Hashimoto Yoshitaka, Tanaka Muhei, Okada Hiroshi, Senmaru Takafumi, Hamaguchi Masahide, Asano Mai, Yamazaki Masahiro, Oda Yohei, Hasegawa Goji, Toda Hitoshi, Nakamura Naoto, Fukui Michiaki
Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan;
Division of Metabolism, Nephrology and Rheumatology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan; and.
Clin J Am Soc Nephrol. 2015 Apr 7;10(4):578-83. doi: 10.2215/CJN.08980914. Epub 2015 Jan 29.
Metabolically healthy obesity (MHO) is a unique obesity phenotype that apparently protects people from the metabolic complications of obesity. The association between MHO phenotype and incident CKD is unclear. Thus, this study investigated the association between MHO phenotype and incident CKD.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A total of 3136 Japanese participants were enrolled in an 8-year follow-up cohort study in 2001. Metabolically healthy status was assessed by common clinical markers: BP, triglycerides, HDL cholesterol, and fasting plasma glucose concentrations. Body mass index ≥25.0 kg/m(2) was defined as obesity. CKD was defined by proteinuria or eGFR of <60 ml/min per 1.73 m(2). To calculate the odds ratio for incident CKD, logistic regression analyses were performed.
The crude incidence proportions of CKD were 2.6% (56 of 2122 participants) in participants with the metabolically healthy nonobesity phenotype, 2.6% (8 of 302) in those with the MHO phenotype, 6.7% (30 of 445) in those with the metabolically abnormal nonobesity phenotype, and 10.9% (29 of 267) in those with the metabolically abnormal obesity phenotype. Compared with metabolically healthy nonobesity phenotype, the odds ratios for incident CKD were 0.83 (95% confidence interval [95% CI], 0.36 to 1.72; P=0.64) for MHO, 1.44 (95% CI, 0.80 to 2.57; P=0.22) for metabolically abnormal nonobesity, and 2.80 (95% CI, 1.45 to 5.35; P=0.02) for metabolically abnormal obesity phenotype after adjustment for confounders, including age, sex, smoking statues, alcohol use, creatinine, uric acid, systolic BP, HDL cholesterol, and impaired fasting glucose or diabetes.
MHO phenotype was not associated with higher risk of incident CKD.
代谢健康型肥胖（MHO）是一种独特的肥胖表型，显然能保护人们免受肥胖相关代谢并发症的影响。MHO表型与新发慢性肾脏病（CKD）之间的关联尚不清楚。因此，本研究调查了MHO表型与新发CKD之间的关联。
设计、地点、参与者及测量方法：2001年，共有3136名日本参与者纳入一项为期8年的随访队列研究。通过常见临床指标评估代谢健康状况：血压、甘油三酯、高密度脂蛋白胆固醇和空腹血糖浓度。体重指数≥25.0kg/m²定义为肥胖。CKD定义为蛋白尿或估算肾小球滤过率（eGFR）<60ml/（min·1.73m²）。为计算新发CKD的比值比，进行了逻辑回归分析。
代谢健康非肥胖表型参与者中CKD的粗发病率为2.6%（2122名参与者中的56名），MHO表型参与者中为2.6%（302名中的8名），代谢异常非肥胖表型参与者中为6.7%（445名中的30名），代谢异常肥胖表型参与者中为10.9%（267名中的29名）。与代谢健康非肥胖表型相比，在调整包括年龄、性别、吸烟状况、饮酒、肌酐、尿酸、收缩压、高密度脂蛋白胆固醇以及空腹血糖受损或糖尿病等混杂因素后，MHO新发CKD的比值比为0.83（95%置信区间[95%CI]，0.36至1.72；P=0.64），代谢异常非肥胖为1.44（95%CI，0.80至2.57；P=0.22），代谢异常肥胖表型为2.80（95%CI，1.45至5.35；P=0.02）。
MHO表型与新发CKD的较高风险无关。
