肥胖、超重和正常体重个体的代谢表型与慢性肾脏病风险：一项系统评价和荟萃分析
Metabolic phenotypes of obese, overweight, and normal weight individuals and risk of chronic kidney disease: a systematic review and meta-analysis.
作者信息
Alizadeh Shahab, Esmaeili Hamed, Alizadeh Mohammad, Daneshzad Elnaz, Sharifi Loghman, Radfar Hossein, Radaei Mohammad Kazem
机构信息
Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
Department of Nutrition and Food Hygiene, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran.
出版信息
Arch Endocrinol Metab. 2019 Jul 29;63(4):427-437. doi: 10.20945/2359-3997000000149.
OBJECTIVE
Chronic kidney disease (CKD) risk is inconsistent in the normal-weight, overweight, and obese individuals due to the heterogeneity of metabolic status. This meta-analysis aimed to examine the combined effects of body mass index (BMI) and metabolic status on CKD risk.
MATERIALS AND METHODS
The MEDLINE, EMBASE, and Web of Knowledge databases were systematically searched up to March 2019 to identify all eligible studies investigating the CKD risk (defined as GFR < 60 mL/min per 1.73 m2 and/or microalbuminuria or proteinuria) associated with the body size phenotypes which are known as metabolically unhealthy normal-weight (MUNW), metabolically healthy overweight (MHOW), metabolically unhealthy overweight, metabolically healthy obese (MHO) and metabolically unhealthy obese (MUHO). The classification of subjects in included studies as metabolically unhealthy was based on the presence of three components of metabolic syndrome. BMI categorization was based on the criteria of included studies. The risk estimates and 95% confidence intervals (CIs) were extracted and pooled using random effects analysis.
RESULTS
A total of 9 prospective cohort studies with 128773 participants and 4797 incident cases were included in the meta-analysis. Compared with healthy normal-weight individuals as reference, MUNW and MHO subjects showed an increased risk for CKD events with a pooled RR of 1.58 (95% CI = 1.28-1.96) in MUNW and 1.55 (95% CI = 1.34-1.79) in MHO persons. Also, MHOW was at increased risk for CKD (RR = 1.34, 95% CI = 1.20-1.51). MUHO individuals were at the highest risk for the development of CKD (RR = 2.13, 95% CI = 1.66-2.72).
CONCLUSIONS
Individuals with metabolic abnormality, although at normal-weight, have an increased risk for CKD. Healthy overweight and obese individuals had higher risk; refuting the notion that metabolically healthy overweight and obese phenotypes are benign conditions.
目的
由于代谢状态的异质性，正常体重、超重和肥胖个体患慢性肾脏病（CKD）的风险并不一致。本荟萃分析旨在研究体重指数（BMI）和代谢状态对CKD风险的综合影响。
材料与方法
系统检索MEDLINE、EMBASE和Web of Knowledge数据库至2019年3月，以确定所有符合条件的研究，这些研究调查了与代谢不健康正常体重（MUNW）、代谢健康超重（MHOW）、代谢不健康超重、代谢健康肥胖（MHO）和代谢不健康肥胖（MUHO）等体型表型相关的CKD风险（定义为肾小球滤过率<60 mL/（min·1.73 m²）和/或微量白蛋白尿或蛋白尿）。纳入研究中受试者代谢不健康的分类基于代谢综合征的三个组成部分的存在情况。BMI分类基于纳入研究的标准。采用随机效应分析提取并汇总风险估计值和95%置信区间（CI）。
结果
荟萃分析共纳入9项前瞻性队列研究，128773名参与者和4797例新发病例。与健康正常体重个体作为对照相比，MUNW和MHO受试者发生CKD事件的风险增加，MUNW的合并相对危险度（RR）为1.58（95%CI=1.28-1.96），MHO个体为1.55（95%CI=1.34-1.79）。此外，MHOW发生CKD的风险也增加（RR=1.34，95%CI=1.20-1.51）。MUHO个体发生CKD的风险最高（RR=2.13，95%CI=1.66-2.72）。
结论
代谢异常的个体，即使体重正常，患CKD的风险也会增加。健康的超重和肥胖个体风险更高；这反驳了代谢健康的超重和肥胖表型是良性状况的观点。
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