Department of Family Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea.
Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
PLoS One. 2021 Feb 10;16(2):e0246017. doi: 10.1371/journal.pone.0246017. eCollection 2021.
Although several self-reported questionnaire-based studies have found an association between smoking and moderately increased albuminuria, this result remains controversial. We investigated whether moderately increased albuminuria was associated with smoking status, verified by urinary cotinine (an objective biomarker of tobacco exposure), using population-based, nationally representative data.
This study included 2059 participants aged ≥ 50 years from the 2014 Korean National Health and Nutrition Examination Survey. Individuals with a urinary cotinine level ≥ 50 ng/mL were identified as cotinine-verified smokers. Moderately increased albuminuria was defined as a urine albumin-to-creatinine ratio ranging between ≥ 30 mg/g and < 300 mg/g. Multivariable logistic regression was used to evaluate the association between cotinine-verified smoking status and moderately increased albuminuria.
Among the study participants, 16.9% were cotinine-verified smokers, 84.8% of whom were men. After adjustment for multiple covariates, cotinine-verified smokers showed a significant positive association with moderately increased albuminuria (adjusted odds ratio: 4.37, 95% confidence interval: 1.63-11.71) compared with cotinine-verified non-smokers. The association between urinary cotinine and moderately increased albuminuria did not differ with age, sex, obesity, or comorbidities (P-value for interaction > 0.05 in all cases).
This large-scale observational study showed that cotinine-verified smoking is associated with moderately increased albuminuria in the Korean middle-aged and older general population, suggesting that smoking must be strictly controlled to reduce the risk of moderately increased albuminuria.
尽管有几项基于自我报告问卷的研究发现吸烟与中等程度白蛋白尿之间存在关联，但这一结果仍存在争议。我们使用基于人群的全国代表性数据，通过尿液可替宁（烟草暴露的客观生物标志物）验证，调查了中等程度白蛋白尿是否与吸烟状况有关。
本研究纳入了 2014 年韩国国家健康与营养调查中 2059 名年龄≥50 岁的参与者。尿液可替宁水平≥50ng/mL 的个体被鉴定为可替宁验证的吸烟者。中等程度白蛋白尿定义为尿白蛋白与肌酐比值在≥30mg/g 至<300mg/g 之间。多变量逻辑回归用于评估可替宁验证的吸烟状态与中等程度白蛋白尿之间的关联。
在研究参与者中，16.9%为可替宁验证的吸烟者，其中 84.8%为男性。在调整了多个协变量后，与可替宁验证的非吸烟者相比，可替宁验证的吸烟者与中等程度白蛋白尿呈显著正相关（调整后的优势比：4.37，95%置信区间：1.63-11.71）。尿液可替宁与中等程度白蛋白尿之间的关联与年龄、性别、肥胖或合并症无关（在所有情况下，交互检验 P 值>0.05）。
这项大规模观察性研究表明，可替宁验证的吸烟与韩国中老年人群的中等程度白蛋白尿有关，这表明必须严格控制吸烟以降低中等程度白蛋白尿的风险。
