Zeng Z Q, Ma Y, Yang C, Yu C Q, Sun D J Y, Pei P, Du H D, Chen J S, Chen Z M, Li L M, Zhang L X, Lyu J
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China.
Department of Nephrology, Peking University First Hospital, Peking University Institute of Nephrology, Beijing 100034, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2024 Jul 10;45(7):903-913. doi: 10.3760/cma.j.cn112338-20240227-00085.
To examine the associations of BMI and waist circumference (WC) with the risk of chronic kidney disease (CKD) and its subtypes in adults in China. The data from the China Kadoorie Biobank were used. After excluding those with cancer, coronary heart disease, stroke, or CKD at baseline survey, 480 430 participants were included in this study. Their body height and weight, and WC were measured at baseline survey. Total CKD was defined as diabetic kidney disease (DKD), hypertensive nephropathy (HTN), glomerulonephritis (GN), chronic tubulointerstitial nephritis (CTIN), obstructive nephropathy (ON), CKD due to other causes, and chronic kidney failure. Cox proportional hazards regression model was used to estimate the associations between exposure factors and risks of outcomes. During a follow-up period of (11.8±2.2) years, 5 486 cases of total CKD were identified, including 1 147 cases of DKD, 340 cases of HTN, 1 458 cases of GN, 460 cases of CTIN, 598 cases of ON, 418 cases of CKD due to other causes, and 1 065 cases of chronic kidney failure. After adjusting for socio-demographic factors, lifestyle factors, baseline prevalence of hypertension and diabetes, and WC and compared to participants with normal BMI (18.5-23.9 kg/m), the hazard ratios (s) of total CKD for underweight (<18.5 kg/m), overweight (24.0-27.9 kg/m), and obese (≥28.0 kg/m) were 1.42 (95%: 1.23-1.63), 1.00 (95%: 0.93-1.08) and 0.98 (95%: 0.87-1.10), respectively. Stratification analysis by WC showed that BMI was negatively associated with risk for total CKD in non-central obese participants (WC: <85.0 cm in men and <80.0 cm in women) (=0.97, 95%: 0.96-0.99), while the association was positive in central obese participants (≥90.0 cm in men and ≥85.0 cm in women) (=1.03, 95%: 1.01-1.05). The association between BMI and GN was similar to that of total CKD. BMI was associated with an increased risk for HTN, with a of 1.12 (95%: 1.06-1.18) per 1.0 kg/m higher BMI. After adjusting for potential confounders and BMI, compared to participants with non-central obesity, the s for pre-central obesity (WC: 85.0-89.9 cm in men and 80.0-84.9 in women) and central obesity were 1.26 (95%: 1.16-1.36) and 1.32 (95%: 1.20-1.45), respectively. With the exception of HTN and CTIN, WC was positively associated with risks for all CKD subtypes. BMI-defined underweight and central obesity were independent risk factors for total CKD, and BMI and WC had different associations with risks for disease subtypes.
旨在研究中国成年人中体重指数（BMI）和腰围（WC）与慢性肾脏病（CKD）及其亚型风险之间的关联。使用了中国嘉道理生物银行的数据。在排除基线调查时患有癌症、冠心病、中风或CKD的人群后，本研究纳入了480430名参与者。在基线调查时测量了他们的身高、体重和腰围。总CKD定义为糖尿病肾病（DKD）、高血压肾病（HTN）、肾小球肾炎（GN）、慢性肾小管间质性肾炎（CTIN）、梗阻性肾病（ON）、其他原因导致的CKD以及慢性肾衰竭。采用Cox比例风险回归模型来估计暴露因素与结局风险之间的关联。在（11.8±2.2）年的随访期内，共确诊5486例总CKD病例，其中包括1147例DKD、340例HTN、1458例GN、460例CTIN、598例ON、418例其他原因导致的CKD以及1065例慢性肾衰竭。在调整了社会人口学因素、生活方式因素、高血压和糖尿病的基线患病率以及WC后，与BMI正常（18.5 - 23.9 kg/m²）的参与者相比，体重过轻（<18.5 kg/m²）、超重（24.0 - 27.9 kg/m²）和肥胖（≥28.0 kg/m²）者发生总CKD的风险比分别为1.42（95%：1.23 - 1.63）、1.00（95%：0.93 - 1.08）和0.98（95%：0.87 - 1.10）。按WC进行分层分析显示，在非中心性肥胖参与者（男性WC < 85.0 cm且女性WC < 80.0 cm）中，BMI与总CKD风险呈负相关（β = 0.97，标准误 = 0.01，95%置信区间：0.96 - 0.99），而在中心性肥胖参与者（男性≥90.0 cm且女性≥85.0 cm）中，该关联为正（β = 1.03，标准误 = 0.01，95%置信区间：1.01 - 1.05）。BMI与GN之间的关联与总CKD相似。BMI每升高1.0 kg/m²，与HTN风险增加相关，风险比为1.12（95%：1.06 - 1.18）。在调整了潜在混杂因素和BMI后，与非中心性肥胖参与者相比，中心性肥胖前期（男性WC：85.0 - 89.9 cm且女性WC：80.0 - 84.9 cm）和中心性肥胖者的风险比分别为1.26（95%：1.16 - 1.36）和1.32（95%：1.20 - 1.45）。除HTN和CTIN外，WC与所有CKD亚型的风险均呈正相关。BMI定义的体重过轻和中心性肥胖是总CKD的独立危险因素，且BMI和WC与疾病亚型风险的关联不同。
