Peng Yong, Chen Fei, Huang Fang-Yang, Xia Tian-Li, Huang Bao-Tao, Chai Hua, Wang Peng-Ju, Zuo Zhi-Liang, Liu Wei, Zhang Chen, Gui Yi-Yue, Chen Mao, Huang De-Jia
Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
J Ren Nutr. 2017 May;27(3):187-193. doi: 10.1053/j.jrn.2017.01.018. Epub 2017 Mar 18.
Obesity is a risk factor for both coronary artery disease (CAD) and chronic renal insufficiency (RI); patients with CAD are prone to obesity and RI. In this study, we try to analyze the effect of body composition on death in CAD patients with mild RI.
Retrospective cohort study.
A total of 1,591 consecutive CAD patients confirmed by coronary angiography were enrolled and met the mild RI criteria by estimated glomerular filtration rate: 60-90 mL/min.
The influence of body composition on mortality of CAD was detected in different body compositions, including body mass index (BMI), body fat (BF), and lean mass index (LMI). The end points were all-cause mortality. Cox models were used to evaluate the relationship of quintiles of body compositions with all-cause mortality.
A survival curve showed that the risk of death was higher in the low BMI group than in the high BMI group (log-rank for overall P = .002); LMI was inversely correlated with risk of death, such that a lower LMI was associated with a higher risk of death (log-rank for overall P < .001). No significant correlation was observed between BF and risk of death. Multifactorial correction show that LMI was still inversely correlated with risk of death (quintile 1: reference; quintile 2: hazard ratio [HR]: 0.49, 95% confidence interval [CI]: 0.26-0.92; quintile 3: HR: 0.35, 95% CI: 0.17-0.70; quintile 4: HR: 0.41, 95% CI: 0.20-0.85; quintile 5: HR: 0.28, 95% CI: 0.12-0.67).
For CAD patients with mild RI, BMI or BF was unrelated to risk of death, while LMI was inversely correlated with risk of death. A weak "obesity paradox" was observed in this study.
肥胖是冠状动脉疾病（CAD）和慢性肾功能不全（RI）的危险因素；CAD患者易患肥胖症和RI。在本研究中，我们试图分析身体成分对轻度RI的CAD患者死亡的影响。
回顾性队列研究。
共有1591例经冠状动脉造影确诊的CAD患者入组，且通过估计肾小球滤过率符合轻度RI标准：60 - 90 mL/分钟。
在不同身体成分中检测身体成分对CAD死亡率的影响，包括体重指数（BMI）、体脂（BF）和瘦体重指数（LMI）。终点为全因死亡率。采用Cox模型评估身体成分五分位数与全因死亡率的关系。
生存曲线显示，低BMI组的死亡风险高于高BMI组（总体对数秩检验P = 0.002）；LMI与死亡风险呈负相关，即较低的LMI与较高的死亡风险相关（总体对数秩检验P < 0.001）。未观察到BF与死亡风险之间存在显著相关性。多因素校正显示LMI仍与死亡风险呈负相关（五分位数1：参照；五分位数2：风险比[HR]：0.49，95%置信区间[CI]：0.26 - 0.92；五分位数3：HR：0.35，95% CI：0.17 - 0.70；五分位数4：HR：0.41，95% CI：0.20 - 0.85；五分位数5：HR：0.28，95% CI：0.12 - 0.67）。
对于轻度RI的CAD患者，BMI或BF与死亡风险无关，而LMI与死亡风险呈负相关。本研究中观察到了微弱的“肥胖悖论”。
