Luo Wenjin, Gong Lilin, Chen Xiangjun, Gao Rufei, Peng Bin, Wang Yue, Luo Ting, Yang Yi, Kang Bing, Peng Chuan, Ma Linqiang, Mei Mei, Liu Zhiping, Li Qifu, Yang Shumin, Wang Zhihong, Hu Jinbo
Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Laboratory of Reproductive Biology, School of Public Health and Management, Chongqing Medical University, Chongqing, China.
Front Nutr. 2022 Jul 22;9:918576. doi: 10.3389/fnut.2022.918576. eCollection 2022.
Individual lifestyle varies in the real world, and the comparative efficacy of lifestyles to preserve renal function remains indeterminate. We aimed to systematically compare the effects of lifestyles on chronic kidney disease (CKD) incidence, and establish a lifestyle scoring system for CKD risk identification.
Using the data of the UK Biobank cohort, we included 470,778 participants who were free of CKD at the baseline. We harnessed the light gradient boosting machine algorithm to rank the importance of 37 lifestyle factors (such as dietary patterns, physical activity (PA), sleep, psychological health, smoking, and alcohol) on the risk of CKD. The lifestyle score was calculated by a combination of machine learning and the Cox proportional-hazards model. A CKD event was defined as an estimated glomerular filtration rate <60 ml/min/1.73 m, mortality and hospitalization due to chronic renal failure, and self-reported chronic renal failure, initiated renal replacement therapy.
During a median of the 11-year follow-up, 13,555 participants developed the CKD event. Bread, walking time, moderate activity, and vigorous activity ranked as the top four risk factors of CKD. A healthy lifestyle mainly consisted of whole grain bread, walking, moderate physical activity, oat cereal, and muesli, which have scored 12, 12, 10, 7, and 7, respectively. An unhealthy lifestyle mainly included white bread, tea >4 cups/day, biscuit cereal, low drink temperature, and processed meat, which have scored -12, -9, -7, -4, and -3, respectively. In restricted cubic spline regression analysis, a higher lifestyle score was associated with a lower risk of CKD event ( for linear relation < 0.001). Compared to participants with the lifestyle score < 0, participants scoring 0-20, 20-40, 40-60, and >60 exhibited 25, 42, 55, and 70% lower risk of CKD event, respectively. The C-statistic of the age-adjusted lifestyle score for predicting CKD events was 0.710 (0.703-0.718).
A lifestyle scoring system for CKD prevention was established. Based on the system, individuals could flexibly choose healthy lifestyles and avoid unhealthy lifestyles to prevent CKD.
在现实世界中，个体生活方式各不相同，而不同生活方式对肾功能的保护作用的比较效果仍不明确。我们旨在系统地比较不同生活方式对慢性肾脏病（CKD）发病率的影响，并建立一种用于CKD风险识别的生活方式评分系统。
利用英国生物银行队列的数据，我们纳入了470778名在基线时无CKD的参与者。我们利用轻梯度提升机算法对37种生活方式因素（如饮食模式、身体活动（PA）、睡眠、心理健康、吸烟和饮酒）对CKD风险的重要性进行排名。生活方式得分通过机器学习和Cox比例风险模型相结合来计算。CKD事件定义为估计肾小球滤过率<60 ml/min/1.73 m²、因慢性肾衰竭导致的死亡和住院，以及自我报告的慢性肾衰竭、开始肾脏替代治疗。
在中位11年的随访期间，13555名参与者发生了CKD事件。面包、步行时间、中等强度活动和剧烈强度活动位列CKD的前四大风险因素。健康的生活方式主要包括全麦面包、步行、中等强度身体活动、燕麦片和什锦早餐，其得分分别为12、12、10、7和7。不健康的生活方式主要包括白面包、每天饮茶>4杯、饼干谷物、低饮品温度和加工肉类，其得分分别为-12、-9、-7、-4和-3。在受限立方样条回归分析中，较高的生活方式得分与较低的CKD事件风险相关（线性关系P<0.001）。与生活方式得分<0的参与者相比，得分在0-20、20-40、40-60和>60的参与者发生CKD事件的风险分别降低了25%、42%、55%和70%。年龄调整后的生活方式得分预测CKD事件的C统计量为0.710（0.703-0.718）。
建立了一种用于CKD预防的生活方式评分系统。基于该系统，个体可以灵活选择健康的生活方式，避免不健康的生活方式以预防CKD。
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