Background Obesity, a known risk factor for chronic kidney disease (CKD), is generally assessed using body mass index (BMI). However, BMI may not effectively reflect body composition, and the impact of muscle‐to‐fat (MF) mass balance on kidney function has not been elucidated. This study evaluated the association between body muscle and fat mass balance, represented as the MF ratio, and incident CKD development. Methods Data were retrieved from a prospective community‐based cohort study (Korean Genome and Epidemiology Study). Muscle and fat mass were measured using multifrequency bioelectrical impedance analysis. The study endpoint was incident CKD (estimated glomerular filtration rate 60 mL/min/1.73 m2 in at least two or more consecutive measurements during the follow‐up period). Results Totally, 7682 participants were evaluated. Their mean age was 51.7 ± 8.7 years, and 48% of the subjects were men. During a median follow‐up of 140.0 (70.0–143.0) months, 633 (8.2%) subjects developed incident CKD. When the association between body composition and incident CKD was investigated, multivariable Cox proportional hazard analysis revealed that increase in MF ratio was related with a decreased risk of CKD development [per 1 increase in MF ratio: hazard ratio (HR), 0.86; 95% confidence interval (CI), 0.77–0.96; P = 0.008]. This association was also maintained when MF ratio was dichotomized according to sex‐specific median values (high vs. low: HR, 0.83; 95% CI, 0.70–0.98; P = 0.031). Analyses preformed in a propensity score matched group also revealed a similar decreased risk of incident CKD in high MF ratio participants (high vs. low: HR, 0.84; 95% CI, 0.71–0.98; P = 0.037). This relationship between MF ratio and incident CKD risk was consistently significant across subgroups stratified by age, sex, hypertension, estimated glomerular filtration rate categories, and proteinuria. Among different BMI groups (normal, overweight, and obese), the relationship between high MF ratio and lower incident CKD risk was significant only in overweight and obese subjects. Conclusions Lower fat mass relative to muscle mass may lower the risk of CKD development in individuals with normal renal function. This relationship seems more prominent in overweight and obese subjects than in normal weight subjects.
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机译：背景技术肥胖，通常使用体重指数（BMI）评估慢性肾病（CKD）的已知风险因素。然而，BMI可能没有有效地反映体组成，并且肌肉到脂肪（MF）质量平衡对肾功能的影响尚未得到阐明。本研究评估了身体肌肉和脂肪量平衡之间的关联，代表了MF比和事件CKD发育。方法从基于前瞻性社区的群组研究（韩国基因组和流行病学研究）中检索数据。使用多频生物电阻抗分析测量肌肉和脂肪质量。研究终点是入射CKD（估计肾小球过滤速率<60ml / min / 1.73m 2，在后续期间至少两个或更多个连续测量）。结果完全，7682名参与者进行了评估。他们的平均年龄为51.7±8.7岁，48％的受试者是男性。在140.0（70.0-143.0）个月的中位随访期间，633（8.2％）受试者发达了CKD。当研究身体成分和事件CKD之间的关联时，多变量的Cox比例危害分析显示，MF比的增加与CKD发育的风险降低有关[每1次数增加MF比率：危险比（HR），0.86; 95％置信区间（CI），0.77-0.96; p = 0.008]。当根据性别特异性中值（高与低：HR，0.83; 95％CI，0.70-0.98; P = 0.031），当MF比例分二分层时，也保持该关联。在倾向得分匹配中预先形成的分析还揭示了高MF比参与者中发生的事件CKD的风险相似（高与低：HR，0.84; 95％CI，0.71-0.98; P = 0.037）。 MF比率和事件CKD风险之间的这种关系在由年龄，性别，高血压，估计的肾小球过滤税率类别和蛋白尿中分层分层的亚组中始终如一。在不同的BMI群中（正常，超重和肥胖），高MF比率与较低事件CKD风险之间的关系仅在超重和肥胖的主题中显着。结论较低的脂肪质量相对于肌肉质量可能降低具有正常肾功能的个体CKD发育的风险。这种关系在超重和肥胖对象中似乎更加突出，而不是正常的重量受试者。
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