U-shaped association between body mass index and proteinuria in a large Japanese general population sample (original) (raw)

Abstract

Background

There is little data on the association between body mass index (BMI) and proteinuria.

Methods

This was a cross-sectional cohort study assessing the association between BMI and proteinuria in a large Japanese population. Using a nationwide health check-up database of 212,251 Japanese aged >20 years with no pre-existing cardiovascular diseases (185,183 men, median age 66 years; 127,068 women, median age 65 years), we examined the association between BMI and proteinuria (≥1+ on dipstick).

Results

Subjects were divided into 11 subgroups by BMI grading in 1 kg/m2 intervals from 18.5−27.5 kg/m2. A BMI of approximately 22 ± 0.5 kg/m2 was considered optimal for Japanese; therefore, this subgroup was set as a reference when logistic analysis was applied. Age, waist circumference, height, weight, smoking and drinking habits, use of medications such as antihypertensive, antidiabetic, or antihyperlipidemic, as well as proteinuria, estimated glomerular filtration rate (eGFR), chemistry data, and blood pressure levels were significantly different between subgroups in both genders. The odds ratio for proteinuria showed a U-shape in men and women, even after adjustment for significant covariates such as age, waist circumference, systolic blood pressure, eGFR, fasting plasma glucose, triglyceride, low-density lipoprotein, antihypertensive use, antidiabetic use, antihyperlipidemic use, and lifestyle factors (smoking and drinking). Gender differences were also prominent—a BMI <20.4 kg/m2 was significantly associated with proteinuria in men compared to a BMI <18.4 kg/m2 in women. On the other hand, a BMI ≥ 25.5 kg/m2 was also significantly associated with proteinuria in men compared to a BMI ≥ 22.5 kg/m2 in women.

Conclusions

We found that BMI levels were associated with proteinuria in a U-shaped manner and showed marked gender differences. Health guidance should not only focus on higher BMI subjects, but also on thin subjects, in terms of the prevention of chronic kidney disease.

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References

  1. World Health Organization. Obesity: preventing and managing the global endemic. Geneva: WHO; 2000. World Health Organ Tech Rep Ser. 2000;894:1–253.
    Google Scholar
  2. Kannel WB, Adrienne Cupples L, Ramaswami R, Stokes J, Kreger BE, Higgins M. Regional obesity and risk of cardiovascular disease; the Framingham study. J Clin Epidemiol. 1991;44(2):183–90.
    Article CAS PubMed Google Scholar
  3. McLaughlin T, Allison G, Abbasi F, Lamendola C, Reaven G. Prevalence of insulin resistance and associated cardiovascular disease risk factors among normal weight, overweight, and obese individuals. Metabolism. 2004;53(4):495–9.
    Article CAS PubMed Google Scholar
  4. Brown CD, Higgins M, Donato KA, Rohde FC, Garrison R, Obarzanek E, et al. Body mass index and the prevalence of hypertension and dyslipidemia. Obes Res. 2000;8(9):605–19.
    Article CAS PubMed Google Scholar
  5. Sato Y, Yano Y, Fujimoto S, Konta T, Iseki K, Moriyama T, et al. Glycohemoglobin not as predictive as fasting glucose as a measure of prediabetes in predicting proteinuria. Nephrol Dial Transplant. 2012;27:3862–8.
    Article CAS PubMed Google Scholar
  6. Praga M, Morales E. Obesity, proteinuria and progression of renal failure. Curr Opin Nephrol Hypertens. 2006;15(5):481–6.
    Article PubMed Google Scholar
  7. Schiffrin EL, Lipman ML, Mann JF. Chronic kidney disease: effects on the cardiovascular system. Circulation. 2007;116(1):85–97.
    Article PubMed Google Scholar
  8. Levey AS, Atkins R, Coresh J, Cohen EP, Collins AJ, Eckardt KU, et al. Chronic kidney disease as a global public health problem: approaches and initiatives—a position statement from Kidney Disease Improving Global Outcomes. Kidney Int. 2007;72(3):247–59.
    Article CAS PubMed Google Scholar
  9. Levey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, Rossert J, et al. Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2005;67(6):2089–100.
    Article PubMed Google Scholar
  10. Yano Y, Sato Y, Fujimoto S, Konta T, Iseki K, Moriyama T, et al. Association of high pulse pressure with proteinuria in subjects with diabetes, prediabetes, or normal glucose tolerance in a large Japanese general population sample. Diabetes Care. 2012;35(6):1310–5.
    Article CAS PubMed Google Scholar
  11. Yano Y, Fujimoto S, Sato Y, Konta T, Iseki K, Moriyama T, et al. Association between prehypertension and chronic kidney disease in the Japanese general population. Kidney Int. 2011;81(3):293–9.
    Article PubMed Google Scholar
  12. Konta T, Hao Z, Takasaki S, Abiko H, Ishikawa M, Takahashi T, et al. Clinical utility of trace proteinuria for microalbuminuria screening in the general population. Clin Exp Nephrol. 2007;11(1):51–5.
    Article PubMed Google Scholar
  13. Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53(6):982–92.
    Article CAS PubMed Google Scholar
  14. Kanazawa M, Yoshiike N, Osaka T, Numba Y, Zimmet P, Inoue S. Criteria and classification of obesity in Japan and Asia-Oceania. Asia Pac J Clin Nutr. 2002;11:S732–7.
    Article PubMed Google Scholar
  15. Tozawa M, Iseki K, Iseki C, Oshiro S, Ikemiya Y, Takishita S. Influence of smoking and obesity on the development of proteinuria. Kidney Int. 2002;62(3):956–62.
    Article PubMed Google Scholar
  16. Kambham N, Markowitz GS, Valeri AM, Lin J, D’Agati VD. Obesity-related glomerulopathy: an emerging epidemic. Kidney Int. 2001;59(4):1498–509.
    Google Scholar
  17. Praga M, Hernandez E, Morales E, Campos AP, Valero MA, Martinez MA, et al. Clinical features and long-term outcome of obesity-associated focal segmental glomerulosclerosis. Nephrol Dial Transpl. 2001;16(9):1790–8.
    Google Scholar
  18. Deurenberg P, Deurenberg-Yap M, Guricci S. Asians are different from Caucasians and from each other in their body mass index/body fat per cent relationship. Obes Rev. 2002;3(3):141–6.
    Article CAS PubMed Google Scholar
  19. Anuurad E, Shiwaku K, Nogi A, Kitajima K, Enkhmaa B, Shimono K, et al. The new BMI criteria for Asians by the regional office for the Western Pacific region of WHO are suitable for screening of overweight to prevent metabolic syndrome in elder Japanese workers. J Occup Health. 2003;45(6):335–43.
    Article PubMed Google Scholar
  20. Ramirez SPB, Hsu SI, McClellan W. Low body weight is a risk factor for proteinuria in multiracial Southeast Asian pediatric population. Am J Kidney Dis. 2001;38(5):1045–54.
    Article CAS PubMed Google Scholar
  21. Chang CJ, Wu C, Chang C, Yao W, Yang Y, Wu J, et al. Low body mass index but high percent body fat in Taiwanese subjects: implications of obesity cutoffs. Int J Obes Relat Metab Disord. 2003;27(2):253–9.
    Article PubMed Google Scholar
  22. Ibrahim MM. Subcutaneous and visceral adipose tissue: structural and functional differences. Obes Rev. 2009;11(1):11–8.
    Article PubMed Google Scholar
  23. Foster MC, Hwang SJ, Massaro JM, Hoffmann U, DeBoer IH, Robins SJ, et al. Association of subcutaneous and visceral adiposity with albuminuria: the Framingham Heart Study. Obesity. 2010;19(6):1284–9.
    Article PubMed Central PubMed Google Scholar
  24. Ramirez SPB, McClellan W, Port FK, Stephen I, Hsu H. Risk factors for proteinuria in a large, multiracial, Southeast Asian population. J Am Soc Nephrol. 2002;13(7):1907–17.
    Article PubMed Google Scholar
  25. Milani G, Bianchetti MG, Bozzani S, Bettinelli A, Fossali EF. Body mass index modulates postural proteinuria. Int Urol Nephrol. 2010;42(2):513–5.
    Article PubMed Google Scholar
  26. Maeda I, Hayashi T, Sato KK, Koh H, Harita N, Nakamura Y, et al. Cigarette smoking and the association with glomerular hyperfiltration and proteinuria in healthy middle-aged men. Clin J Am Soc Nephrol. 2011;6(10):2462–9.
    Article PubMed Google Scholar
  27. Harik-Khan RI, Fleg JL, Wise RA. Body mass index and the risk of COPD. Chest. 2002;121(2):370–6.
    Article PubMed Google Scholar
  28. Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, Halsey J, et al. Body-mass index and cause-specific mortality in 900,000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373(9669):1083–96.
    Article PubMed Google Scholar
  29. Casanova C, de Torres JP, Navarro J, Aguirre-Jaíme A, Toledo P, Cordoba E, et al. Microalbuminuria and hypoxemia in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2010;182(8):1004–10.
    Article CAS PubMed Google Scholar
  30. Barr RG. The epidemiology of vascular dysfunction relating to chronic obstructive pulmonary disease and emphysema. Proc Am Thorac Soc. 2011;8(6):522–7.
    Article PubMed Central PubMed Google Scholar
  31. Brenner BM, Chertow GM. Congenital oligonephropathy and the etiology of adult hypertension and progressive renal injury. Am J Kidney Dis. 1994;23(2):171–5.
    CAS PubMed Google Scholar
  32. Luyckx VA, Brenner BM. Low birth weight, nephron number, and kidney disease. Kidney Int. 2005;68:S68–77.
    Article Google Scholar
  33. Burchfiel CM, Tracy RE, Chyou P-H, Strong JP. Cardiovascular risk factors and hyalinization of renal arterioles at autopsy. The Honolulu Heart Program. Arterioscler Thromb Vasc Biol. 1997;17(4):760–8.
    Article CAS PubMed Google Scholar
  34. Fujibayashi K, Fukuda H, Yokokawa H, Haniu T, Oka F, Ooike M, et al. Associations between healthy lifestyle behaviors and proteinuria and the estimated glomerular filtration rate (eGFR). J Atheroscler Thromb. 2012;19:932–40.
    Article CAS PubMed Google Scholar
  35. White SL, Polkinghorne KR, Cass A, Shaw JE, Atkins RC, Chadban SJ. Alcohol consumption and 5-year onset of chronic kidney disease: the AusDiab study. Nephrol Dial Transplant. 2009;24(8):2464–72.
    Article PubMed Google Scholar
  36. White SL, Yu R, Craig JC, Polkinghorne KR, Atkins RC, Chadban SJ. Diagnostic accuracy of urine dipsticks for detection of albuminuria in the general community. Am J Kidney Dis. 2011;58(1):19–28.
    Article PubMed Google Scholar

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Acknowledgments

This work was supported by Health and Labor Sciences Research grants for ‘Research on the Positioning of Chronic Kidney Disease in Specific Health Check and Guidance in Japan’ (20230601) from the Ministry of Health, Labor, and Welfare of Japan. SF designed the study, collected data. TK, KI, TM, KY, KT, HY, KA, IK and YO, collected data. TW supervised this whole study.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Dialysis Division, University of Miyazaki Hospital, Miyazaki, Japan
    Yuji Sato
  2. Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
    Shouichi Fujimoto
  3. Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
    Tsuneo Konta
  4. Steering Committee for the “Examination of the Positioning of CKD in Specific Health Check and Guidance”, Tokyo, Japan
    Kunitoshi Iseki, Toshiki Moriyama, Kunihiro Yamagata, Kazuhiko Tsuruya, Hideaki Yoshida, Koichi Asahi & Tsuyoshi Watanabe
  5. Department of Planning, Information, and Management, University of Tokyo Hospital, Tokyo, Japan
    Issei Kurahashi
  6. Department of Biostatistics/Epidemiology and Preventive Health Sciences, School of Health Sciences and Nursing, University of Tokyo, Tokyo, Japan
    Yasuo Ohashi

Authors

  1. Yuji Sato
  2. Shouichi Fujimoto
  3. Tsuneo Konta
  4. Kunitoshi Iseki
  5. Toshiki Moriyama
  6. Kunihiro Yamagata
  7. Kazuhiko Tsuruya
  8. Hideaki Yoshida
  9. Koichi Asahi
  10. Issei Kurahashi
  11. Yasuo Ohashi
  12. Tsuyoshi Watanabe

Corresponding author

Correspondence toYuji Sato.

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Sato, Y., Fujimoto, S., Konta, T. et al. U-shaped association between body mass index and proteinuria in a large Japanese general population sample.Clin Exp Nephrol 18, 75–86 (2014). https://doi.org/10.1007/s10157-013-0809-5

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