unclear if this "benign" obesity phenotype is really favorable or just a transition status to unhealthy obesity and if these subjects presented subclinical levels of cardiovascular risk that are not commonly detected. To further elucidate these issues, the investigation of pathophysiological mechanisms that can increase cardiovascular risk in MHO individuals, such as hormones and cytokines, may offer some responses. In parallel, the evaluation of subclinical cardiovascular derangement, using the systemic microcirculation as a proxy, may be an alternative to anticipate overt cardiovascular disease. Overall, further studies are needed to better understand the pathophysiology of MHO as well as to identify high-risk individuals who deserve more intensive management.
Collapse
Affiliation(s)
- Alice P Duque
- Department of Research and Education, National Institute of CardiologyRio de Janeiro, RJ, Brazil
| | - Luiz F Rodrigues Junior
- Department of Research and Education, National Institute of CardiologyRio de Janeiro, RJ, Brazil
- Department of Physiological Sciences, Biomedical Institute, Federal University of The State of Rio de JaneiroRio de Janeiro, RJ, Brazil
| | - Mauro F F Mediano
- Department of Research and Education, National Institute of CardiologyRio de Janeiro, RJ, Brazil
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz FoundationRio de Janeiro, RJ, Brazil
| | - Eduardo Tibiriça
- Department of Research and Education, National Institute of CardiologyRio de Janeiro, RJ, Brazil
| | - Andrea De Lorenzo
- Department of Research and Education, National Institute of CardiologyRio de Janeiro, RJ, Brazil
| |
Collapse
|
47
|
Jhee JH, Joo YS, Han SH, Yoo TH, Kang SW, Park JT. High muscle-to-fat ratio is associated with lower risk of chronic kidney disease development. J Cachexia Sarcopenia Muscle 2020; 11:726-734. [PMID: 32020762 PMCID: PMC7296269 DOI: 10.1002/jcsm.12549] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 12/03/2019] [Accepted: 12/19/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Obesity, a known risk factor for chronic kidney disease (CKD), is generally assessed using body mass index (BMI). However, BMI may not effectively reflect body composition, and the impact of muscle-to-fat (MF) mass balance on kidney function has not been elucidated. This study evaluated the association between body muscle and fat mass balance, represented as the MF ratio, and incident CKD development. METHODS Data were retrieved from a prospective community-based cohort study (Korean Genome and Epidemiology Study). Muscle and fat mass were measured using multifrequency bioelectrical impedance analysis. The study endpoint was incident CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2 in at least two or more consecutive measurements during the follow-up period). RESULTS Totally, 7682 participants were evaluated. Their mean age was 51.7 ± 8.7 years, and 48% of the subjects were men. During a median follow-up of 140.0 (70.0-143.0) months, 633 (8.2%) subjects developed incident CKD. When the association between body composition and incident CKD was investigated, multivariable Cox proportional hazard analysis revealed that increase in MF ratio was related with a decreased risk of CKD development [per 1 increase in MF ratio: hazard ratio (HR), 0.86; 95% confidence interval (CI), 0.77-0.96; P = 0.008]. This association was also maintained when MF ratio was dichotomized according to sex-specific median values (high vs. low: HR, 0.83; 95% CI, 0.70-0.98; P = 0.031). Analyses preformed in a propensity score matched group also revealed a similar decreased risk of incident CKD in high MF ratio participants (high vs. low: HR, 0.84; 95% CI, 0.71-0.98; P = 0.037). This relationship between MF ratio and incident CKD risk was consistently significant across subgroups stratified by age, sex, hypertension, estimated glomerular filtration rate categories, and proteinuria. Among different BMI groups (normal, overweight, and obese), the relationship between high MF ratio and lower incident CKD risk was significant only in overweight and obese subjects. CONCLUSIONS Lower fat mass relative to muscle mass may lower the risk of CKD development in individuals with normal renal function. This relationship seems more prominent in overweight and obese subjects than in normal weight subjects.
Collapse
Affiliation(s)
- Jong Hyun Jhee
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Institute of Kidney Disease Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Su Joo
- Division of Nephrology, Department of Internal Medicine, Myongji Hospital, Goyang, Gyeonggi-do, Korea.,Department of Internal Medicine, Institute of Kidney Disease Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Hyeok Han
- Department of Internal Medicine, Institute of Kidney Disease Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, Institute of Kidney Disease Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, Institute of Kidney Disease Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Department of Internal Medicine, College of Medicine, Severance Biomedical Science Institute, Brain Korea 21 PLUS, Yonsei University, Seoul, Korea
| | - Jung Tak Park
- Department of Internal Medicine, Institute of Kidney Disease Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
48
|
Sakai R, Hashimoto Y, Hamaguchi M, Ushigome E, Okamura T, Majima S, Asano M, Yamazaki M, Fukui M. Living alone is associated with visit-to-visit HbA1c variability in men but not in women in people with type 2 diabetes: KAMOGAWA-DM cohort study. Endocr J 2020; 67:419-426. [PMID: 31932536 DOI: 10.1507/endocrj.ej19-0436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The purpose of this study was to evaluate the association between living alone and glycemic parameters, especially glycemic variability, in men and women with type 2 diabetes. Lifestyle factors, including living alone, were assessed by a questionnaire in this cross-sectional study. Average, standard deviation (SD), and coefficient of variation (CV) of HbA1c were calculated using the values of HbA1c, which were extracted from the medical record for 1 year. Eighteen percent of men (35/198) and 17% of women (18/103) were living alone. In men, the average of HbA1c (59.9 mmol/mol [11.0] vs. 55.7 mmol/mol [9.1], 7.6% [1.0] vs. 7.2% [0.8], p = 0.018), and CV of HbA1c (0.06 [0.03-0.08] vs. 0.03 [0.02-0.05], p < 0.001) were all significantly higher in men who were living alone than in men who weren't. However, there were no differences in the average (53.2 mmol/mol [11.4] vs. 56.0 mmol/mol [8.8], 7.0% [1.0] vs. 7.3% [0.8], p = 0.252) or CV (0.03 [0.02-0.05] vs. 0.03 [0.02-0.04], p = 0.845) between women who were living alone and women who weren't. Multiple regression analyses revealed that living alone was associated with CV of HbA1c after adjusting for covariates in men (β = 0.180, p = 0.005), but not in women (β = 0.085, p = 0.369). We showed that living alone is associated with visit-to-visit HbA1c variability in men, but not women, with type 2 diabetes. In clinical practice, it is necessary to pay attention to glycemic control in men who are living alone.
Collapse
Affiliation(s)
- Ryosuke Sakai
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshitaka Hashimoto
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masahide Hamaguchi
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Emi Ushigome
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takuro Okamura
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Saori Majima
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Mai Asano
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masahiro Yamazaki
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| |
Collapse
|
49
|
Shahali A, Tasdighi E, Barzin M, Mahdavi M, Valizadeh M, Niroomand M, Azizi F, Hosseinpanah F. Abdominal obesity phenotypes and risk of kidney function decline: Tehran Lipid and Glucose Study. Obes Res Clin Pract 2020; 14:168-175. [PMID: 32307280 DOI: 10.1016/j.orcp.2020.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/17/2020] [Accepted: 03/24/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Obesity and related health risk in different obesity phenotypes has always been a controversial subject. The present study was conducted with the aim of investigating the risk of kidney function decline (KFD) incidence in different abdominal obesity phenotypes. METHODS In this prospective observational cohort study, 7002 individuals (56.1% female), aged ≥20 years, were followed for the incidence of KFD defined as 40% decline in eGFR. Abdominal obesity was defined based on waist circumference cut-offs ≥89/91cm for men/women, respectively. Metabolic health was defined as ≤1 criterion of the metabolic syndrome criteria, according to the Joint Interim Statement (JIS) definition. RESULTS At baseline 4273 individuals (61.0%) were abdominally obese, among whom, 1188 (27.8%) belonged to the metabolically healthy abdominal obese (MHAO) phenotype. Totally, 251 incidences of KFD was indicated throughout the 12-year follow-up. After adjusting for the confounding variables, MHAO phenotype was not associated with increased risk of KFD in both males and females. Furthermore, results indicated that hazard ratios (HRs) for incidence of KFD did not increase in males with unhealthy obesity phenotypes. However, females with metabolically unhealthy abdominal obese (MUAO) phenotype had increased risk of KFD. CONCLUSION Findings of this study indicated that MHAO phenotype was not associated with KFD incidence, regardless of the participants gender. Furthermore, MUAO phenotype was associated with higher risk of KFD only in females. Further studies with longer follow up and larger sample size are needed to shed more light upon the regarded relationship and the influential role of gender.
Collapse
Affiliation(s)
- Asharf Shahali
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Erfan Tasdighi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Maryam Barzin
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Maryam Mahdavi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mahtab Niroomand
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
50
|
Bamba R, Okamura T, Hashimoto Y, Hamaguchi M, Obora A, Kojima T, Fukui M. The Visceral Adiposity Index Is a Predictor of Incident Chronic Kidney Disease: A Population-Based Longitudinal Study. Kidney Blood Press Res 2020; 45:407-418. [PMID: 32224619 DOI: 10.1159/000506461] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 02/11/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Visceral adiposity index (VAI), calculated with body mass index, high density lipoprotein-cholesterol, triglycerides and waist circumference, has been proposed as a marker of visceral fat accumulation and dysfunction in adipose tissue. METHODS The impact of VAI on incident chronic kidney disease (CKD) in a historical cohort study of 15,159 (8,260 men and 6,899 women) participants was investigated. CKD was defined when estimated glomerular filtration rate was <60 mL/min/1.73 m2 or proteinuria (positive: ≥1+). We divided the participants into 2 groups according to sex and into quartiles according to VAI (Q1-4). We performed Cox proportional hazard models, adjusting for age, smoking status, exercise, alcohol consumption, systolic blood pressure, hemoglobin A1c, uric acid, and creatinine. RESULTS During the median 3.3-year follow-up for men and 3.2-year follow-up for women, 1,078 participants (629 men and 449 women) developed CKD. The 4,000 days cumulative incidence rate of CKD for men and women were 3.7 and 3.9% in Q1, 5.2 and 5.9% in Q2, 6.5 and 7.0% in Q3, and 8.4 and 9.3% in Q4 respectively. Compared to Q1, the hazard ratios of incident CKD in Q2, Q3 and Q4 for men and women were 1.23 (95% CI 0.91-1.66, p = 0.184) and 1.30 (0.87-1.96, p = 0.203), 1.42 (1.06-1.90, p = 0.018) and 1.38 (0.94-2.05, p = 0.105), and 1.51 (1.12-2.02, p = 0.006) and 1.65 (1.12-2.46, p = 0.013) respectively. Additionally, the area under the curve of VAI for incidence of CKD was superior to that of VAI in men (0.595 vs. 0.552, p < 0.001) and equal to in women (0.597 vs. 0.591, p = 0.708). CONCLUSIONS The VAI can be a predictor of incident CKD.
Collapse
Affiliation(s)
- Ryo Bamba
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Takuro Okamura
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Yoshitaka Hashimoto
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Masahide Hamaguchi
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan,
| | - Akihiro Obora
- Department of Gastroenterology, Asahi University Hospital, Gifu, Japan
| | - Takao Kojima
- Department of Gastroenterology, Asahi University Hospital, Gifu, Japan
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| |
Collapse
|