Division of Endocrinology and Metabolism, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.
Diabetes Metab J. 2019 Aug;43(4):461-473. doi: 10.4093/dmj.2018.0081. Epub 2019 Mar 7.
BACKGROUND: Although the involvement of obesity in metabolic disorders is well known, leg fat depot influences on albuminuria have not been determined. METHODS: This population-based, cross-sectional study used a nationally representative sample of 2,076 subjects aged ≥20 years from the Korea National Health and Nutrition Examination Surveys of 2008 to 2011. The ratio of leg fat to total fat (LF/TF ratio) was assessed by dual X-ray absorptiometry, and albuminuria was defined as more than one positive dipstick test or an albumin-to-creatinine ratio of ≥30 mg/g. RESULTS: Individuals whose LF/TF ratio was in the lowest tertile showed a higher proportion of albuminuria than those in the highest tertile (odds ratio [OR], 2.82; 95% confidence interval [CI], 2.01 to 3.96; <0.001). This association was observed in both sexes, all age groups, and all subgroups stratified by body mass index, waist circumference, homeostasis model assessments of insulin resistance, and the presence of metabolic syndrome (all, <0.05). Multiple logistic regression analyses also demonstrated that the lowest LF/TF ratio was independently associated with albuminuria risk (OR, 1.55 to 2.16; all, <0.05). In addition, the risk of albuminuria was higher in sarcopenic individuals with lower LF/TF ratios than in the highest LF/TF ratio subjects without sarcopenia (OR, 3.73; 95% CI, 2.26 to 6.13). CONCLUSION: A lower LF/TF ratio was associated with an increased risk of albuminuria independent of obesity, insulin resistance, and metabolic syndrome, and when combined with sarcopenia, the albuminuria risk synergistically increased. Hence, our findings may have implications to improve risk stratification and recommendations on body fat distribution in the general population.
背景:尽管肥胖与代谢紊乱的关系众所周知,但腿部脂肪储量对白蛋白尿的影响尚未确定。
方法:本研究采用基于人群的横断面研究,使用了 2008 年至 2011 年韩国全国健康和营养调查中 2076 名年龄≥20 岁的具有代表性的全国性样本。通过双能 X 线吸收法评估腿部脂肪与总脂肪的比例(LF/TF 比值),白蛋白尿定义为一次以上尿试纸检测阳性或白蛋白/肌酐比值≥30mg/g。
结果:腿部脂肪与总脂肪比值最低的 tertile 个体出现白蛋白尿的比例高于最高 tertile 个体(比值比[OR],2.82;95%置信区间[CI],2.01 至 3.96;<0.001)。这种关联在男性和女性、所有年龄组以及按体重指数、腰围、胰岛素抵抗的稳态模型评估和代谢综合征的存在进行分层的所有亚组中均观察到(所有 P<0.05)。多变量逻辑回归分析还表明,腿部脂肪与总脂肪比值最低与白蛋白尿风险独立相关(OR,1.55 至 2.16;所有 P<0.05)。此外,腿部脂肪与总脂肪比值较低的肌少症个体发生白蛋白尿的风险高于腿部脂肪与总脂肪比值最高的非肌少症个体(OR,3.73;95%CI,2.26 至 6.13)。
结论:腿部脂肪与总脂肪比值较低与白蛋白尿风险增加独立相关,与肥胖、胰岛素抵抗和代谢综合征无关,当与肌少症合并时,白蛋白尿风险呈协同增加。因此,我们的研究结果可能对改善一般人群的风险分层和身体脂肪分布建议具有重要意义。
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