Koch Vera H
Pediatric Nephrology Unit, Department of Pediatrics, Instituto da Criança e do Adolescente do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Front Med (Lausanne). 2021 Nov 12;8:704409. doi: 10.3389/fmed.2021.704409. eCollection 2021.
Obesity is a chronic disease, with a rapidly increasing prevalence worldwide. Body mass index (BMI) provides the most useful population-level measure of overweight and obesity. For adults, overweight is defined as a BMI (Kg/m) ≥ 25, and obesity as a BMI ≥ 30, for non-Asians and ≥ 27.5 for Asians. Abdominal obesity can be defined as a waist circumference equal to or higher than 102 cm for men and ≥88 cm for women. The definition of children and adolescents BMI changes with age and sex. Obesity may be exogenous or endogenous obesity, the latter is multifactorial and predominantly manifested during childhood. Presently, overweight and obesity are linked to more deaths worldwide than underweight. The total kidney glomerular filtration rate (GFR) is determined by the sum of nephrons and the GFR within each nephron or single nephron GFR. In clinical practice, GFR is more frequently calculated by GFR estimating equations based upon the plasma levels of creatinine, cystatin C, or both. The measured value of plasma creatinine is strongly influenced by non-GFR factors, by its tubular and gastrointestinal secretion, and by the problems associated with the lack of standardization of creatinine's laboratory assay discrediting it as an ideal GFR biomarker. Unlike creatinine, cystatin C plasma levels are mainly determined by GFR. Obesity may affect the kidney, development of systemic arterial hypertension and/or diabetes mellitus, or directly, by ectopic accumulation of adipose tissue in the kidney. As obesity is a clinical condition associated with altered body composition, creatinine may not be the ideal biomarker for GFR measurement in obese individuals.
肥胖是一种慢性疾病，在全球范围内患病率迅速上升。体重指数（BMI）是衡量超重和肥胖最有用的人群水平指标。对于成年人，非亚洲人超重定义为BMI（千克/米²）≥25，肥胖定义为BMI≥30；亚洲人超重定义为BMI≥25，肥胖定义为BMI≥27.5。腹型肥胖可定义为男性腰围等于或高于102厘米，女性腰围≥88厘米。儿童和青少年BMI的定义随年龄和性别而变化。肥胖可能是外源性或内源性肥胖，后者是多因素的，主要在儿童期表现出来。目前，全球范围内超重和肥胖导致的死亡人数比体重不足更多。总肾小球滤过率（GFR）由肾单位总数以及每个肾单位内的GFR（即单个肾单位GFR）之和决定。在临床实践中，GFR更常通过基于血浆肌酐、胱抑素C水平或两者的GFR估算方程来计算。血浆肌酐的测量值受非GFR因素、肾小管和胃肠道分泌以及肌酐实验室检测缺乏标准化相关问题的强烈影响，这使其作为理想的GFR生物标志物受到质疑。与肌酐不同，胱抑素C的血浆水平主要由GFR决定。肥胖可能影响肾脏、全身动脉高血压和/或糖尿病的发生发展，或者通过脂肪组织在肾脏中的异位积聚直接产生影响。由于肥胖是一种与身体成分改变相关的临床状况，肌酐可能不是肥胖个体中测量GFR的理想生物标志物。
