Shen Feng-Ching, Chiu Yi-Wen, Kuo Mei-Chuan, Lin Ming-Yen, Lee Jia-Jung, Hwang Shang-Jyh, Chang Jer-Ming, Hung Chi-Chih, Chen Hung-Chun
Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
J Pers Med. 2021 Dec 13;11(12):1355. doi: 10.3390/jpm11121355.
The obesity paradox, referring to the association of high body mass index (BMI) with low all-cause mortality risk, is found in patients with chronic kidney disease (CKD). Central obesity is associated with metabolic syndrome and may have better prognostic value than BMI for all-cause mortality. Whether central obesity is associated with all-cause mortality in cases of obesity paradox in CKD patients remains unknown. We included 3262 patients with stage 3-5 CKD, grouped into five quintiles (Q1-5) by waist-to-hip ratio (WHR). Low WHR and BMI were associated with malnutrition and inflammation. In Cox regression, high BMI was not associated with all-cause mortality, but BMI < 22.5 kg/m increased the mortality risk. A U-shaped association between central obesity and all-cause mortality was found: WHR Q1, Q4, and Q5 had higher risk for all-cause mortality. The hazard ratio (95% confidence interval) of WHR Q5 and Q1 for all-cause mortality was 1.39 (1.03-1.87) and 1.53 (1.13-2.05) in male and 1.42 (1.02-1.99) and 1.28 (0.88-1.85) in female, respectively. Waist-to-height ratio and conicity index showed similar results. Low WHR or low BMI and high WHR, but not high BMI, are associated with all-cause mortality in advanced CKD.
肥胖悖论是指高体重指数（BMI）与低全因死亡率风险之间的关联，在慢性肾脏病（CKD）患者中也有发现。中心性肥胖与代谢综合征相关，对于全因死亡率而言，其预后价值可能优于BMI。在CKD患者的肥胖悖论病例中，中心性肥胖是否与全因死亡率相关仍不清楚。我们纳入了3262例3-5期CKD患者，根据腰臀比（WHR）分为五个五分位数组（Q1-5）。低WHR和BMI与营养不良和炎症相关。在Cox回归分析中，高BMI与全因死亡率无关，但BMI<22.5kg/m²会增加死亡风险。研究发现中心性肥胖与全因死亡率之间呈U形关联：WHR Q1、Q4和Q5的全因死亡风险更高。WHR Q5和Q1的全因死亡风险比（95%置信区间）在男性中分别为1.39（1.03-1.87）和1.53（1.13-2.05），在女性中分别为1.42（1.02-1.99）和1.28（0.88-1.85）。腰高比和锥度指数显示出相似的结果。在晚期CKD中，低WHR或低BMI以及高WHR（而非高BMI）与全因死亡率相关。
