Wang Yang, Li Fei, Chu Chao, Zhang Xi, Zhang Xiao-Yu, Liao Yue-Yuan, Du Ming-Fei, Zou Ting, Ma Qiong, Chen Chen, Wang Dan, Wang Ke-Ke, Yan Yu, Sun Yue, Hu Gui-Lin, Jia Hao, Li Hao, Niu Ze-Jiaxin, Yan Rui-Chen, Man Zi-Yue, Wang Lan, Luo Wen-Jing, Zhang Jie, Li Chun-Hua, Lu Wan-Hong, Chang John, Safirstein Robert, Lu Yao, Mu Jian-Jun
Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an 710061, China.
Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China.
EClinicalMedicine. 2022 Apr 28;48:101420. doi: 10.1016/j.eclinm.2022.101420. eCollection 2022 Jun.
Albuminuria is a marker of vascular dysfunction and is associated with chronic renal and cardiovascular diseases. Data on the association between the longitudinal patterns of weight change early in life and albuminuria later in life are limited. We aimed to identify the body mass index (BMI) trajectory across a 30-year span and evaluate its association with middle-age albuminuria.
Of the 4623 participants aged 6-18-year-old recruited by Hanzhong Adolescent Hypertension Study cohort in northern China from March 10, 1987 to June 3, 2017, a total of 1,825 participants followed up with 6 visits over 30 years were enrolled. Group-based trajectory modeling was used to identify distinct BMI trajectories in longitudinal analyses. Albuminuria was defined as a urinary albumin-to-creatinine ratio (uACR) ≥ 30 mg/g.
Three distinct BMI trajectories were identified: low-increasing ( = 671, 36.8%), moderate-increasing ( = 940, 51.5%), and high-increasing ( = 214, 11.7%); male participants exhibited a steeper increase in BMI than females. The uACR was increased linearly from the low- to high-increasing group. A total of 201 individuals developed albuminuria, with an incidence of 11.0%. Compared with the low-increasing group, the odds ratio (OR) of albuminuria in middle age was 2.13(95% confidence interval [CI]: 1.26 to 3.61) for the high-increasing group after full adjustment for age, sex, smoking, alcohol consumption, marital status, systolic blood pressure, diabetes, and hyperlipidemia. The unadjusted ORs of the high-increasing BMI group were 5.08 (2.76-9.37) for males and 3.45 (1.78-6.69) for females, and the association remained significant in males in the fully adjusted models.
Higher BMI trajectories are associated with higher uACR and an increased risk of albuminuria in middle age, especially in males. Identifying long-term BMI trajectories from an early age may assist in predicting the risk of renal diseases and cardiovascular disease later in life.
This work was supported by the National Natural Science Foundation of China (81600327, 82070437, 81870319, 82070549, and 82170437), Natural Science Basic Research Program of Shaanxi Province (2021JM-257 and 2021JM-588), Institutional Foundation of the First Affiliated Hospital of Xi'an Jiaotong University (2019QN-06 and 2021ZXY-14), the Clinical Research Award of the First Affiliated Hospital of Xi'an Jiaotong University of China (XJTU1AF-CRF-2019-004, XJTU1AF2021CRF-021, and XJTU1AFCRF-2017-021), Research Incubation Fund of Xi'an People's Hospital (FZ-61), Grants from the Major Chronic Non-communicable Disease Prevention and Control Research Key Project of the Ministry of Science and Technology of China (2017YFC1307604 and 2016YFC1300104).
蛋白尿是血管功能障碍的一个指标，与慢性肾脏疾病和心血管疾病相关。关于生命早期体重变化的纵向模式与生命后期蛋白尿之间关联的数据有限。我们旨在确定30年间的体重指数（BMI）轨迹，并评估其与中年蛋白尿的关联。
在中国北方汉中青少年高血压研究队列于1987年3月10日至2017年6月3日招募的4623名6至18岁参与者中，共有1825名在30年间接受了6次随访的参与者被纳入研究。在纵向分析中，采用基于群组的轨迹模型来确定不同的BMI轨迹。蛋白尿定义为尿白蛋白与肌酐比值（uACR）≥30mg/g。
确定了三种不同的BMI轨迹：低增长型（n = 671，36.8%）、中度增长型（n = 940，51.5%）和高增长型（n = 214，11.7%）；男性参与者的BMI增长比女性更陡峭。uACR从低增长组到高增长组呈线性增加。共有201人出现蛋白尿，发病率为11.0%。在对年龄、性别、吸烟、饮酒、婚姻状况、收缩压、糖尿病和高脂血症进行全面调整后，与低增长组相比，高增长组中年蛋白尿的比值比（OR）为2.13（95%置信区间[CI]：1.26至3.61）。高增长BMI组未调整的OR值，男性为5.08（2.76 - 9.37），女性为3.45（1.78 - 6.69），在完全调整模型中，男性的这种关联仍然显著。
较高的BMI轨迹与较高的uACR以及中年蛋白尿风险增加相关，尤其是在男性中。从早年识别长期BMI轨迹可能有助于预测生命后期的肾脏疾病和心血管疾病风险。
本研究得到了中国国家自然科学基金（81600327、82070437、81870319、82070549和82170437）、陕西省自然科学基础研究计划（2021JM - 257和2021JM - 588）、西安交通大学第一附属医院院基金（2019QN - 06和2021ZXY - 14）、中国西安交通大学第一附属医院临床研究奖（XJTU1AF - CRF - 2019 - 004、XJTU1AF2021CRF - 021和XJTU1AFCRF - 2017 - 021）、西安市人民医院研究孵化基金（FZ - 61）、中国科学技术部重大慢性非传染性疾病防控研究重点项目资助（2017YFC1307604和2016YFC1300104）。
