Abstract
The purpose of this study is to determine if renal function varies by metabolic phenotype. A total of 9599 patients from a large Federally Qualified Health Center (FQHC) were included in the analysis. Metabolic health was classified as the absence of metabolic abnormalities defined by the National Cholesterol Education Program Adult Treatment Panel III criteria, excluding waist circumference. Obesity was defined as body mass index >30 kg/m2 and renal health as an estimated glomerular filtration rate (eGFR) >60 mL/min/1.73 m2. Linear and logistic regressions were used to analyze the data. The metabolically healthy overweight (MHO) phenotype had the highest eGFR (104.86 ± 28.76 mL/min/1.72 m2) and lowest unadjusted odds of chronic kidney disease (CKD) (OR = 0.46, 95%CI = 0.168, 1.267, p = 0.133), while the metabolically unhealthy normal weight (MUN) phenotype demonstrated the lowest eGFR (91.34 ± 33.28 mL/min/1.72 m2) and the highest unadjusted odds of CKD (OR = 3.63, p < 0.0001). After controlling for age, sex, and smoking status, the metabolically unhealthy obese (MUO) (OR = 1.80, 95%CI = 1.08, 3.00, p = 0.024) was the only phenotype with significantly higher odds of CKD as compared to the reference. We demonstrate that the metabolically unhealthy phenotypes have the highest odds of CKD compared to metabolically healthy individuals.
Highlights
Chronic kidney disease (CKD) is one of the top ten causes of death in the UnitedStates (USA), with its prevalence growing from 11.8% in the early 1990s [1] to over 15% in2019 [2]
The strictly defined metabolically healthy phenotypes made up 6.41% of the population, and 39.76% of the population was of normal weight (BMI < 30 kg/m2 )
The metabolically healthy obese (MHO) phenotype accounted for the smallest proportion of the population (2.46%), whereas the metabolically unhealthy obese (MUO) accounted for the largest proportion of the population (57.79%)
Summary
Chronic kidney disease (CKD) is one of the top ten causes of death in the UnitedStates (USA), with its prevalence growing from 11.8% in the early 1990s [1] to over 15% in2019 [2]. Concomitant increases have been observed in obesity and metabolic syndrome over the past three decades, with the prevalence of obesity rising from 22.9% to 42.4% [3]. Diagnoses of metabolic syndrome increasing from 25.3% to 34.7% [4]. This milieu is prime for the development and progression of chronic diseases, such as cardiovascular disease (CVD) and CKD, as well as mortality. Recent research studies have analyzed the impact of metabolic phenotypes, which integrate metabolic risk factors and obesity, in the assessment and prediction of CVD [5,6]. The definition of metabolic health has been inconsistent in prior research, but recent studies by
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