Division of Internal Medicine-Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Special Task force for Activating Research in Renal Nutrition (Renal Nutrition Research Group), Office of Research Affairs, Chulalongkorn University, Bangkok, Thailand.
PLoS One. 2018 May 9;13(5):e0196332. doi: 10.1371/journal.pone.0196332. eCollection 2018.
Although the prevalence of obesity and metabolic syndrome (MetS) among dialysis patients has been exceeding than general population, little is known regarding obesity and MetS in non-dialysis chronic kidney disease (CKD). We aimed to find the magnitude of obesity and MetS and their associations with impaired renal function among type 2 diabetes mellitus (T2DM) patients.
A national survey of T2DM patients was collected in the Thai National Health Security Office database during 2014-5. The sampling frame was designated as distinct geographic regions throughout the country. A stratified two-stage cluster sampling was used to select the study population. Anthropometry and 12-hour fasting blood samples were obtained by trained personnel. BMI of ≥25 kg/m2 was classified as obesity. MetS was defined as having elevated waist circumference (>90 and >80 cm in men and women, respectively) plus any two of the followings: triglyceride ≥150 mg/dL, HDL-C <40 in men or <50 mg/dL in women, blood pressure ≥130/85 mmHg, and fasting blood sugar ≥100 mg/dL. CKD was defined as an impaired renal function (eGFR <60 mL/min/1.73m2 according to the CKD-EPI equation). Logistic regression analysis was performed to examine the relationship between obesity and MetS with the presence of CKD.
A total of 32,616 diabetic patients were finally recruited from 997 hospitals. The mean age was 61.5±10.9 years with 67.5% women. Of the participants, 35.4% were CKD patients. The prevalence of obesity was 46.5% in CKD and 54.1% in non-CKD patients with T2DM (p<0.001). In contrast, the prevalence of MetS in CKD patients was higher than their non-CKD counterparts (71.3 vs 68.8%, p<0.001). Moreover, there was an association between the prevalence of MetS with CKD stage from 3a to 5 (70.1, 72.3, 73.4, and 72.7%, respectively, p trend = 0.02). MetS, but not obesity, had a significant association with CKD in T2DM patients after adjusting for age, sex, and comorbidities [OR 1.14; 95% CI 1.06-1.22, p<0.001]. When stratified by each component of MetS, only high serum triglyceride and low HDL-C levels were increased in patients with CKD stage 4 and 5 compared with CKD stage 3 (p<0.001) and had a significant relationship with impaired renal function.
There were relatively high prevalences of both obesity and MetS in T2DM patients. A higher prevalence of MetS, but lower prevalence of obesity, was observed among diabetic CKD group compared with their non-CKD counterparts. MetS, as a surrogate of insulin resistance, appeared to be more important than obesity in the development of impaired renal function in diabetic population.
尽管透析患者的肥胖症和代谢综合征（MetS）患病率已经超过了一般人群，但对于非透析慢性肾脏病（CKD）患者的肥胖症和 MetS 却知之甚少。我们旨在研究 2 型糖尿病（T2DM）患者中肥胖症和 MetS 的严重程度及其与肾功能受损的关系。
在 2014-5 年期间，我们从泰国国家健康保障办公室数据库中收集了一项针对 T2DM 患者的全国性调查。抽样框架指定为全国不同的地理区域。采用分层两阶段聚类抽样选择研究人群。由经过培训的人员测量人体测量学和 12 小时禁食血样。BMI≥25kg/m2 被归类为肥胖症。MetS 定义为腰围升高（男性>90cm，女性>80cm）加上以下任何两种情况：甘油三酯≥150mg/dL，男性 HDL-C<40mg/dL，女性<50mg/dL，血压≥130/85mmHg，空腹血糖≥100mg/dL。CKD 定义为肾功能受损（根据 CKD-EPI 方程估算的 eGFR<60mL/min/1.73m2）。使用 logistic 回归分析检查肥胖症和 MetS 与 CKD 存在之间的关系。
从 997 家医院共招募了 32616 名糖尿病患者。平均年龄为 61.5±10.9 岁，其中 67.5%为女性。参与者中，35.4%患有 CKD。在 CKD 和非 CKD 的 T2DM 患者中，肥胖症的患病率分别为 46.5%和 54.1%（p<0.001）。相比之下，CKD 患者的 MetS 患病率高于非 CKD 患者（71.3%比 68.8%，p<0.001）。此外，MetS 的患病率与 CKD 分期从 3a 到 5 期呈正相关（分别为 70.1%、72.3%、73.4%和 72.7%，p趋势=0.02）。调整年龄、性别和合并症后，MetS 而不是肥胖症与 T2DM 患者的 CKD 有显著关联[比值比 1.14；95%置信区间 1.06-1.22，p<0.001]。当按 MetS 的每个组成部分分层时，只有血清甘油三酯升高和高密度脂蛋白胆固醇降低在 CKD 4 期和 5 期患者中比 CKD 3 期患者更为明显（p<0.001），并且与肾功能受损有显著关系。
T2DM 患者中肥胖症和 MetS 的患病率均较高。与非 CKD 对照组相比，糖尿病 CKD 组的 MetS 患病率较高，而肥胖症患病率较低。作为胰岛素抵抗的替代指标，MetS 在糖尿病患者肾功能受损的发展中似乎比肥胖症更为重要。
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