Sgambat Kristen, Amatya Kaushal, Vogel Siobhan, Clauss Sarah, Moudgil Asha
Nephrology, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC, 20010, USA.
Nutrition, Children's National Hospital, District of Columbia, Washington, DC, USA.
Pediatr Nephrol. 2025 Jan 14. doi: 10.1007/s00467-024-06635-8.
Obesity and metabolic syndrome (MS) accelerate arterial stiffening, increasing cardiovascular (CV) risk after transplant. BMI is limited by inability to differentiate muscle, fat mass, and fat distribution patterns. The aim of this study was to identify the best anthropometric measure to detect arterial stiffness as assessed by pulse wave velocity (PWV) in a racially diverse pediatric transplant population.
Kidney transplant recipients 6-20 years old and ≥ 6 months post-transplant were prospectively enrolled. PWV was measured oscillometrically by Mobil-O-Graph. Skeletal muscle-to-fat mass ratio (SM:FM) and percent body fat (PBF) were evaluated by dual-frequency bioelectrical impedance. BMI and waist-to-height ratio (WHR) were calculated. Associations of arterial stiffness (high PWV) with obesity and MS as defined by WHR, SM:FM, PBF, and BMI were evaluated.
Participants (n = 67) were 15 (IQR 11, 18) years old and 39 (IQR 10, 68) months post-transplant. Participants with SM:FM-obesity (OR 3.2) and WHR-obesity (OR 3.0) had increased odds of high PWV (p = 0.04) while PBF-obesity (OR 2.6, p = 0.09) and BMI-obesity (OR 2.2, p = 0.17) were not significant. Participants with WHR-MS (OR 12.5, p = 0.02), SM:FM-MS (OR 5.2, p = 0.03), and PBF-MS (OR 5.0, p = 0.02) had increased odds of arterial stiffness, while BMI-MS was not significant (OR 3.7, p = 0.08).
Obesity is associated with arterial stiffness in a racially diverse cohort of pediatric transplant recipients. Anthropometric measures that assess body fat distribution (WHR) and body composition (SM:FM) are more strongly associated with arterial stiffness than BMI. MS has a stronger association with arterial stiffness than obesity alone, particularly when WHR is used.
肥胖和代谢综合征（MS）会加速动脉僵硬度增加，从而增加移植后心血管（CV）风险。体重指数（BMI）因无法区分肌肉、脂肪量和脂肪分布模式而存在局限性。本研究的目的是在种族多样化的儿科移植人群中，确定通过脉搏波速度（PWV）评估来检测动脉僵硬度的最佳人体测量指标。
前瞻性纳入6至20岁且移植后≥6个月的肾移植受者。使用Mobil-O-Graph通过示波法测量PWV。通过双频生物电阻抗评估骨骼肌与脂肪量之比（SM:FM）和体脂百分比（PBF）。计算BMI和腰高比（WHR）。评估动脉僵硬度（高PWV）与由WHR、SM:FM、PBF和BMI定义的肥胖及MS之间的关联。
参与者（n = 67）年龄为15岁（四分位间距11，18），移植后39个月（四分位间距10，68）。SM:FM肥胖（比值比3.2）和WHR肥胖（比值比3.0）的参与者出现高PWV的几率增加（p = 0.04），而PBF肥胖（比值比2.6，p = 0.09）和BMI肥胖（比值比2.2，p = 0.17）则不显著。WHR-MS（比值比12.5，p = 0.02）、SM:FM-MS（比值比5.2，p = 0.03）和PBF-MS（比值比5.0，p = 0.02）的参与者出现动脉僵硬度增加的几率增加，而BMI-MS不显著（比值比3.7，p = 0.08）。
在种族多样化的儿科移植受者队列中，肥胖与动脉僵硬度相关。评估体脂分布（WHR）和身体成分（SM:FM）的人体测量指标与动脉僵硬度的关联比BMI更强。MS与动脉僵硬度的关联比单纯肥胖更强，尤其是在使用WHR时。
