Abstract
Background
Abdominal obesity as a risk factor for diagnosing metabolic syndrome (MetS) is conventionally evaluated using waist circumference (WC), although WC does not necessarily reflect visceral adiposity.
Objective
To examine whether replacing WC with “A Body Shape Index (ABSI)”, an abdominal obesity index calculated by dividing WC by an allometric regression of weight and height, in MetS diagnosis is useful for predicting renal function decline.
Subjects/Methods
In total, 5438 Japanese urban residents (median age 48 years) who participated in a public health screening program for 4 consecutive years were enrolled. Systemic arterial stiffness was assessed by cardio-ankle vascular index (CAVI). The predictability of the new-onset renal function decline (eGFR < 60 mL/min/1.73 m2) by replacing high WC with high ABSI (ABSI ≥ 0.080) was examined using three sets of MetS diagnostic criteria: Japanese, IDF and NCEP-ATPIII.
Results
In Japanese and NCEP-ATPIII criteria, MetS diagnosed using ABSI (ABSI-MetS) was associated with significantly higher age-adjusted CAVI compared to non-MetS, whereas MetS diagnosed using WC (WC-MetS) showed no association. Kaplan–Meier analysis of the rate of new-onset renal function decline over 4 years (total 8.7%) showed remarkable higher rate in subjects with ABSI-MetS than in those without (log-rank test p < 0.001), but almost no difference between subjects with and without WC-MetS (p = 0.014–0.617). In gender-specific Cox-proportional hazards analyses including age, proteinuria, and treatments of metabolic disorders as confounders, ABSI-MetS (Japanese criteria for both sexes, IDF criteria for men) contributed independently to the new-onset renal function decline. Of these, the contribution of IDF ABSI-MetS disappeared after adjustment by high CAVI in the subsequent analysis.
Conclusion
In this study, replacing WC with ABSI in MetS diagnostic criteria more efficiently predicted subjects at risk of renal function decline and arterial stiffening.
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Introduction
Abdominal obesity with visceral fat accumulation has been considered to play an essential role in the development of cardiometabolic disorders including glucose intolerance, dyslipidemia and hypertension, so-called the metabolic syndrome (MetS) [1, 2]. Several epidemiological studies have demonstrated that MetS increases the risk of not only cardiovascular disease (CVD) morbidity and mortality [3, 4], but also the incidence of chronic kidney disease (CKD) [5, 6] and end-stage renal disease (ESRD) [7]. On the other hand, the validity of MetS diagnostic criteria remains controversial. Reaven [8] highlighted the fact that there are many non-MetS patients who are clearly at higher risk of CVD than MetS patients. Furthermore, it has been claimed that MetS does not necessarily predict CVD risk above and beyond its individual components [9, 10]. Some reports have also shown that elevated waist circumference (WC), an indicator of abdominal obesity for diagnosing MetS, is associated with CKD to a less extent after adjusting for MetS components [11, Replacing WC with ABSI in MetS diagnostic criteria may more efficiently predict people at risk of renal function decline and arterial stiffening. Further studies are needed to confirm whether diagnosis of MetS using ABSI also predicts CVD morbidity and mortality.Conclusion
Data availability
The data that support the findings of this study are not publicly available because they contain information that could compromise the privacy of research participants. Further enquiries may be directed to the corresponding author.
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Nagayama, D., Fujishiro, K., Tsuda, S. et al. Enhanced prediction of renal function decline by replacing waist circumference with “A Body Shape Index (ABSI)” in diagnosing metabolic syndrome: a retrospective cohort study in Japan. Int J Obes 46, 564–573 (2022). https://doi.org/10.1038/s41366-021-01026-7
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DOI: https://doi.org/10.1038/s41366-021-01026-7
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