Sato Yuji, Fujimoto Shouichi, Konta Tsuneo, Iseki Kunitoshi, Moriyama Toshiki, Yamagata Kunihiro, Tsuruya Kazuhiko, Yoshida Hideaki, Asahi Koichi, Kurahashi Issei, Ohashi Yasuo, Watanabe Tsuyoshi
Dialysis Division, University of Miyazaki Hospital, Miyazaki, Japan,
Clin Exp Nephrol. 2014 Feb;18(1):75-86. doi: 10.1007/s10157-013-0809-5. Epub 2013 May 8.
There is little data on the association between body mass index (BMI) and proteinuria.
This was a cross-sectional cohort study assessing the association between BMI and proteinuria in a large Japanese population. Using a nationwide health check-up database of 212,251 Japanese aged >20 years with no pre-existing cardiovascular diseases (185,183 men, median age 66 years; 127,068 women, median age 65 years), we examined the association between BMI and proteinuria (≥ 1+ on dipstick).
Subjects were divided into 11 subgroups by BMI grading in 1 kg/m(2) intervals from 18.5-27.5 kg/m(2). A BMI of approximately 22 ± 0.5 kg/m(2) was considered optimal for Japanese; therefore, this subgroup was set as a reference when logistic analysis was applied. Age, waist circumference, height, weight, smoking and drinking habits, use of medications such as antihypertensive, antidiabetic, or antihyperlipidemic, as well as proteinuria, estimated glomerular filtration rate (eGFR), chemistry data, and blood pressure levels were significantly different between subgroups in both genders. The odds ratio for proteinuria showed a U-shape in men and women, even after adjustment for significant covariates such as age, waist circumference, systolic blood pressure, eGFR, fasting plasma glucose, triglyceride, low-density lipoprotein, antihypertensive use, antidiabetic use, antihyperlipidemic use, and lifestyle factors (smoking and drinking). Gender differences were also prominent--a BMI <20.4 kg/m(2) was significantly associated with proteinuria in men compared to a BMI <18.4 kg/m(2) in women. On the other hand, a BMI ≥ 25.5 kg/m(2) was also significantly associated with proteinuria in men compared to a BMI ≥ 22.5 kg/m(2) in women.
We found that BMI levels were associated with proteinuria in a U-shaped manner and showed marked gender differences. Health guidance should not only focus on higher BMI subjects, but also on thin subjects, in terms of the prevention of chronic kidney disease.
关于体重指数（BMI）与蛋白尿之间关联的数据较少。
这是一项横断面队列研究，旨在评估日本一大群人中BMI与蛋白尿之间的关联。利用一个包含212,251名年龄大于20岁且无心血管疾病病史的日本人的全国性健康检查数据库（185,183名男性，中位年龄66岁；127,068名女性，中位年龄65岁），我们研究了BMI与蛋白尿（试纸检测≥1+）之间的关联。
根据BMI分级，以1 kg/m²的间隔将受试者分为11个亚组，范围从18.5至27.5 kg/m²。对于日本人而言，BMI约为22±0.5 kg/m²被认为是最佳的；因此，在进行逻辑分析时，将该亚组设为参照组。年龄、腰围、身高、体重、吸烟和饮酒习惯、使用抗高血压药、抗糖尿病药或抗高血脂药等药物情况，以及蛋白尿、估计肾小球滤过率（eGFR）、化学数据和血压水平在男女亚组之间均存在显著差异。即使在对年龄、腰围、收缩压、eGFR、空腹血糖、甘油三酯、低密度脂蛋白、抗高血压药使用、抗糖尿病药使用、抗高血脂药使用和生活方式因素（吸烟和饮酒）等显著协变量进行调整后，男性和女性蛋白尿的优势比均呈U形。性别差异也很显著——男性中BMI<20.4 kg/m²与蛋白尿显著相关，而女性中BMI<18.4 kg/m²与蛋白尿显著相关。另一方面，男性中BMI≥25.5 kg/m²与蛋白尿显著相关，而女性中BMI≥22.5 kg/m²与蛋白尿显著相关。
我们发现BMI水平与蛋白尿呈U形关联，且存在明显的性别差异。在预防慢性肾脏病方面，健康指导不仅应关注BMI较高的人群，还应关注体型偏瘦的人群。
