启动减肥计划的大型队列中体重指数与肾小球滤过率的关系：脂肪量、去脂体重和腹部脂肪区的不同贡献。
Relationship between bmi and glomerular filtration rate in a large cohort initiating a weight loss program: differential contributions of fat mass, fat-free mass, and abdominal fat compartments.
作者信息
Leone Alessandro, Menichetti Francesca, Vignati Laila, Sileo Federica, De Amicis Ramona, Foppiani Andrea, Bertoli Simona, Battezzati Alberto
机构信息
International Center for the Assessment of Nutritional Status and the development of Dietary Intervention Strategies (ICANS-DIS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy.
IRCCS Istituto Auxologico Italiano, Clinical Nutrition Unit, Department of Endocrine and Metabolic Medicine, Milan, 20100, Italy.
出版信息
Nutr J. 2025 May 11;24(1):78. doi: 10.1186/s12937-025-01150-4.
BACKGROUND
The relationship between BMI and chronic kidney disease is controversial, likely due to the inability of BMI to accurately define body composition and adipose tissue distribution. Our objective was to evaluate the synergistic contribution of fat-free mass, fat mass, visceral (VAT) and subcutaneous (SAT) adipose tissue, to glomerular filtration rate (GFR) in a large cohort of subjects.
METHODS
A cross-sectional study of 9704 subjects (72% female, median age 47y, median BMI 28.1 kg/m) was carried out. Each patient underwent an anthropometric assessment (weight, height, waist circumference, % of body fat by body skinfolds), an ultrasound measurement of VAT and SAT and blood sampling to measure metabolic syndrome (MS) parameters and serum creatinine. GFR was estimated using the EPI-CKD equation. MS was defined according to the harmonized criteria.
RESULTS
Among 9,704 subjects, 61.1% had a normal renal function, while 29.3% reported a reduction, from slightly to severely. The BMI was initially negatively associated with GFR in the univariate model (β = -0.32, 95% CI: -0.39, -0.25), but after adjusting for %body fat, the association was lost. We then split the BMI into its two components, Fat Mass Index (FMI) and Fat Free Mass Index (FFMI), and observed that FMI (β = -1.23, 95% CI: -1.35, -1.12) and FFMI (β = 0.79, 95% CI: 0.65, 0.92) were associated with a decrease and an increase in GFR, respectively. VAT (β = -1.83, 95% CI: -2.00, -1.67) and SAT (β = 3.21, 95% CI: 2.86, 3.57) were independently associated with a decrease and an increase in GFR, respectively. Similar results were obtained when studying the association between BMI, body composition, adipose tissue distribution, and the risk of reduced GFR (<90 ml/min/1.73 m). Stratification by sex and MS did not substantially alter the results. A significant association between VAT and reduced GFR was observed only in women.
CONCLUSIONS
Our study highlights the importance of considering body composition and fat distribution when assessing renal function.
背景
体重指数（BMI）与慢性肾脏病之间的关系存在争议，这可能是由于BMI无法准确界定身体组成和脂肪组织分布。我们的目标是评估在一大群受试者中，去脂体重、脂肪量、内脏脂肪组织（VAT）和皮下脂肪组织（SAT）对肾小球滤过率（GFR）的协同作用。
方法
对9704名受试者（72%为女性，中位年龄47岁，中位BMI为28.1kg/m²）进行了一项横断面研究。每位患者都接受了人体测量评估（体重、身高、腰围、通过体褶厚度测量的体脂百分比）、VAT和SAT的超声测量以及血液采样以测量代谢综合征（MS）参数和血清肌酐。使用EPI-CKD方程估算GFR。MS根据统一标准进行定义。
结果
在9704名受试者中，61.1%肾功能正常，而29.3%的受试者报告肾功能有不同程度降低，从轻度到重度。在单变量模型中，BMI最初与GFR呈负相关（β=-0.32，95%CI：-0.39，-0.25），但在调整体脂百分比后，这种关联消失了。然后我们将BMI分为其两个组成部分，脂肪量指数（FMI）和去脂体重指数（FFMI），并观察到FMI（β=-1.23，95%CI：-1.35，-1.12）和FFMI（β=0.79，95%CI：0.65，0.92）分别与GFR的降低和升高相关。VAT（β=-1.83，95%CI：-2.00，-1.67）和SAT（β=3.21，95%CI：2.86，3.57）分别独立与GFR的降低和升高相关。在研究BMI、身体组成、脂肪组织分布与GFR降低风险（<90ml/min/1.73m²）之间的关联时，也得到了类似结果。按性别和MS分层并没有实质性改变结果。仅在女性中观察到VAT与GFR降低之间存在显著关联。
结论
我们的研究强调了在评估肾功能时考虑身体组成和脂肪分布的重要性。
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