陕西汉中儿童和青少年体重指数轨迹变化与成年期亚临床肾损伤的相关性分析：一项 30 年的队列随访研究

Objective To investigate the association between body mass index (BMI) trajectories in children and adolescents and subclinical renal damage (SRD) in adulthood. Methods 4 623 participants aged 6-18 years old were recruited from the ongoing cohort of Hanzhong adolescent hypertension study in 1987, and the subjects were followed up in 1989, 1992, 1995, 2005, 2013 and 2017, respectively. Group ⁃ based trajectory modeling was used to identify distinct BMI trajectories in longitudinal analysis. Generalized linear model was applied to examine the association between different BMI trajectories and SRD incidence in adulthood. Results A total of 2 678 subjects from childhood to adulthood were enrolled in this study. All subjects were divided into three groups according to three distinct BMI trajectories: low ⁃ increasing BMI group (n=1 017), moderate ⁃ increasing BMI group (n=1 353), and high ⁃ increasing BMI group (n=308). Over follow up for 30 years, a total of 248 participants (9.3%) developed SRD. Urinary albumin ⁃ to ⁃ creatinine ratio (uACR) in low to high ⁃ increasing BMI group was 0.9(0.6, 1.4), 1.0(0.7, 1.7), 1.6(0.8, 3.2), respectively (P trend＜0.001), and estimated glomerular filtration rate was 98.5(87.6, 111.6）, 96.2(86.4, 109.7), 95.3（87.5, 125.0) ml· min^-1·(1.73 m²)^-1, respectively (P trend=0.025). The generalized linear model analysis showed that uACR was increased linearly from low to high ⁃ increasing BMI group [β=3.16(95%CI 1.02-5.31), Ptrend= 0.004]. There was no correlation or linear trend between BMI trajectory and estimated glomerular filtration rate [β =-2.30(95% CI -5.18-0.57), Ptrend=0.117]. Compared with the low ⁃ increasing BMI group, the high ⁃ increasing BMI group had greater odds of experiencing SRD in adulthood after adjusting for multiple confounders such as age, gender, medical history and lifestyle (OR=2.83, 95%CI 1.84-4.36, Ptrend＜0.001). Conclusions Higher BMI trajectorie is correlated with higher level of uACR and risk of SRD in middle age. Identifying long ⁃ term BMI trajectorie from early age may assist in predicting individuals′ renal function in later life.