中国成年人BMI和腰围与慢性肾脏病发病风险的关联研究

曾芷青; 马钰; 杨超; 余灿清; 孙点剑一; 裴培; 杜怀东; 陈君石; 陈铮鸣; 李立明; 张路霞; 吕筠; 代表中国慢性病前瞻性研究项目协作组

Abstract

曾芷青,马钰,杨超,余灿清,孙点剑一,裴培,杜怀东,陈君石,陈铮鸣,李立明,张路霞,吕筠,代表中国慢性病前瞻性研究项目协作组.中国成年人BMI和腰围与慢性肾脏病发病风险的关联研究[J].Chinese journal of Epidemiology,2024,45(7):903-913

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

Received:February 27, 2024

DOI：10.3760/cma.j.cn112338-20240227-00085

KeyWord: 慢性肾脏病体质指数腰围亚型队列研究

English Key Word: Chronic kidney disease Body mass index Waist circumference Disease subtypes Cohort study

FundProject: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

Author Name	Affiliation	E-mail
Zeng Zhiqing	Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
Ma Yu	Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
Yang Chao	Department of Nephrology, Peking University First Hospital, Peking University Institute of Nephrology, Beijing 100034, China
Yu Canqing	Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, 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
Sun Dianjianyi	Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, 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
Pei Pei	Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing 100191, China
Du Huaidong	Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom
Chen Junshi	China National Center for Food Safety Risk Assessment, Beijing 100022, China
Chen Zhengming	Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom
Li Liming	Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, 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
Zhang Luxia	Department of Nephrology, Peking University First Hospital, Peking University Institute of Nephrology, Beijing 100034, China National Institute for Health Data Science, Peking University, Beijing 100191, China
Lyu Jun	Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, 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 State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing 100191, China	lvjun@bjmu.edu.cn
for the China Kadoorie Biobank Collaborative Group

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Abstract:

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480 430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5 486例新发总CKD事件，其中DKD 1 147例，HTN 340例，GN 1 458例，CTIN 460例，ON 598例，其他病因导致的肾病418例，慢性肾衰竭1 065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/m²）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/m²，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。

English Abstract:

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, 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. Results 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/m²), the hazard ratios (HRs) of total CKD for underweight (<18.5 kg/m²), overweight (24.0-27.9 kg/m²), and obese (≥28.0 kg/m²) 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/m² higher BMI. After adjusting for potential confounders and BMI, compared to participants with non-central obesity, the HRs 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%CI: 1.16-1.36) and 1.32 (95%CI: 1.20-1.45), respectively. With the exception of HTN and CTIN, WC was positively associated with risks for all CKD subtypes. Conclusions 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.

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