中国成年人BMI和腰围与慢性肾脏病发病风险的关联研究  

Associations of body mass index and waist circumference with risk of chronic kidney disease in adults in China

作　　者：曾芷青 马钰 杨超 余灿清[1,3,4] 孙点剑一 裴培 杜怀东 陈君石[6] 陈铮鸣 李立明[1,3,4] 张路霞[2,7] 吕筠[1,3,4,8] 中国慢性病前瞻性研究项目协作组[9] Zeng Zhiqing;Ma Yu;Yang Chao;Yu Canqing;Sun Dianjianyi;Pei Pei;Du Huaidong;Chen Junshi;Chen Zhengming;Li Liming;Zhang Luxia;Lyu Jun(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;Peking University Center for Public Health and Epidemic Preparedness&Response,Beijing 100191,China;Key Laboratory of Epidemiology of Major Diseases(Peking University),Ministry of Education,Beijing 100191,China;Clinical Trial Service Unit and Epidemiological Studies Unit,Nuffield Department of Population Health,University of Oxford,Oxford OX37LF,United Kingdom;China National Center for Food Safety Risk Assessment,Beijing 100022,China;National Institute for Health Data Science,Peking University,Beijing 100191,China;State Key Laboratory of Vascular Homeostasis and Remodeling,Peking University,Beijing 100191,China)

机构地区：[1]北京大学公共卫生学院流行病与卫生统计学系,北京100191 [2]北京大学第一医院肾脏内科,北京大学肾脏病研究所,北京100034 [3]北京大学公众健康与重大疫情防控战略研究中心,北京100191 [4]重大疾病流行病学教育部重点实验室(北京大学),北京100191 [5]牛津大学临床与流行病学研究中心纳菲尔德人群健康系,牛津OX37LF [6]国家食品安全风险评估中心,北京100022 [7]北京大学健康医疗大数据国家研究院,北京100191 [8]血管稳态与重构全国重点实验室,北京100191 [9]不详

出　　处：《中华流行病学杂志》2024年第7期903-913,共11页Chinese Journal of Epidemiology

基　　金：国家自然科学基金(82388102,82192900);英国Wellcome Trust(212946/Z/18/Z,202922/Z/16/Z,104085/Z/14/Z,088158/Z/09/Z);中国香港Kadoorie Charitable基金。

摘　　要：目的分析中国成年人BMI和腰围与慢性肾脏病(CKD)及其各亚型发病风险之间的关联。方法利用中国慢性病前瞻性研究数据,剔除基线自报患有恶性肿瘤、冠心病、脑卒中和CKD者,最终纳入480430例研究对象。身高、体重和腰围为基线测量。将满足以下任意一种诊断定义为总CKD事件:糖尿病肾病(DKD)、高血压肾病(HTN)、肾小球肾炎(GN)、小管间质性肾炎(CTIN)和梗阻性肾病(ON)、其他病因导致的肾病、慢性肾衰竭。采用Cox比例风险回归模型分析暴露因素与各结局风险间的关联。结果研究对象随访(11.8±2.2)年,随访期间共记录5486例新发总CKD事件,其中DKD 1147例,HTN 340例,GN 1458例,CTIN 460例,ON 598例,其他病因导致的肾病418例,慢性肾衰竭1065例。调整社会人口学特征、生活方式、基线高血压、糖尿病的患病情况以及腰围后,与BMI(kg/m^(2))分类为正常(18.5~23.9)的研究对象相比,体重过低(<18.5)、超重(24.0~27.9)和肥胖(≥28.0)的研究对象总CKD发病的风险比(HR)值(95%CI)分别为1.42(1.23~1.63)、1.00(0.93~1.08)和0.98(0.87~1.10)。按腰围进行分层后,在非中心性肥胖者(腰围:男性<85.0 cm、女性<80.0 cm)中,BMI与总CKD发病风险呈负相关(HR=0.97,95%CI:0.96~0.99);在中心性肥胖者(男性≥90.0 cm、女性≥85.0 cm)中,两者呈正相关(HR=1.03,95%CI:1.01~1.05)。BMI与GN的关联类似总CKD。BMI每增加1.0 kg/m^(2),HTN发病HR值(95%CI)为1.12(1.06~1.18)。调整潜在的混杂因素和BMI后,与非中心性肥胖者相比,中心性肥胖前期(腰围:男性85.0~89.9 cm、女性80.0~84.9 cm)和中心性肥胖的研究对象总CKD发病的HR值(95%CI)分别为1.26(1.16~1.36)和1.32(1.20~1.45)。腰围与除HTN和CTIN外的所有亚型发病风险均呈正相关。结论BMI分类的体重过低和中心性肥胖是总CKD的独立危险因素,BMI和腰围与不同CKD亚型发病风险间的关联存在差异。Objective 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.Methods The data from the China Kadoorie Biobank were used.After excluding those with cancer,coronary heart disease,stroke,or CKD at baseline survey,480430 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.Results During a follow-up period of(11.8±2.2)years,5486 cases of total CKD were identified,including 1147 cases of DKD,340 cases of HTN,1458 cases of GN,460 cases of CTIN,598 cases of ON,418 cases of CKD due to other causes,and 1065 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^(2)),the hazard ratios(HRs)of total CKD for underweight(<18.5 kg/m^(2)),overweight(24.0-27.9 kg/m^(2)),and obese(≥28.0 kg/m^(2))were 1.42(95%CI:1.23-1.63),1.00(95%CI:0.93-1.08)and 0.98(95%CI: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)(HR=0.97,95%CI:0.96-0.99),while the association was positive in central obese participants(≥90.0 cm in men and≥85.0 cm in women)(HR=1.03,95%CI: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 HR of 1.12(95%CI:1.06-1.18)per 1.0 kg/m^(2)higher BMI.After adjusting for potential confounders and BMI,compared to participants with non-central obesity,the

关 键 词：慢性肾脏病 体质指数 腰围 亚型 队列研究 

分 类 号：R692[医药卫生—泌尿科学]