Department of Applied Nutrition, Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil.
Nephrology Division, Rio de Janeiro State University, Rio de Janeiro, Brazil.
Nutrition. 2014 Mar;30(3):279-85. doi: 10.1016/j.nut.2013.08.004. Epub 2013 Dec 12.
Chronic kidney disease (CKD) is associated with metabolic disorders, including insulin resistance (IR), mainly when associated with obesity and characterized by high abdominal adiposity (AbAd). Anthropometric measures are recommended for assessing AbAd in clinical settings, but their accuracies need to be evaluated. The aim of this study was to evaluate the precision of different anthropometric measures of AbAd in patients with CKD. We also sought to determine the AbAd association with high homeostasis model assessment index of insulin resistance (HOMA-IR) values and the cutoff point for AbAd index to predict high HOMA-IR values.
A subset of clinically stable nondialyzed patients with CKD followed at a multidisciplinary outpatient clinic was enrolled in this cross-sectional study. The accuracy of the following anthropometric indices: waist circumference, waist-to-hip ratio, conicity index and waist-to-height ratio (WheiR) to assess AbAd, was evaluated using trunk fat, by dual x-ray absorptiometry (DXA), as a reference method. HOMA-IR was estimated to stratify patients in high and low HOMA-IR groups. The total area under the receiver-operating characteristic curves (AUC-ROC; sensitivity/specificity) was calculated: AbAd with high HOMA-IR values (95% confidence interval [CI]).
We studied 134 patients (55% males; 54% overweight/obese, body mass index ≥ 25 kg/m(2), age 64.9 ± 12.5 y, estimated glomerular filtration rate 29.0 ± 12.7 mL/min). Among studied AbAd indices, WheiR was the only one to show correlation with DXA trunk fat after adjusting for confounders (P < 0.0001). Thus, WheiR was used to evaluate the association between AbAd with HOMA-IR values (r = 0.47; P < 0.0001). The cutoff point for WheiR as a predictor for high HOMA-IR values was 0.55 (AUC-ROC = 0.69 ± 0.05; 95% CI, 0.60-0.77; sensitivity/specificity, 68.9/61.9).
WheiR is recommended as an effective and precise anthropometric index to assess AbAd and to predict high HOMA-IR values in nondialyzed patients with CKD.
慢性肾脏病（CKD）与代谢紊乱有关，包括胰岛素抵抗（IR），主要与肥胖相关，其特征为腹部脂肪过多（AbAd）。在临床环境中，推荐使用人体测量学指标来评估 AbAd，但需要对其准确性进行评估。本研究旨在评估 CKD 患者不同 AbAd 人体测量学指标的精确性。我们还旨在确定 AbAd 与高稳态模型评估胰岛素抵抗指数（HOMA-IR）值的关系，以及 AbAd 指数的截断点来预测高 HOMA-IR 值。
本横断面研究纳入了在多学科门诊接受治疗的、临床稳定的非透析 CKD 患者亚组。使用双能 X 线吸收法（DXA）作为参考方法，评估了腰围、腰臀比、锥形指数和腰高比（WheiR）等人体测量学指标评估 AbAd 的准确性。使用 HOMA-IR 对患者进行分层，分为高 HOMA-IR 组和低 HOMA-IR 组。计算了受试者工作特征曲线下的总面积（AUC-ROC；灵敏度/特异性）：高 HOMA-IR 值（95%置信区间 [CI]）的 AbAd。
我们研究了 134 名患者（55%为男性；54%超重/肥胖，体重指数≥25kg/m2，年龄 64.9±12.5 岁，估算肾小球滤过率 29.0±12.7mL/min）。在研究的 AbAd 指标中，WheiR 是唯一在调整混杂因素后与 DXA 躯干脂肪相关的指标（P<0.0001）。因此，使用 WheiR 来评估 AbAd 与 HOMA-IR 值之间的关系（r=0.47；P<0.0001）。作为高 HOMA-IR 值预测因子的 WheiR 截断点为 0.55（AUC-ROC=0.69±0.05；95%CI，0.60-0.77；灵敏度/特异性，68.9/61.9）。
推荐 WheiR 作为一种有效的、精确的人体测量学指标，用于评估非透析 CKD 患者的 AbAd 并预测高 HOMA-IR 值。
Zotero 插件