Abstract
BackgroundObesity, 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.MethodsData 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).ResultsTotally, 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.ConclusionsLower 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.
Highlights
Obesity is considered a major public health problem owing to its rapidly increasing prevalence and close association with poor outcomes.[1]
Several recent large epidemiologic investigations have reported that the risk of chronic kidney disease (CKD) development clearly increases with the increase in body mass index (BMI).[4]
The association of BMI and the MF ratio with CKD development was investigated in a general population cohort with preserved kidney function
Summary
Obesity is considered a major public health problem owing to its rapidly increasing prevalence and close association with poor outcomes.[1]. One major shortcoming of using BMI to determine obesity is that BMI does not account for body composition.[7,8] BMI, calculated based only on height and weight, is an inaccurate measure of body fat content and does not take into account the fluid status, muscle mass, or bone density.[9,10] Individuals with the same BMI may largely vary in body composition This inaccuracy of BMI in representing adiposity may be one of the reasons for the controversial results among studies evaluating the association between BMI and CKD development. This study evaluated the association between body muscle and fat mass balance, represented as the MF ratio, and incident CKD development
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