Department of Endocrinology, The First Clinical Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China.
Medical School of Chinese PLA, Beijing, China.
J Diabetes. 2022 Aug;14(8):541-550. doi: 10.1111/1753-0407.13302.
Urinary albumin-creatinine ratio (UACR) is a sensitive marker of kidney injury. This study analyzed the prevalence of different metabolic phenotypes and investigated their relationship with UACR in Chinese community adults.
This study involved 33 303 participants over 40 years old from seven centers across China. They were stratified into six groups according to their body mass index (BMI) and metabolic status: metabolically healthy normal weight (MHNW), metabolically healthy overweight (MHOW), metabolically healthy obesity (MHO), metabolically unhealthy normal weight (MUNW), metabolically unhealthy overweight (MUOW), and metabolically unhealthy obesity (MUO). Increased albuminuria was defined as a UACR ≥30 mg/g.
The percentages of MHNW, MHOW, MHO, MUNW, MUOW, and MUO were 27.6%, 15.9%, 4.1%, 19.8%, 22.5%, and 9.6%, respectively. Multiple logistic regression analysis showed that the MHO group (odds ratio [OR] 1.205; 95% CI, 1.081-1.343), MUNW group (OR 1.232; 95% CI, 1.021-1.486), MUOW group (OR 1.447; 95% CI, 1.303-1.607), and MUO group (OR 1.912; 95% CI, 1.680-2.176) were at higher risk of increased albuminuria compared to the MHNW group. Subgroup analysis indicated that the risk of increased albuminuria was further elevated among regular smokers in men aged 40 to 55 years old with abdominal obesity.
Among Chinese community adults, increased albuminuria was associated with increased BMI whether metabolism was normal or not, and those with abnormal metabolism were at greater risk of increased albuminuria than those with normal metabolism. These findings suggest that overweight or obesity or metabolic abnormalities are risk factors for chronic kidney disease.
尿白蛋白与肌酐比值（UACR）是肾脏损伤的敏感标志物。本研究分析了不同代谢表型的流行情况，并探讨了其与中国社区成年人 UACR 的关系。
本研究纳入了来自中国 7 个中心的 33303 名 40 岁以上的参与者。根据体重指数（BMI）和代谢状态，他们被分为 6 组：代谢健康正常体重（MHNW）、代谢健康超重（MHOW）、代谢健康肥胖（MHO）、代谢不健康正常体重（MUNW）、代谢不健康超重（MUOW）和代谢不健康肥胖（MUO）。白蛋白尿增加定义为 UACR≥30mg/g。
MHNW、MHOW、MHO、MUNW、MUOW 和 MUO 的比例分别为 27.6%、15.9%、4.1%、19.8%、22.5%和 9.6%。多因素 logistic 回归分析显示，MHO 组（比值比[OR]1.205；95%置信区间[CI]，1.081-1.343）、MUNW 组（OR 1.232；95%CI，1.021-1.486）、MUOW 组（OR 1.447；95%CI，1.303-1.607）和 MUO 组（OR 1.912；95%CI，1.680-2.176）发生白蛋白尿增加的风险高于 MHNW 组。亚组分析表明，在 40-55 岁的男性中，有规律吸烟且腹型肥胖者，白蛋白尿增加的风险进一步升高。
在中国社区成年人中，无论代谢是否正常，BMI 增加与白蛋白尿增加相关，而代谢异常者发生白蛋白尿增加的风险高于代谢正常者。这些发现提示超重或肥胖或代谢异常是慢性肾脏病的危险因素。
