Iqbal Junaid, Wu Hui-Xuan, Nawaz Muhammad Asad, Jiang Hong-Li, Xu Shi-Na, Huang Bi-Ling, Li Long, Cai Jun-Min, Zhou Hou-De
National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory for Metabolic Bone Diseases, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China.
Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China.
Obes Rev. 2024 Feb;25(2):e13656. doi: 10.1111/obr.13656. Epub 2023 Oct 30.
Studies have reported inconsistent results about the risk of incident chronic kidney disease (CKD) in people with metabolically healthy obesity (MHO). We designed this systematic review and meta-analysis to evaluate the risk of developing CKD in people with MHO and metabolically unhealthy normal weight (MUNW). We used a predefined search strategy to retrieve eligible studies from multiple databases up to June 20, 2022. Random-effects model meta-analyses were implied to estimate the overall hazard ratio (HR) of incident CKD in obesity phenotypes. Eight prospective cohort studies, including approximately 5 million participants with a median follow-up ranging between 3 and 14 years, were included in this meta-analysis. Compared to the metabolically healthy normal weight (MHNW), the mean differences in cardiometabolic and renal risk factors in MHO, MUNW, and metabolically unhealthy obesity (MUO) were evaluated with overall HR of 1.42, 1.49, and 1.84, respectively. Compared to MHNW, the mean estimated glomerular filtration rate (eGFR) and high-density lipoprotein (HDL) were significantly lower, and low-density lipoprotein (LDL), blood pressure, blood glucose, and triglycerides were higher in MHO and MUNW. In conclusion, MHO and MUNW are not benign conditions and pose a higher risk for incident CKD. Obesity, whether in the presence or absence of metabolic health, is a risk factor for CKD.
关于代谢健康型肥胖（MHO）患者发生慢性肾脏病（CKD）的风险，研究报告的结果并不一致。我们开展了这项系统评价和荟萃分析，以评估MHO和代谢不健康的正常体重（MUNW）人群发生CKD的风险。我们采用预先设定的检索策略，从多个数据库中检索截至2022年6月20日的 eligible 研究。采用随机效应模型荟萃分析来估计肥胖表型中CKD发病的总体风险比（HR）。本荟萃分析纳入了8项前瞻性队列研究，包括约500万名参与者，中位随访时间在3至14年之间。与代谢健康的正常体重（MHNW）相比，MHO、MUNW和代谢不健康型肥胖（MUO）中心血管代谢和肾脏危险因素的平均差异分别通过总体HR为1.42、1.49和1.84进行评估。与MHNW相比，MHO和MUNW的平均估计肾小球滤过率（eGFR）和高密度脂蛋白（HDL）显著降低，而低密度脂蛋白（LDL）、血压、血糖和甘油三酯则较高。总之，MHO和MUNW并非良性状态，发生CKD的风险更高。肥胖，无论是否伴有代谢健康，都是CKD的一个危险因素。
