Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Korea.
Department of Internal Medicine, National Health Insurance Service Medical Center, Ilsan Hospital, Goyang-si, Korea.
Diabetes Obes Metab. 2018 Dec;20(12):2778-2791. doi: 10.1111/dom.13458. Epub 2018 Jul 30.
To examine the association between metabolically healthy obese (MHO) phenotype and incident chronic kidney disease (CKD) and study whether changes in metabolic phenotypes over time could affect CKD risk.
A total of 8589 subjects from the Korean Genome and Epidemiology Study were categorized into four groups based on the presence of obesity and metabolic abnormalities (MA). The primary endpoint was an onset of incident CKD defined as an estimated glomerular filtration rate of ≤ 60 mL/min/1.73 m . Multivariable Cox analysis and time-varying Cox analysis were performed to delineate the relationship between obese metabolic phenotypes and incident CKD after adjustment for sociodemographic factors and clinical and laboratory parameters.
During a mean follow-up duration of 9.3 years, CKD occurred in 782 (9.1%) participants. In the multivariable Cox model, the hazard ratio (HR) for incident CKD in the MHO, metabolically abnormal non-obese (MANO), and metabolically abnormal obese (MAO) groups was 1.42 (P = 0.002), 1.45 (P < 0.001), and 1.77 (P < 0.001), respectively, compared with the metabolically healthy non-obese (MHNO) group. Time-varying analysis with these four phenotypes as time-varying exposures showed the same results. Furthermore, subjects with persistent MHO through follow-up were at a 2.0-fold increased risk of CKD (P < 0.001). 41.0% of subjects experienced phenotype changes during follow-up. Over the long term, the MHO group had a higher proportion of transition to the MA phenotype and unfavourable metabolic profiles than the MHNO group. Among MHO subjects, those who transitioned to MAO were at a 4.1-fold increased risk of incident CKD than those who regressed to MHNO. In addition, transition to MHO from other groups carried a higher risk of CKD than persistent MHNO.
MHO subjects are at increased risk for incident CKD.
研究代谢健康肥胖（MHO）表型与慢性肾脏病（CKD）事件之间的关系，并研究随着时间的推移代谢表型的变化是否会影响 CKD 风险。
共纳入韩国基因组与流行病学研究中的 8589 名受试者，根据肥胖和代谢异常（MA）的存在情况将其分为四组。主要终点为新发 CKD 的发生，定义为估算肾小球滤过率≤60ml/min/1.73m 。采用多变量 Cox 分析和时变 Cox 分析，在校正社会人口学因素和临床及实验室参数后，探讨肥胖代谢表型与新发 CKD 之间的关系。
在平均 9.3 年的随访期间，782 名（9.1%）参与者发生 CKD。在多变量 Cox 模型中，MHO、代谢异常非肥胖（MANO）和代谢异常肥胖（MAO）组发生 CKD 的风险比（HR）分别为 1.42（P=0.002）、1.45（P<0.001）和 1.77（P<0.001），与代谢健康非肥胖（MHNO）组相比。用这四种表型作为时变暴露进行时变分析，结果相同。此外，通过随访持续存在 MHO 的患者发生 CKD 的风险增加 2 倍（P<0.001）。41.0%的患者在随访期间经历了表型变化。在长期随访中，MHO 组向 MA 表型和不良代谢特征转变的比例高于 MHNO 组。在 MHO 患者中，从 MAO 组向 MAO 组转变的患者发生 CKD 的风险比从其他组向 MHO 组转变的患者增加了 4.1 倍。此外，与持续的 MHNO 相比，从其他组转变为 MHO 的患者发生 CKD 的风险更高。
MHO 患者发生 CKD 的风险增加。
