Arora Sumeet, Dunkley Laura, Waldman Lee M, Chin Vivian L, Umpaichitra Vatcharapan
Pediatric Endocrinology Division, Department of Pediatrics, NYC Health + Hospitals/Kings County and SUNY Downstate Health Sciences University, Brooklyn, New York.
Department of Pediatrics, NYC Health + Hospitals/Kings County, Brooklyn, New York.
Clin Obes. 2020 Feb;10(1):e12345. doi: 10.1111/cob.12345. Epub 2019 Nov 6.
Metabolic syndrome and/or body mass index (BMI) ≥40 kg/m are risk factors for kidney function decline in the general population. To compare creatinine (Cr), estimated glomerular filtration rate (eGFR) and blood urea nitrogen (BUN) between minority children and adolescents with metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO), a chart review was conducted on subjects aged 4 to 20 years with BMI ≥95 percentile from July 2014 to April 2017. They were stratified into MHO and MUO groups. Cr, eGFR and BUN were studied. Total n = 277: MHO n = 105 vs MUO n = 172. Cr was higher and BUN was lower in MUO whereas eGFR did not differ between the groups. Using general linear model, we found that metabolic status predicted BUN (P = .009) but not Cr or eGFR. When age, sex and Tanner stage matched, BUN, Cr and eGFR were similar between the groups. Higher BUN in MHO could be due to higher dietary protein intake. Subjects were divided into BMI ≥40 vs <40 kg/m , BUN and eGFR were not different. A trend towards higher Cr in those with BMI ≥40 kg/m (P = .054) was found; the group being older and taller. After age and height matching, all outcomes were not different. Higher Cr was found in those with elevated blood pressures vs the MHO (P = .047). Those with diastolic blood pressure (DBP) ≥90 percentile had higher Cr than those with systolic blood pressure ≥90 percentile (P = .017). Children and adolescents with MUO, and those with BMI ≥40 kg/m did not appear to have early diminished kidney function. Higher Cr, although in normal range, occurred in those with abnormal DBP.
代谢综合征和/或体重指数(BMI)≥40kg/m²是一般人群肾功能下降的危险因素。为比较代谢健康肥胖(MHO)和代谢不健康肥胖(MUO)的少数族裔儿童及青少年之间的肌酐(Cr)、估计肾小球滤过率(eGFR)和血尿素氮(BUN),对2014年7月至2017年4月期间年龄在4至20岁、BMI≥第95百分位数的受试者进行了图表回顾。他们被分为MHO组和MUO组。对Cr、eGFR和BUN进行了研究。总样本量n = 277:MHO组n = 105,MUO组n = 172。MUO组的Cr较高而BUN较低,而两组之间的eGFR无差异。使用一般线性模型,我们发现代谢状态可预测BUN(P = 0.009),但不能预测Cr或eGFR。当年龄、性别和坦纳分期匹配时,两组之间的BUN、Cr和eGFR相似。MHO组中较高的BUN可能归因于较高的膳食蛋白质摄入量。受试者被分为BMI≥40与<40kg/m²,BUN和eGFR无差异。发现BMI≥40kg/m²者有Cr升高的趋势(P = 0.054);该组年龄更大且身高更高。在年龄和身高匹配后,所有结果均无差异。血压升高者的Cr高于MHO组(P = 0.047)。舒张压(DBP)≥第90百分位数者的Cr高于收缩压≥第90百分位数者(P = 0.017)。MUO儿童及青少年以及BMI≥40kg/m²者似乎没有早期肾功能减退。虽然Cr在正常范围内,但异常DBP者的Cr较高。