Department of Pediatrics, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Pediatr Nephrol. 2021 Jul;36(7):1851-1860. doi: 10.1007/s00467-020-04907-7. Epub 2021 Jan 21.
Longitudinal changes in body mass index (BMI) among overweight and obese children with chronic kidney disease (CKD) are not well characterized. We studied longitudinal trajectories and correlates of these trajectories, as results may identify opportunities to optimize health outcomes.
Longitudinal changes in age-sex-specific BMI z-scores over 1851 person-years of follow-up were assessed in 524 participants of the Chronic Kidney Disease in Children Study. A total of 353 participants were categorized as normal (BMI > 5th to < 85th percentile), 56 overweight (BMI ≥ 85th to 95th percentile) and 115 obese (BMI ≥ 95th percentile) based on the average of three BMI measurements during the first year of follow-up. Studied covariates included age, sex, race, CKD etiology, corticosteroid usage, household income, and maternal education.
In unadjusted analysis, BMI z-scores decreased over time in elevated BMI groups (overweight: mean = - 0.06 standard deviations (SD) per year, 95% CI: - 0.11, - 0.01; obese: mean = - 0.04 SD per year, 95% CI: - 0.07, - 0.01). Among obese children, only age was associated with change in BMI z-score; children < 6 years had a mean decrease of 0.19 SD during follow-up (95% CI: - 0.30, - 0.09). Socioeconomic factors were not associated with change in BMI.
Overweight and obese children with CKD demonstrated a significant annual decline in BMI, though the absolute change was modest. Among obese children, only age < 6 years was associated with significant decline in BMI. Persistence of elevated BMI in older children and adolescents with CKD underscores the need for early prevention and effective intervention.
超重和肥胖的慢性肾脏病（CKD）患儿的体重指数（BMI）纵向变化尚不清楚。我们研究了这些轨迹的纵向轨迹和相关性，因为结果可能会确定优化健康结果的机会。
在慢性肾脏病儿童研究中，对 524 名参与者进行了 1851 人年的随访，评估了年龄-性别特异性 BMI z 分数的纵向变化。根据随访第一年三次 BMI 测量的平均值，共有 353 名参与者被归类为正常（BMI > 5th 至 < 85th 百分位），56 名超重（BMI ≥ 85th 至 95th 百分位）和 115 名肥胖（BMI ≥ 95th 百分位）。研究的协变量包括年龄、性别、种族、CKD 病因、皮质类固醇使用、家庭收入和母亲教育。
在未调整分析中，超重和肥胖组的 BMI z 分数随时间呈下降趋势（超重：平均每年下降 0.06 个标准差（SD），95%置信区间：-0.11，-0.01；肥胖：平均每年下降 0.04 SD，95% CI：-0.07，-0.01）。在肥胖儿童中，只有年龄与 BMI z 分数的变化相关；6 岁以下儿童在随访期间平均下降 0.19 SD（95% CI：-0.30，-0.09）。社会经济因素与 BMI 变化无关。
患有 CKD 的超重和肥胖儿童的 BMI 呈显著的年度下降趋势，尽管绝对变化较小。在肥胖儿童中，只有年龄<6 岁与 BMI 的显著下降有关。年龄较大的儿童和青少年 CKD 患者持续存在的 BMI 升高，突显了早期预防和有效干预的必要性。
