Mehran Ladan, Amouzegar Atefeh, Masoumi Safdar, Adib Maryam, Azizi Fereidoun, Amouzegar Atieh
Endocrine Research Center, Research Institute for Endocrine Disorders, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Firoozgar Clinical Research Development Center, Iran University of Medical Sciences, Tehran, Iran.
Kidney Dis (Basel). 2025 May 28;11(1):530-542. doi: 10.1159/000545726. eCollection 2025 Jan-Dec.
Despite the reported connection between different combinations of the standard MetS criteria and chronic kidney diseases (CKDs), most data raise significant concerns about its predictive usefulness in clinical settings beyond its components. Metabolic syndrome severity, expressed by the continuous metabolic syndrome severity score (cMetS-S), is a more applicable health metric that may more accurately predict future health outcomes. However, no evidence is known about the association between the trajectory of cMetS-S and the development of CKD.
In the population-based Tehran Lipid and Glucose Study, 4,462 participants aged 20-60 years free of CKD at baseline were included and followed at 3-year intervals. We examined the trajectories of cMetS-S over 9 years (1999-2009) using latent growth mixture modeling and subsequent risks of incident CKD 8 years later (2010-2018). The prospective association of identified trajectories with CKD was examined using the Cox proportional hazard model adjusting for age, sex, education, and family history of diabetes, physical activity, obesity (BMI ≥30 kg/m), antihypertensive, and lipid-lowering medication, and baseline fasting plasma glucose in a stepwise manner.
Three cMetS-S trajectory groups of low (28.3%), medium (50.0%), and high (21.7%) were identified during the exposure period. High cMetS-S trajectory pattern was associated with increased risk of CKD adjusting for age, sex, education, smoking, physical activity, baseline estimated glomerular filtration rate, and even after further adjustment for MetS components (1.32; 95% CI: 1.04-1.67). The associated risk remained significant even in normoglycemic, nonobese, and non-hypertensive individuals. Sex-specific subgroup analysis showed that MetS severity score is associated with CKD only in men.
The trend of cMetS-S over time is associated with the development of CKD, even in those without major risk factors, for example, obesity, diabetes mellitus, and hypertension. It could be clinically helpful in identifying individuals at elevated risk rather than stating it as a predictive or causative factor. It could be clinically beneficial in identifying and tracking individuals at elevated risk rather than stating it as a predictive or causative factor.
尽管有报道称标准代谢综合征（MetS）标准的不同组合与慢性肾脏病（CKD）之间存在联系，但大多数数据对其在临床环境中的预测效用提出了重大质疑，超出了其组成部分。由连续代谢综合征严重程度评分（cMetS-S）表示的代谢综合征严重程度是一种更适用的健康指标，可能更准确地预测未来的健康结果。然而，关于cMetS-S轨迹与CKD发生之间的关联尚无证据。
在基于人群的德黑兰血脂和血糖研究中，纳入了4462名年龄在20至60岁之间、基线时无CKD的参与者，并每3年进行一次随访。我们使用潜在增长混合模型研究了9年（1999 - 2009年）期间cMetS-S的轨迹以及8年后（2010 - 2018年）发生CKD的后续风险。使用Cox比例风险模型逐步调整年龄、性别、教育程度、糖尿病家族史、身体活动、肥胖（BMI≥30 kg/m）、抗高血压和降脂药物以及基线空腹血糖，检查已识别轨迹与CKD的前瞻性关联。
在暴露期间确定了低（28.3%）、中（50.0%）、高（21.7%）三个cMetS-S轨迹组。调整年龄、性别、教育程度、吸烟、身体活动、基线估计肾小球滤过率后，高cMetS-S轨迹模式与CKD风险增加相关，甚至在进一步调整MetS组成部分后（1.32；95%CI：1.04 - 1.67）。即使在血糖正常、非肥胖和非高血压个体中，相关风险仍然显著。性别特异性亚组分析表明，MetS严重程度评分仅在男性中与CKD相关。
cMetS-S随时间的变化趋势与CKD的发生相关，即使在没有肥胖、糖尿病和高血压等主要危险因素的个体中也是如此。它在临床上有助于识别风险升高的个体，而不是将其作为预测或致病因素。它在临床上有助于识别和跟踪风险升高的个体，而不是将其作为预测或致病因素。
