Arch Intern Med：青少年肥胖可增加未来患终末期肾脏疾病的风险

研究者报告说，青少年肥胖或体重超标会增加未来患终末期肾脏疾病(ESRD)的风险。他们的研究表明青少年过高的体重指数（BMI）与形成糖尿病型和非糖尿病型ESRD有关。

在1967年到1997年间，有1,194,704名以色列青少年，平均年龄为17.4岁，服兵役时做了健康检查。研究者将检查结果和记录了1980年到2010年间接受ESRD治疗的患者信息的登记表结合起来，得出了这种联系。

如ArchivesofInternalMedicine上报告的，相对于正常体重的青少年（男生BMI为17.71-24.89kg/m2，女生BMI为17.21-25.19kg/m2），需要ESRD治疗的超重（男生BMI为24.90-28.19kg/m2女生BMI为25.20-29.59kg/m2）或肥胖（男生BMI为28.20-40.00kg/m2女生BMI为29.60-40.00kg/m2）个体大大地增加了。体重不足和体重正常的青少年每年接受ESRC（各种原因引起的）治疗的人数很接近，分别为2.30人/100000人和2.32人/100000人，而超重和肥胖的青少年则分别为6.08人/100000人和13.40人/100000人。调整性别，国籍，收缩压和入学时期后，与正常体重的个体相比，超重和肥胖的个体患ESRD的风险率高出了3.0到6.9倍。超重的青少年患糖尿病型ESRD的风险也高了六倍，肥胖青少年则为19倍。而且，超重和肥胖青年患非糖尿病型ESRD的风险还分别有2.17和3.41倍之高。

AsafVivante（以色列Sheba医疗中心）和他的同事写道：“要证明ESRD与升高的BMI有关，可能需要童年时期的早期检测。”他们同时也说：“虽然此种联系并不能证明患病的起因，但是这个发现突出了这种迫切需要将儿童和青少年肥胖作为患病的可能性危险因素的益处。”

与肥胖相关的拓展阅读：

• Cell Metabolism：高胰岛素水平可导致肥胖
• Arch Intern Med：青少年肥胖可增加未来患终末期肾脏疾病的风险
• ISME J：阴沟肠杆菌可能是肥胖的关键原因
• RSNA:腹型肥胖男子骨质疏松风险增加
• ACCOMPLISH:并非所有肥胖高血压患者需使用利尿剂
更多信息请点击：有关肥胖更多资讯

doi: 10.1001/2013.jamainternmed.85
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Body Mass Index in 1.2 Million Adolescents and Risk for End-Stage Renal Disease.

Vivante A, Golan E, Tzur D, Leiba A, Tirosh A, Skorecki K, Calderon-Margalit R.

BACKGROUND The relationship between adolescent body mass index (BMI) and future risk for end-stage renal disease (ESRD) is not fully understood, nor is it known the extent to which this association is limited to diabetic ESRD. We evaluated the association between BMI in adolescence and the risk for all-cause, diabetic, and nondiabetic ESRD. METHODS Medical data about 1 194 704 adolescents aged 17 years who had been examined for fitness for military service between January 1, 1967, and December 31, 1997, were linked to the Israeli ESRD registry in this nationwide population-based retrospective cohort study. Incident cases of treated ESRD between January 1, 1980, and May 31, 2010, were included. Cox proportional hazards models were used to estimate the hazard ratio (HR) for treated ESRD among study participants for their BMI at age 17 years, defined in accord with the US Centers for Disease Control and Prevention BMI for age and sex classification. RESULTS During 30 478 675 follow-up person-years (mean [SD], 25.51 [8.77] person-years), 874 participants (713 male and 161 female) developed treated ESRD, for an overall incidence rate of 2.87 cases per 100 000 person-years. Compared with adolescents of normal weight, overweight adolescents (85th to 95th percentiles of BMI) and obese adolescents (≥95th percentile of BMI) had an increased future risk for treated ESRD, with incidence rates of 6.08 and 13.40 cases per 100 000 person-years, respectively. In a multivariate model adjusted for sex, country of origin, systolic blood pressure, and period of enrollment in the study, overweight was associated with an HR of 3.00 (95% CI, 2.50-3.60) and obesity with an HR of 6.89 (95% CI, 5.52-8.59) for all-cause treated ESRD. Overweight (HR, 5.96; 95% CI, 4.41-8.06) and obesity (HR, 19.37; 95% CI, 14.13-26.55) were strong and independent risk factors for diabetic ESRD. Positive associations of overweight (HR, 2.17; 95% CI, 1.71-2.74) and obesity (HR, 3.41; 95% CI, 2.42-4.79) with nondiabetic ESRD were also documented. CONCLUSIONS Overweight and obesity in adolescents were associated with significantly increased risk for all-cause treated ESRD during a 25-year period. Elevated BMI constitutes a substantial risk factor for diabetic and nondiabetic ESRD