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.

IF 4.4 2区医学 Q1 NUTRITION & DIETETICS

Nutrition Journal Pub Date : 2025-05-11 DOI:10.1186/s12937-025-01150-4

Alessandro Leone, Francesca Menichetti, Laila Vignati, Federica Sileo, Ramona De Amicis, Andrea Foppiani, Simona Bertoli, Alberto Battezzati

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引用次数: 0

Abstract

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/m²) 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 m²). 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.

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在一个开始减肥计划的大队列中，bmi和肾小球滤过率的关系：脂肪量、无脂肪量和腹部脂肪区室的差异贡献

背景：BMI与慢性肾脏疾病之间的关系存在争议，可能是因为BMI无法准确定义身体组成和脂肪组织分布。我们的目的是评估无脂量、脂肪量、内脏（VAT）和皮下（SAT）脂肪组织对肾小球滤过率（GFR）的协同作用。方法：对9704名受试者进行横断面研究，其中女性72%，中位年龄47y，中位BMI 28.1 kg/m2。每位患者均接受了人体测量学评估（体重、身高、腰围、身体皮肤皱褶占体脂的百分比），超声测量VAT和SAT，并采血测量代谢综合征（MS）参数和血清肌酐。使用EPI-CKD方程估计GFR。根据统一标准定义质谱。结果：9704名受试者中，61.1%肾功能正常，29.3%肾功能从轻微到严重下降。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。然后，我们将BMI分为两个组成部分，脂肪质量指数（FMI）和无脂肪质量指数（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的降低和增加相关。VAT （β = -1.83, 95% CI: -2.00, -1.67）和SAT （β = 3.21, 95% CI: 2.86, 3.57）分别与GFR的降低和增加独立相关。在研究BMI、身体组成、脂肪组织分布与GFR降低风险之间的关系时，也得到了类似的结果(2)。性别和多发性硬化症的分层并没有实质性地改变结果。仅在女性中观察到VAT和GFR降低之间的显著关联。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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来源期刊

Nutrition Journal NUTRITION & DIETETICS-

CiteScore

9.80

自引率

0.00%

发文量

审稿时长

4-8 weeks

期刊介绍： Nutrition Journal publishes surveillance, epidemiologic, and intervention research that sheds light on i) influences (e.g., familial, environmental) on eating patterns; ii) associations between eating patterns and health, and iii) strategies to improve eating patterns among populations. The journal also welcomes manuscripts reporting on the psychometric properties (e.g., validity, reliability) and feasibility of methods (e.g., for assessing dietary intake) for human nutrition research. In addition, study protocols for controlled trials and cohort studies, with an emphasis on methods for assessing dietary exposures and outcomes as well as intervention components, will be considered. Manuscripts that consider eating patterns holistically, as opposed to solely reductionist approaches that focus on specific dietary components in isolation, are encouraged. Also encouraged are papers that take a holistic or systems perspective in attempting to understand possible compensatory and differential effects of nutrition interventions. The journal does not consider animal studies. In addition to the influence of eating patterns for human health, we also invite research providing insights into the environmental sustainability of dietary practices. Again, a holistic perspective is encouraged, for example, through the consideration of how eating patterns might maximize both human and planetary health.