Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.
Obesity (Silver Spring). 2021 Jun;29(6):1058-1066. doi: 10.1002/oby.23145. Epub 2021 Apr 16.
This study aimed to investigate the relationship of BMI trajectories from childhood with subclinical kidney damage (SKD) in midlife, a surrogate measure for chronic kidney disease.
The study followed up 1,442 participants from the 1985 Australian Schools Health and Fitness Survey who were between 7 and 15 years old at the time the survey was conducted and who had BMI measurements in childhood and at least two follow-ups in adulthood. Measures of kidney function for participants 36 to 50 years old were also included. Latent class growth mixture modeling was used to identify the BMI trajectories. Log-binomial regression determined the associations of BMI trajectories with SKD defined as either 1) an estimated glomerular filtration rate (eGFR) of 30 to 60 mL/min/1.73 m or 2) an eGFR > 60 mL/min/1.73 m with a urine albumin-creatinine ratio ≥ 2.5 mg/mmol (males) or 3.5 mg/mmol (females), adjusting for childhood age, sex, and duration of follow-up.
Relative to the persistently low trajectory (n = 534, 37.0%), being in higher BMI trajectories was associated with greater risk of SKD in midlife (relative risk [RR] = 1.89, 95% CI = 1.10-3.25 for progressing to moderate [n = 633, 43.9%]; RR = 1.91, 95% CI = 0.95-3.81 for progressing to moderate/high [n = 194, 13.5%]; RR = 2.86, 95% CI = 1.03-7.99 for progressing to high/very high [n = 39, 2.7%]; and RR = 2.47, 95% CI = 0.77-7.94 for adult-onset high [n = 35, 2.4%]).
Participants with increasing BMI trajectories from childhood had an increased risk of SKD in midlife.
本研究旨在探讨儿童时期 BMI 轨迹与中年亚临床肾脏损伤（SKD）的关系，SKD 是慢性肾脏病的替代指标。
该研究对 1985 年澳大利亚学校健康与健身调查中的 1442 名参与者进行了随访，这些参与者在调查时年龄在 7 至 15 岁之间，并且在儿童时期和成年后至少有两次随访时都进行了 BMI 测量。还包括了 36 至 50 岁参与者的肾功能测量值。采用潜在类别增长混合模型来识别 BMI 轨迹。使用对数二项式回归确定 BMI 轨迹与 SKD 的关联，SKD 定义为：1）估算肾小球滤过率（eGFR）为 30 至 60 mL/min/1.73 m，或 2）eGFR>60 mL/min/1.73 m，同时尿液白蛋白/肌酐比值≥2.5 mg/mmol（男性）或 3.5 mg/mmol（女性），调整儿童时期的年龄、性别和随访时间。
与持续低 BMI 轨迹（n=534，37.0%）相比，处于较高 BMI 轨迹（n=908，63.0%）的参与者在中年时发生 SKD 的风险更高（相对风险[RR]为 1.89，95%CI 为 1.10-3.25，进展为中度[n=633，43.9%]；RR 为 1.91，95%CI 为 0.95-3.81，进展为中/高度[n=194，13.5%]；RR 为 2.86，95%CI 为 1.03-7.99，进展为高度/非常高[n=39，2.7%]；RR 为 2.47，95%CI 为 0.77-7.94，成人发病的高 BMI 轨迹[n=35，2.4%]）。
儿童时期 BMI 轨迹增加的参与者在中年时发生 SKD 的风险增加。
