Institute of Nephrology, Havana, Cuba.
MEDICC Rev. 2008 Apr;10(2):14-20. doi: 10.37757/MR2008.V10.N2.7.
Obesity is a social disease constituting a global pandemic. It is present in 90% of diabetic and 65% of hypertensive patients. It is associated with cardiometabolic syndrome and with damaging physiopathological mechanisms, particularly for the vascular system and the kidneys. On Cuba's Isle of Youth, a community-based epidemiological study of chronic kidney disease (CKD), hypertension (HTN), diabetes mellitus (DM) and cardio-cerebral vascular disease was carried out in total population, including an examination of common risk factors.
Based on the Isle of Youth Study (ISYS) data, determine prevalence of obesity and overweight, and their association with CKD, HTN, DM, and shared risk factors for all these conditions in total population of the Isle of Youth, Cuba.
Phase 1: Population diagnosis (November 2004-April 2006): 96.6% of the Isle of Youth’s total population (80,117) was studied, including all ages and both sexes. Information was offered to the public, and written informed consent obtained. Screening was conducted by participant questionnaire including risk factors, physical measurements (weight, height, blood pressure and body mass index), and a single first-morning urine sample to determine the presence of vascular-renal damage markers – proteinuria and hematuria (Combur 10 Test, Roche), and microalbuminuria (Micral Test, Roche). When results were positive, serum creatinine was determined and glomerular filtration rate (GFR) estimated with Modification of Diet in Renal Disease (MDRD) formula for adults and Schwartz formula for children <15 years. Data obtained were analyzed to determine association of participants’ nutritional status with prevalence of chronic kidney disease, hypertension and diabetes mellitus, as well as a set of common risk factors.
Population <20 years: Obesity prevalence 3.2%; positive urine markers in 56.9% of obese and 8.9% of non-obese participants; positive albuminuria in 38% of obese and 3% of non-obese. Obese participants were found to be hyperfiltrating. DM prevalence was 9.5% in obese and 1.1% in non-obese participants. Population ≥20 years: Overweight, 31.3%; obese, 13.4%. Positive markers in normal-weight, overweight and obese individuals were 18.3%, 21.2% and 32.7%, respectively; microalbuminuria values increased with weight. Obese individuals were found to be hyperfiltrating. HTN prevalence in normal-weight, overweight and obese individuals was 18.3%, 31.5%, and 51.0% respectively; DM rates were 2.8%, 5.2% y 11.3%, respectively.
In Cuba, obesity poses significant risk for vascular and renal damage and should be the focus of increased prevention efforts.
肥胖是一种社会疾病，构成了全球大流行。它存在于 90%的糖尿病患者和 65%的高血压患者中。它与心脏代谢综合征以及破坏性的生理病理机制有关，特别是对血管系统和肾脏。在古巴的青年岛，对慢性肾脏病 (CKD)、高血压 (HTN)、糖尿病 (DM) 和心脏脑血管疾病进行了一项基于社区的流行病学研究，包括对常见危险因素的检查。
根据青年岛研究 (ISYS) 数据，确定肥胖和超重的患病率，以及它们与青年岛总人口 (80117 人) 中 CKD、HTN、DM 以及所有这些疾病的共同危险因素的相关性。
第 1 阶段：人群诊断 (2004 年 11 月至 2006 年 4 月)：研究了青年岛总人口的 96.6% (80117 人)，包括所有年龄和性别。向公众提供信息，并获得书面知情同意。通过参与者问卷进行筛查，包括危险因素、身体测量 (体重、身高、血压和体重指数) 和单次晨尿样本，以确定血管-肾脏损伤标志物的存在——蛋白尿和血尿 (罗氏公司的 Combust 10 试验)，和微量白蛋白尿 (罗氏公司的 Micral 试验)。当结果为阳性时，测定血清肌酐，并使用成人改良肾脏病饮食 (MDRD) 公式和儿童<15 岁的 Schwartz 公式估计肾小球滤过率 (GFR)。分析获得的数据，以确定参与者的营养状况与慢性肾脏病、高血压和糖尿病的患病率以及一组常见危险因素的相关性。
<20 岁人群：肥胖患病率 3.2%；肥胖参与者尿液标志物阳性率为 56.9%，非肥胖参与者为 8.9%；肥胖参与者白蛋白尿阳性率为 38%，非肥胖参与者为 3%。肥胖参与者被发现高滤过。肥胖参与者的糖尿病患病率为 9.5%，非肥胖参与者为 1.1%。≥20 岁人群：超重，31.3%；肥胖，13.4%。正常体重、超重和肥胖个体的阳性标志物分别为 18.3%、21.2%和 32.7%；随着体重的增加，微量白蛋白尿值增加。肥胖个体被发现高滤过。正常体重、超重和肥胖个体的高血压患病率分别为 18.3%、31.5%和 51.0%；糖尿病发生率分别为 2.8%、5.2%和 11.3%。
在古巴，肥胖对血管和肾脏损伤构成重大风险，应成为加强预防工作的重点。
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