Department of Epidemiology, School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP, 01246-904, Brazil.
Center of Clinical and Epidemiological Research at University of São Paulo, São Paulo, Brazil.
J Nephrol. 2023 Jun;36(5):1373-1382. doi: 10.1007/s40620-022-01549-w. Epub 2023 Jan 17.
An adverse intrauterine environment reflected by low birth weight (LBW) and prematurity may induce fetal programming that favors kidney dysfunction in adulthood. We examined the association of LBW and prematurity with blood pressure (BP) and kidney function markers in non-diabetic, middle-aged adults without kidney disease from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).
A cross-sectional analysis of 768 subjects aged 35-54 years was conducted. Comparisons were performed according to self-reported birth weight: LBW (< 2.5 kg) or normal birth weight (2.5-4.0 kg). Associations of LBW and prematurity with BP levels and kidney function markers "(estimated glomerular filtration rate [eGFR], albumin-creatinine ratio [ACR] and serum cystatin-C) were tested by multiple linear regression using adjustments based on Directed Acyclic Graphs. Propensity score matching was applied to control imbalances.
Mean age of participants was 45.5 ± 4.6 years and 56.8% were female; 64 (8.3%) participants reported LBW and 39 (5.0%) prematurity. The LBW group had higher systolic (p = 0.015) and diastolic BP (p = 0.014) and ACR values (p = 0.031) and lower eGFR (p = 0.015) than the normal birth weight group, but no group difference for cystatin-C was found. The preterm group had higher mean levels of systolic and diastolic BP, but no difference in kidney function markers was evident. In a regression model adjusted for sex, skin color and family history of hypertension, both systolic and diastolic BP levels were associated with LBW, but this association disappeared after adding for prematurity, which remained associated with BP (p = 0.017). Having applied a propensity score matching, LBW was associated with ACR values (p = 0.003), but not with eGFR or BP levels.
The study findings of independent associations of prematurity with higher BP levels, and of LBW with markers of kidney function in adulthood, support that early life events may predict risk for hypertension and kidney dysfunction in adulthood. The study design precluded the inferring of causality, and prospective studies are needed to further investigate this hypothesis.
低出生体重（LBW）和早产等不良宫内环境可能导致胎儿编程，使成年后肾功能受损。我们在巴西成年人健康纵向研究（ELSA-Brasil）中，研究了非糖尿病、无肾脏疾病的中年成年人中 LBW 和早产与血压（BP）和肾功能标志物的关系。
对 768 名 35-54 岁的受试者进行了横断面分析。根据自我报告的出生体重进行比较：LBW（<2.5kg）或正常出生体重（2.5-4.0kg）。使用基于有向无环图的调整的多元线性回归测试 LBW 和早产与 BP 水平和肾功能标志物（估计肾小球滤过率[eGFR]、白蛋白-肌酐比[ACR]和血清胱抑素-C）之间的关联。应用倾向评分匹配来控制不平衡。
参与者的平均年龄为 45.5±4.6 岁，56.8%为女性；64 名（8.3%）参与者报告 LBW，39 名（5.0%）参与者早产。与正常出生体重组相比，LBW 组的收缩压（p=0.015）和舒张压（p=0.014）以及 ACR 值（p=0.031）更高，eGFR 值更低（p=0.015），但两组间胱抑素-C 无差异。早产组的平均收缩压和舒张压水平较高，但肾功能标志物无差异。在调整性别、肤色和高血压家族史的回归模型中，收缩压和舒张压水平均与 LBW 相关，但添加早产后这种关联消失，而早产仍与 BP 相关（p=0.017）。应用倾向评分匹配后，LBW 与 ACR 值相关（p=0.003），但与 eGFR 或 BP 水平无关。
早产与较高的 BP 水平相关，LBW 与成年后肾功能标志物相关的独立关联研究结果支持，早期生活事件可能预示成年后高血压和肾功能障碍的风险。该研究设计排除了因果关系的推断，需要前瞻性研究进一步验证这一假设。
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