Zaheer Sarah, de Boer Ian H, Allison Matthew, Brown Jenifer M, Psaty Bruce M, Robinson-Cohen Cassianne, Michos Erin D, Ix Joachim H, Kestenbaum Bryan, Siscovick David, Vaidya Anand
Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115.
Division of Nephrology, Department of Medicine, and.
J Clin Endocrinol Metab. 2017 Apr 1;102(4):1387-1395. doi: 10.1210/jc.2016-3563.
Obesity is associated with poor bone mineralization and quality. Fibroblast growth factor 23 (FGF23) plays an important role in skeletal physiology.
To test hypothesis that greater adiposity results in higher FGF23 levels among individuals with normal estimated glomerular filtration rate (eGFR).
DESIGN, SETTING, PARTICIPANTS: Cross-sectional analyses among participants with eGFR ≥60 mL/min/1.73m2. We assessed the association between crude [body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR); n = 5610] and refined (abdominal adipose tissue area by computed tomography; n = 1313) measures of adiposity and FGF23 using multivariable linear regression.
Serum FGF23.
FGF23 was higher across BMI categories (BMI <25: 37.7; BMI 25 to 29.99: 38.7; BMI 30 to 39.99: 39.8; BMI ≥40: 40.9 pg/mL, unadjusted P trend < 0.0001). The association between BMI and FGF23 was independent of known confounders of FGF23 (adjusted β = +7.2% higher FGF23 per 10 kg/m2; P < 0.0001). Similar results were observed using WC and WHR. Abdominal adipose tissue area was also independently associated with higher FGF23 (P < 0.01). Notably, the positive associations between FGF23 and adiposity were observed despite the fact that eGFR did not decline and serum phosphate levels did not increase with adiposity.
In a large cohort with normal kidney function, adiposity was associated with higher FGF23 levels independent of known confounders, including eGFR and phosphate. Further studies are needed to evaluate the causes of higher FGF23 in settings of greater adiposity and the potential impact on skeletal health.
肥胖与骨矿化不良及质量欠佳有关。成纤维细胞生长因子23（FGF23）在骨骼生理中起重要作用。
检验以下假设，即在估算肾小球滤过率（eGFR）正常的个体中，更高的肥胖程度会导致FGF23水平升高。
设计、地点、参与者：对eGFR≥60 mL/min/1.73m²的参与者进行横断面分析。我们使用多变量线性回归评估了粗略（体重指数（BMI）、腰围（WC）和腰臀比（WHR）；n = 5610）和精细（通过计算机断层扫描测量的腹部脂肪组织面积；n = 1313）肥胖指标与FGF23之间的关联。
血清FGF23。
FGF23在各个BMI类别中均较高（BMI<25：37.7；BMI 25至29.99：38.7；BMI 30至39.99：39.8；BMI≥40：40.9 pg/mL，未调整的P趋势<0.0001）。BMI与FGF23之间的关联独立于FGF23的已知混杂因素（调整后的β=每10 kg/m²FGF23升高+7.2%；P<0.0001）。使用WC和WHR时观察到类似结果。腹部脂肪组织面积也与较高的FGF23独立相关（P<0.01）。值得注意的是，尽管随着肥胖程度增加eGFR未下降且血清磷酸盐水平未升高，但仍观察到FGF23与肥胖之间的正相关。
在一个肾功能正常的大型队列中，肥胖与较高的FGF23水平相关，独立于已知的混杂因素，包括eGFR和磷酸盐。需要进一步研究来评估在肥胖程度较高的情况下FGF23升高的原因以及对骨骼健康的潜在影响。
