肥胖、性别与慢性肾脏病儿童心血管疾病风险：一项入组慢性肾脏病儿童研究（CKiD）的青少年纵向研究
Adiposity, Sex, and Cardiovascular Disease Risk in Children With CKD: A Longitudinal Study of Youth Enrolled in the Chronic Kidney Disease in Children (CKiD) Study.
机构信息
Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
出版信息
Am J Kidney Dis. 2020 Aug;76(2):166-173. doi: 10.1053/j.ajkd.2020.01.011. Epub 2020 May 7.
RATIONALE & OBJECTIVE: Traditional and nontraditional cardiovascular disease risk factors are highly prevalent in children with chronic kidney disease (CKD). We examined the longitudinal association of adiposity with cardiac damage among children with CKD and explored whether this association was modified by sex.
STUDY DESIGN
Prospective cohort study.
SETTING & PARTICIPANTS: Children with mild-to-moderate CKD enrolled in the Chronic Kidney Disease in Children (CKiD) Study at 49 pediatric nephrology centers across North America.
EXPOSURE
Age- and sex-specific body mass index (BMI) z score.
OUTCOME
Age- and sex-specific left ventricular mass index (LVMI) z score and left ventricular hypertrophy (LVH).
ANALYTICAL APPROACH
Longitudinal analyses using mixed-effects models to estimate sex-specific associations of BMI z scores with LVMI z score and with LVH, accounting for repeated measurements over time.
RESULTS
Among 725 children with 2,829 person-years of follow-up, median age was 11.0 years and median estimated glomerular filtration rate was 52.6mL/min/1.73m. Nearly one-third of both boys and girls were overweight or obese, median LVMI z score was 0.18 (IQR: -0.67, 1.08), and 11% had LVH. Greater BMI z scores were independently associated with greater LVMI z scores and greater odds of LVH. For each 1-unit higher BMI z score, LVMI z score was 0.24 (95% CI, 0.17-0.31) higher in boys and 0.38 (95% CI, 0.29-0.47) higher in girls (P = 0.01). For each 1-unit higher BMI z score, the odds of LVH was 1.5-fold (95% CI, 1.1-2.1) higher in boys and 3.1-fold (95% CI, 1.8-4.4) higher in girls (P = 0.005).
LIMITATIONS
Not all children had repeated measurements. LVH is a surrogate and not a hard cardiac outcome. The observational design limits causal inference.
CONCLUSIONS
In children, adiposity is independently associated with the markers of cardiac damage, LVMI z score and LVH. This association is stronger among girls than boys. Pediatric overweight and obesity may therefore have a substantial impact on cardiovascular risk among children with CKD.
背景与目的
传统和非传统心血管疾病危险因素在慢性肾脏病（CKD）患儿中普遍存在。我们研究了肥胖与 CKD 患儿心脏损伤的纵向关联，并探讨了这种关联是否受性别影响。
研究设计
前瞻性队列研究。
研究场所和参与者
北美 49 家儿科肾脏病中心的慢性肾脏病儿童研究（CKiD）入组的轻度至中度 CKD 患儿。
暴露因素
年龄和性别特异性体重指数（BMI）z 评分。
主要转归
年龄和性别特异性左心室质量指数（LVMI）z 评分和左心室肥厚（LVH）。
分析方法
使用混合效应模型进行纵向分析，以估计 BMI z 评分与 LVMI z 评分和 LVH 的性别特异性关联，同时考虑随时间的重复测量。
结果
在 725 名患儿中，共随访 2829 人年，中位年龄为 11.0 岁，中位估计肾小球滤过率为 52.6mL/min/1.73m。几乎三分之一的男孩和女孩超重或肥胖，中位 LVMI z 评分为 0.18（IQR：-0.67，1.08），11%的患儿有 LVH。较高的 BMI z 评分与较高的 LVMI z 评分和更高的 LVH 发生率独立相关。每增加 1 个单位的 BMI z 评分，男孩的 LVMI z 评分增加 0.24（95%CI，0.17-0.31），女孩的 LVMI z 评分增加 0.38（95%CI，0.29-0.47）（P=0.01）。每增加 1 个单位的 BMI z 评分，男孩的 LVH 发生率增加 1.5 倍（95%CI，1.1-2.1），女孩的 LVH 发生率增加 3.1 倍（95%CI，1.8-4.4）（P=0.005）。
局限性
并非所有患儿都有重复测量。LVH 只是一个替代指标，而非硬性的心脏结局。观察性设计限制了因果关系的推断。
结论
在儿童中，肥胖与心脏损伤标志物（LVMI z 评分和 LVH）独立相关。这种关联在女孩中比男孩更强。儿科超重和肥胖可能会对 CKD 患儿的心血管风险产生重大影响。
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