Centre for Public Health, Institute of Clinical Sciences Block B, Queen's University Belfast, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, UK.
QJM. 2013 Oct;106(10):933-42. doi: 10.1093/qjmed/hct123. Epub 2013 May 20.
Obesity is increasingly prevalent in many countries. Obesity is a major risk factor for the development of type 2 diabetes but its relationship with diabetic kidney disease (DKD) remains unclear. Some studies have suggested that the metabolic syndrome (including obesity) may be associated with DKD in type 1 diabetes.
To investigate the association between obesity and DKD.
Retrospective cross-sectional study.
National Diabetes Audit data were available for the 2007-08 cycle. Type 1 and 2 diabetes patients with both a valid serum creatinine and urinary albumin:creatinine ratio were included. DKD was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2), albuminuria or both. Logistic regression was used to analyse associations of obesity (body mass index ≥30 kg/m(2)) and other variables including year of birth, year of diagnosis, ethnicity and stage of kidney disease.
A total of 58 791 type 1 and 733 769 type 2 diabetes patients were included in the analysis. After adjustment, when compared with type 1 diabetes patients with normal renal function those with DKD were up to twice as likely to be obese. Type 2 DKD patients were also more likely to be obese. For example, type 2 diabetes patients with an eGFR <15 ml/min/1.73 m(2) and normoalbuminuria, microalbuminuria or macroalbuminuria were all more likely to be obese; odds ratios (95% CI) 1.65 (1.3-2.1), 1.56 (1.28-1.92) and 1.27 (1.05-1.54), respectively.
This study has highlighted a strong association between obesity and kidney disease in type 1 diabetes and confirmed their association in type 2 diabetes.
肥胖在许多国家越来越普遍。肥胖是 2 型糖尿病发展的主要危险因素，但它与糖尿病肾病（DKD）的关系尚不清楚。一些研究表明，代谢综合征（包括肥胖）可能与 1 型糖尿病的 DKD 有关。
研究肥胖与 DKD 的关系。
回顾性横断面研究。
可获得 2007-08 年周期的国家糖尿病审计数据。纳入同时有有效血清肌酐和尿白蛋白/肌酐比值的 1 型和 2 型糖尿病患者。DKD 的定义为估计肾小球滤过率（eGFR）<60ml/min/1.73m2、白蛋白尿或两者兼有。使用 logistic 回归分析肥胖（体重指数≥30kg/m2）和其他变量（包括出生年份、诊断年份、种族和肾病阶段）与 DKD 的关联。
共纳入 58791 例 1 型和 733769 例 2 型糖尿病患者。调整后，与肾功能正常的 1 型糖尿病患者相比，DKD 患者肥胖的可能性高达两倍。2 型 DKD 患者也更有可能肥胖。例如，eGFR<15ml/min/1.73m2 且无白蛋白尿、微量白蛋白尿或大量白蛋白尿的 2 型糖尿病患者均更有可能肥胖；比值比（95%CI）分别为 1.65（1.3-2.1）、1.56（1.28-1.92）和 1.27（1.05-1.54）。
本研究强调了肥胖与 1 型糖尿病患者肾病之间的强烈关联，并证实了其与 2 型糖尿病患者肾病之间的关联。
