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The magnitude of obesity and metabolic syndrome among diabetic chronic kidney disease population: A nationwide study.
PLoS One 2018; 13(5):e0196332Plos

Abstract

BACKGROUND

Although the prevalence of obesity and metabolic syndrome (MetS) among dialysis patients has been exceeding than general population, little is known regarding obesity and MetS in non-dialysis chronic kidney disease (CKD). We aimed to find the magnitude of obesity and MetS and their associations with impaired renal function among type 2 diabetes mellitus (T2DM) patients.

METHODS

A national survey of T2DM patients was collected in the Thai National Health Security Office database during 2014-5. The sampling frame was designated as distinct geographic regions throughout the country. A stratified two-stage cluster sampling was used to select the study population. Anthropometry and 12-hour fasting blood samples were obtained by trained personnel. BMI of ≥25 kg/m2 was classified as obesity. MetS was defined as having elevated waist circumference (>90 and >80 cm in men and women, respectively) plus any two of the followings: triglyceride ≥150 mg/dL, HDL-C <40 in men or <50 mg/dL in women, blood pressure ≥130/85 mmHg, and fasting blood sugar ≥100 mg/dL. CKD was defined as an impaired renal function (eGFR <60 mL/min/1.73m2 according to the CKD-EPI equation). Logistic regression analysis was performed to examine the relationship between obesity and MetS with the presence of CKD.

RESULTS

A total of 32,616 diabetic patients were finally recruited from 997 hospitals. The mean age was 61.5±10.9 years with 67.5% women. Of the participants, 35.4% were CKD patients. The prevalence of obesity was 46.5% in CKD and 54.1% in non-CKD patients with T2DM (p<0.001). In contrast, the prevalence of MetS in CKD patients was higher than their non-CKD counterparts (71.3 vs 68.8%, p<0.001). Moreover, there was an association between the prevalence of MetS with CKD stage from 3a to 5 (70.1, 72.3, 73.4, and 72.7%, respectively, p trend = 0.02). MetS, but not obesity, had a significant association with CKD in T2DM patients after adjusting for age, sex, and comorbidities [OR 1.14; 95% CI 1.06-1.22, p<0.001]. When stratified by each component of MetS, only high serum triglyceride and low HDL-C levels were increased in patients with CKD stage 4 and 5 compared with CKD stage 3 (p<0.001) and had a significant relationship with impaired renal function.

CONCLUSION

There were relatively high prevalences of both obesity and MetS in T2DM patients. A higher prevalence of MetS, but lower prevalence of obesity, was observed among diabetic CKD group compared with their non-CKD counterparts. MetS, as a surrogate of insulin resistance, appeared to be more important than obesity in the development of impaired renal function in diabetic population.

Authors+Show Affiliations

Division of Internal Medicine-Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand. Special Task force for Activating Research in Renal Nutrition (Renal Nutrition Research Group), Office of Research Affairs, Chulalongkorn University, Bangkok, Thailand. Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.Ramathibodi Comprehensive Cancer Center, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.Special Task force for Activating Research in Renal Nutrition (Renal Nutrition Research Group), Office of Research Affairs, Chulalongkorn University, Bangkok, Thailand. Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.Special Task force for Activating Research in Renal Nutrition (Renal Nutrition Research Group), Office of Research Affairs, Chulalongkorn University, Bangkok, Thailand. Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29742114

Citation

Kittiskulnam, Piyawan, et al. "The Magnitude of Obesity and Metabolic Syndrome Among Diabetic Chronic Kidney Disease Population: a Nationwide Study." PloS One, vol. 13, no. 5, 2018, pp. e0196332.
Kittiskulnam P, Thokanit NS, Katavetin P, et al. The magnitude of obesity and metabolic syndrome among diabetic chronic kidney disease population: A nationwide study. PLoS ONE. 2018;13(5):e0196332.
Kittiskulnam, P., Thokanit, N. S., Katavetin, P., Susanthitaphong, P., Srisawat, N., Praditpornsilpa, K., ... Eiam-Ong, S. (2018). The magnitude of obesity and metabolic syndrome among diabetic chronic kidney disease population: A nationwide study. PloS One, 13(5), pp. e0196332. doi:10.1371/journal.pone.0196332.
Kittiskulnam P, et al. The Magnitude of Obesity and Metabolic Syndrome Among Diabetic Chronic Kidney Disease Population: a Nationwide Study. PLoS ONE. 2018;13(5):e0196332. PubMed PMID: 29742114.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The magnitude of obesity and metabolic syndrome among diabetic chronic kidney disease population: A nationwide study. AU - Kittiskulnam,Piyawan, AU - Thokanit,Nintita Sripaiboonkij, AU - Katavetin,Pisut, AU - Susanthitaphong,Paweena, AU - Srisawat,Nattachai, AU - Praditpornsilpa,Kearkiat, AU - Tungsanga,Kriang, AU - Eiam-Ong,Somchai, Y1 - 2018/05/09/ PY - 2017/12/19/received PY - 2018/04/11/accepted PY - 2018/5/10/entrez PY - 2018/5/10/pubmed PY - 2018/8/2/medline SP - e0196332 EP - e0196332 JF - PloS one JO - PLoS ONE VL - 13 IS - 5 N2 - BACKGROUND: Although the prevalence of obesity and metabolic syndrome (MetS) among dialysis patients has been exceeding than general population, little is known regarding obesity and MetS in non-dialysis chronic kidney disease (CKD). We aimed to find the magnitude of obesity and MetS and their associations with impaired renal function among type 2 diabetes mellitus (T2DM) patients. METHODS: A national survey of T2DM patients was collected in the Thai National Health Security Office database during 2014-5. The sampling frame was designated as distinct geographic regions throughout the country. A stratified two-stage cluster sampling was used to select the study population. Anthropometry and 12-hour fasting blood samples were obtained by trained personnel. BMI of ≥25 kg/m2 was classified as obesity. MetS was defined as having elevated waist circumference (>90 and >80 cm in men and women, respectively) plus any two of the followings: triglyceride ≥150 mg/dL, HDL-C <40 in men or <50 mg/dL in women, blood pressure ≥130/85 mmHg, and fasting blood sugar ≥100 mg/dL. CKD was defined as an impaired renal function (eGFR <60 mL/min/1.73m2 according to the CKD-EPI equation). Logistic regression analysis was performed to examine the relationship between obesity and MetS with the presence of CKD. RESULTS: A total of 32,616 diabetic patients were finally recruited from 997 hospitals. The mean age was 61.5±10.9 years with 67.5% women. Of the participants, 35.4% were CKD patients. The prevalence of obesity was 46.5% in CKD and 54.1% in non-CKD patients with T2DM (p<0.001). In contrast, the prevalence of MetS in CKD patients was higher than their non-CKD counterparts (71.3 vs 68.8%, p<0.001). Moreover, there was an association between the prevalence of MetS with CKD stage from 3a to 5 (70.1, 72.3, 73.4, and 72.7%, respectively, p trend = 0.02). MetS, but not obesity, had a significant association with CKD in T2DM patients after adjusting for age, sex, and comorbidities [OR 1.14; 95% CI 1.06-1.22, p<0.001]. When stratified by each component of MetS, only high serum triglyceride and low HDL-C levels were increased in patients with CKD stage 4 and 5 compared with CKD stage 3 (p<0.001) and had a significant relationship with impaired renal function. CONCLUSION: There were relatively high prevalences of both obesity and MetS in T2DM patients. A higher prevalence of MetS, but lower prevalence of obesity, was observed among diabetic CKD group compared with their non-CKD counterparts. MetS, as a surrogate of insulin resistance, appeared to be more important than obesity in the development of impaired renal function in diabetic population. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/29742114/The_magnitude_of_obesity_and_metabolic_syndrome_among_diabetic_chronic_kidney_disease_population:_A_nationwide_study_ L2 - http://dx.plos.org/10.1371/journal.pone.0196332 DB - PRIME DP - Unbound Medicine ER -