Unravelling gender-specific factors that link obesity to albuminuria

Association between cardiometabolic index and albuminuria: Evidence from NHANES 2017-2020

INTRODUCTION

Albuminuria is a crucial marker of kidney damage and serves as an early indicator of the risk for chronic kidney disease (CKD). Recent studies have suggested that the cardiometabolic index (CMI), could be valuable for screening renal insufficiency. However, the relationship between CMI and albuminuria remains underexplored. Therefore, the aim of this study was to investigate the association between CMI and albuminuria, with the goal of providing new insights for the clinical diagnosis, assessment, and early intervention of kidney disease.

METHODS

The National Health and Nutrition Examination Survey (NHANES) for the period between 2017-2020 provided the data for this cross-sectional investigation. Triglyceride (TG) (mmol/L)/High density lipid-cholesterol (HDL-C) (mmol/L) ×  Waist height ratio (WHtR) was the formula used for calculating CMI. Using multifactorial logistic regression, the independent connection between albuminuria and CMI was investigated. The threshold effect was determined by means of a two-stage linear regression model. Additionally, subgroup analysis and interaction tests were carried out.

RESULTS

A total of 3,339 participants were included, and 12.38% of them had albuminuria. As the CMI quartiles grew (quartile 1: 7.78%, quartile 2: 13.43%, quartile 3: 12.93%, quartile 4: 17.01%), so did the probability of albuminuria. The results of adjusted model 3 showed that a greater probability of albuminuria prevalence was strongly correlated with CMI (OR =  2.26, 95% CI: 1.58-3.23). This association held true for all subgroups (all P for trend >  0.05). Furthermore, with a two-stage linear regression model with an inflection point of 0.92, we discovered a nonlinear relationship between CMI and albuminuria.

CONCLUSIONS

Our findings indicate that CMI levels are significantly associated with the risk of albuminuria prevalence, suggesting that CMI could serve as a valuable biomarker for assessing the risk of albuminuria.

Association Between Weight-Adjusted Waist Index and Albuminuria in Type 2 Diabetes Mellitus in the Chinese Population

Purpose

This study aimed to investigate the relationship between weight-adjusted waist index (WWI) and albuminuria in patients with type 2 diabetes mellitus (T2DM) in the Chinese population.

Patients and Methods

A total of 860 adult patients in the Department of Endocrinology of the Affiliated Hospital of Jiangsu University were retrospectively analyzed from June 2018 to September 2023. Correlations between WWI and albuminuria (albumin-to-creatinine ratio (UACR) ≥ 30 mg/g were defined as albuminuria) were analyzed using the Pearson and Spearman methods. The associations between albuminuria and Age, gender, body mass index (BMI), waist circumference/ hip circumference (WHR), systolic blood pressure(SBP), diastolic blood pressure (DBP), fasting plasma glucose (FPG), 2-hour postprandial plasma glucose (2h PG), fasting plasma insulin (FIns), 2-h postprandial insulin (2hINS), glycosylated hemoglobin (HbA1c), WWI, homeostasis model assessment of insulin resistance (HOMA-IR) were analyzed via binary logistic regression.

Results

Compared with the normal albumin group, serum urea nitrogen, serum creatinine, UACR, and WWI levels in the albuminuria group were significantly increased, while estimated glomerular filtration rate (eGFR) levels were significantly decreased (P < 0.05). Correlation analyses revealed that WWI was positively correlated with UACR but negatively correlated with urea nitrogen, serum creatinine, and eGFR (P < 0.05). Binary logistic regression analyses indicated that WWI was an independent risk factor for albuminuria in T2DM patients. Receiver operating characteristic curve results showed that the area under the curve for albuminuria as predicted by WWI was 0.605 [95% CI = (0.563-0.646), P < 0.001].

Conclusion

WWI is independently associated with albuminuria in the Chinese patients with type 2 diabetes and may serve as a simple indicator for albuminuria risk assessment.

The association between weight-adjusted-waist index and increased urinary albumin excretion in adults: A population-based study

Aims

The negative effect of obesity on kidney health has been reported. The association between weight-adjusted-waist index (WWI, a newly developed adiposity index) and albuminuria has not been reported earlier.

Methods

This cross-sectional study was conducted among adults with complete data about WWI and urinary albumin-to-creatinine ratio (ACR) in 2005–2018 National Health and Nutrition Examination Survey (NHANES). WWI was calculated as waist circumference (WC) divided by the square root of weight. Weighted multivariable logistic regression and generalized additive model were employed to explore the independent relationship between WWI with albuminuria and its non-linearity. A two-piecewise linear regression model was used to calculate the threshold effect. Subgroup analysis and interaction tests were also performed.

Results

A total of 36,921 participants were enrolled with a prevalence of albuminuria of 9.32%. The prevalence of albuminuria increased with the higher WWI tertiles (Tertile 1: 5.31%, Tertile 2: 8.23%, Tertile 3: 15.65%). WWI was positively associated with a higher likelihood of albuminuria (OR = 1.28, 95% CI: 1.15–1.43), and this relationship remains stable in subgroups (all P for trend > 0.05). Non-linear positive relationships were detected in females with a breakpoint of 10.93. A positive association between WWI and albuminuria (OR = 1.39, 95% CI: 1.20–1.61) was observed on the right of the breakpoint, while the association on the left was of no statistical significance. WWI showed a stronger correlation with albuminuria (OR = 1.28) than other markers of obesity including body mass index (BMI, OR = 1.02) and WC (OR = 1.01).

Conclusion

Weight-adjusted-waist index levels were positively related to an increased likelihood of albuminuria in United States adults and showed a stronger relationship than BMI and WC. Our findings indicated that WWI may serve as a simple anthropometric index to predict albuminuria.

Coronary circulatory function with increasing obesity: A complex U-turn

AIMS

The aim of this investigation was to explore and characterize alterations in coronary circulatory function in function of increasing body weight with medically controlled cardiovascular risk factors and, thus, "metabolically" unhealthy obesity.

MATERIALS AND METHODS

We prospectively enrolled 106 patients with suspected CAD but with normal stress-rest myocardial perfusion on 13 N-ammonia PET/CT and with medically controlled or no cardiovascular risk factors. 13 N-ammonia PET/CT concurrently determined myocardial blood flow (MBF) during pharmacologically induced hyperaemia and at rest. Based on body mass index (BMI), patients were grouped into normal weight (BMI: 20.0-24.9 kg/m2 , n = 22), overweight (BMI: 25.0-29.9 kg/m2 , n = 27), obese (BMI: 30.0-39.9 kg/m2 , n = 31), and morbidly obese (BMI ≥ 40kg/m2 , n = 26).

RESULTS

Resting MBF was comparable among groups (1.09 ± 0.18 vs. 1.00 ± 0.15 vs. 0.96 ± 0.18 vs.. 1.06 ± 0.31 ml/g/min; p = .279 by ANOVA). Compared to normal weight individuals, the hyperaemic MBF progressively decreased in in overweight and obese groups, respectively (2.54 ± 0.48 vs. 2.02 ± 0.27 and 1.75 ± 0.39 ml/g/min; p < .0001), while it increased again in the group of morbidly obese individuals comparable to normal weight (2.44 ± 0.41 vs. 2.54 ± 0.48 ml/g/min, p = .192). The BMI of the study population correlated with the hyperaemic MBF in a quadratic or U-turn fashion (r = .34, SEE = 0.46; p ≤ .002).

CONCLUSIONS

The U-turn of hyperaemic MBF from obesity to morbid obesity is likely to reflect contrasting effects of abdominal versus subcutaneous adipose tissue on coronary circulatory function indicative of two different disease entities, but needing further investigations.

Association of metabolic syndrome with the incidence of low-grade albuminuria: a cohort study in middle-aged and elderly Chinese adults

Background: Individuals with metabolic syndrome have elevated risks of micro- and macro-albuminuria as well as chronic kidney disease (CKD).

Objective: To assess the influence of metabolic abnormalities on the presence of low-grade albuminuria (below the threshold for microalbuminuria).

Design, participants, and main outcome measures: This community-based cohort study included 3,935 eligible individuals aged 40 years or older. The presence of low-grade albuminuria was detected in those without micro- or macro-albuminuria and analyzed according to the highest quartile of the baseline urinary albumin-to-creatinine ratio (ACR ≥11.13 mg/g). CKD was defined by an estimated glomerular filtration rate <60 mL/min/1.73 m² or the new presence of albuminuria (ACR ≥30 mg/g).

Results: Overall, 577 (14.7%) participants developed low-grade albuminuria and 164 (4.2%) participants developed CKD during a mean follow-up period of 3.6 years. Compared with participants without metabolic syndrome, those with metabolic syndrome had greater risks of low-grade albuminuria [adjusted odd ratio (OR) and 95% confidence interval (95% CI): 1.30 (1.05–1.61)] and CKD [1.71 (1.20–2.44)]. Moreover, the incidence rates of low-grade albuminuria and CKD increased as the number of metabolic syndrome components increased (P for trend <0.0001).

Conclusions: The presence of metabolic syndrome is associated with increased incidence rates of low-grade albuminuria and CKD the middle-aged and elderly Chinese populations.

Nanocolloids in drinking water increase the risk of obesity in mice by modulating gut microbes

Both gut microbes and environmental contamination may cause metabolic disorders and obesity. However, the relationships among gut microbes, environmental contamination and obesity remain obscure. The drinking water on a national scale (31 cities in China) contained nanocolloid-pattern contamination at the mg/L level, a concentration that is 10- to 100-fold higher than commonly reported pollutants. Exposure to nanocolloids (environmentally related dose, 0.15 mg/kg) for three weeks increased the body weight and leptin levels of mice and decreased the expression of adiponectin. Nanocolloids increased the ratio of Firmicutes to Bacteroidetes, a typical obesity-related phenomenon, in the obese individuals. Oral administration of resveratrol verified the role of gut microbes in the tendency toward obesity induced by nanocolloids. The ratio of Firmicutes to Bacteroidetes is positively correlated with body weight and leptin levels. Compared to the control, the levels of triglycerides and high-density lipoprotein cholesterol were up- and downregulated by the tested nanocolloids at 0.15 mg/kg, respectively. Long-chain fatty acids, lipid metabolites and the expression of lipid synthesis-related genes (Fas, Srebp-1 and ACC-1) were also significantly increased by nanocolloids. The present study provides new insights that improve our understanding the risks of obesity associated with drinking water contamination that are mediated by gut microbes.