Lurbe Empar, Torro Maria Isabel, Alvarez Julio, Aguilar Francisco, Fernandez-Formoso José Antonio, Redon Josep
aPediatric Department, Consorcio Hospital General, University of Valencia, Valencia bCIBER Fisiopatología Obesidad y Nutrición (CB06/03), Instituto de Salud Carlos III, Madrid cInternal Medicine, Hospital Clinico, INCLIVA, University of Valencia, Valencia, Spain.
J Hypertens. 2013 Nov;31(11):2230-6; discussion 2236. doi: 10.1097/HJH.0b013e328364bcbf.
The aim of the present study is to assess whether obesity is associated with urinary albumin excretion and what the main determinants are.
One hundred and thirty-four obese white children and adolescents of both sexes, ranging from 9 to 18 years of age (mean age 12.6 ± 2.0), were included in the study. Obesity was defined on the basis of a threshold BMI z-score of more than 2 (Cole's LMS method) and overweight with a BMI from the 85th to 95th percentile. Office blood pressure was measured using a mercury sphygmomanometer. Urinary albumin excretion was measured in the first voiding urine of the morning and expressed in albumin/creatinine ratio in mg/g. Reproducibility of the urinary albumin excretion was studied by the Bland and Altman technique in a subgroup. Triglycerides, uric acid, fasting glucose and insulin were measured and the homeostatic model assessment (HOMA) index was calculated.
The prevalence of microalbuminuria was 2.4%. No differences in the prevalence of microalbuminuria were observed when the different groups of obesity degree were compared (0, 2.2 and 0% in overweight, moderate and severe obese, respectively). A significant relationship emerged between the Log urinary albumin excretion and BMI z-score, waist circumference, Log triglycerides, fasting insulin and HOMA index, adjusted by age and sex. In a multiple regression analysis, the main determinants of Log urinary albumin excretion were sex, waist circumference and Log triglycerides. In 17% of the individuals who fulfil criteria for metabolic syndrome, urinary albumin excretion was significantly higher than those without.
The prevalence of elevated urinary albumin excretion is not prominent in obese children, and when it is increased, it depends mainly on metabolic factors.
本研究旨在评估肥胖是否与尿白蛋白排泄相关以及主要决定因素是什么。
134名9至18岁（平均年龄12.6±2.0）的肥胖白人儿童及青少年（男女均有）被纳入研究。肥胖基于BMI z评分阈值超过2（科尔的LMS方法）来定义，超重则为BMI处于第85至95百分位数。使用汞柱式血压计测量诊室血压。在晨尿首次排尿时测量尿白蛋白排泄，并以mg/g的白蛋白/肌酐比值表示。通过布兰德-奥特曼技术在一个亚组中研究尿白蛋白排泄的可重复性。测量甘油三酯、尿酸、空腹血糖和胰岛素，并计算稳态模型评估（HOMA）指数。
微量白蛋白尿的患病率为2.4%。比较不同肥胖程度组时，未观察到微量白蛋白尿患病率的差异（超重、中度肥胖和重度肥胖组分别为0、2.2%和0%）。经年龄和性别校正后，Log尿白蛋白排泄与BMI z评分、腰围、Log甘油三酯、空腹胰岛素和HOMA指数之间出现显著关系。在多元回归分析中，Log尿白蛋白排泄的主要决定因素是性别、腰围和Log甘油三酯。在符合代谢综合征标准的个体中，17%的人的尿白蛋白排泄显著高于未患代谢综合征的个体。
肥胖儿童中尿白蛋白排泄升高的患病率并不突出，当其升高时，主要取决于代谢因素。
