Reynolds Kristi, Gu Dongfeng, Muntner Paul, Chen Jing, Wu Xigui, Yau C Lillian, Duan Xiufang, Chen Chung-Shiuan, Hamm L Lee, He Jiang
Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
Am J Kidney Dis. 2007 Nov;50(5):754-64. doi: 10.1053/j.ajkd.2007.08.011.
The relationship between body mass index (BMI) and risk of end-stage renal disease (ESRD) in Asians has not been well established.
Prospective cohort study.
SETTING & PARTICIPANTS: 143,802 men and women 40 years and older in China.
Body weight, height, and covariables were obtained at a baseline examination in 1991 by following a standardized protocol. BMI was calculated as weight in kilograms divided by the square of height in meters.
Time to onset of ESRD, ascertained in 1999 to 2000 from medical records, death certificates, and interviews with participants or their proxies.
During 1,112,667 person-years of follow-up, 350 participants initiated renal replacement therapy or died of renal failure. After adjustment for age, sex, geographic region (north versus south China), urbanization (urban versus rural residence), education, physical activity, cigarette smoking, and alcohol consumption, a J-shaped association between BMI and all-cause ESRD was observed. Compared with those with normal body weight (BMI, 18.5 to 24.9 kg/m(2)), multivariate-adjusted relative risks for all-cause ESRD for underweight (BMI < 18.5 kg/m(2)), overweight (BMI, 25.0 to 29.9 kg/m(2)), and obese subjects (BMI >or= 30 kg/m(2)) were 1.39 (95% confidence interval [CI], 1.02 to 1.91), 1.21 (95% CI, 0.92 to 1.59), and 2.14 (95% CI, 1.39 to 3.29), respectively. The J-shaped association existed even after additional adjustment for systolic blood pressure and history of diabetes and cardiovascular disease.
Although patients with ESRD at baseline were excluded, information for chronic kidney disease at the baseline examination was not available.
Strategies aimed at preventing the development of ESRD should incorporate measures to maintain a normal body weight.
亚洲人的体重指数（BMI）与终末期肾病（ESRD）风险之间的关系尚未明确确立。
前瞻性队列研究。
中国143,802名40岁及以上的男性和女性。
1991年通过遵循标准化方案进行基线检查时获取体重、身高及协变量。BMI计算为体重（千克）除以身高（米）的平方。
从医疗记录、死亡证明以及对参与者或其代理人的访谈中确定1999年至2000年期间ESRD的发病时间。
在1,112,667人年的随访期间，350名参与者开始接受肾脏替代治疗或死于肾衰竭。在对年龄、性别、地理区域（中国北方与南方）、城市化程度（城市与农村居住）、教育程度、身体活动、吸烟和饮酒情况进行调整后，观察到BMI与全因ESRD之间呈J形关联。与体重正常者（BMI，18.5至24.9kg/m²）相比，体重过轻（BMI<18.5kg/m²）、超重（BMI，25.0至29.9kg/m²）和肥胖受试者（BMI≥30kg/m²）的全因ESRD多变量调整相对风险分别为1.39（95%置信区间[CI]，1.02至1.91）、1.21（95%CI，0.92至1.59）和2.14（95%CI，1.39至3.29）。即使在进一步调整收缩压以及糖尿病和心血管疾病病史后，J形关联仍然存在。
尽管排除了基线时患有ESRD的患者，但基线检查时慢性肾病的信息不可用。
旨在预防ESRD发生的策略应纳入维持正常体重的措施。
