Epidemic Investigation On The Association Of Metabolic Syndrome Components With Chronic Kidney Disease In A Community Population Aged 40 Years And Older

BackgroundChronic non-communicable diseases(NCD)have become a worldwide health problem.There is close interaction between NCD and chronic kidney disease(CKD),hypertension,diabetes and cardiovascular diseases and they have common risk factors.This project was funded by Southern Medical University for studying the correlation of CKD and insulin resistance and metabolic diseases(MS),and investing the association of metabolic syndrome components and chronic kidney disease in a Chinese population aged 40 years and older.In addition to epidemiological investigation in the community,this study focused on the relationship between CKD and single or multi-component synergism of MS.And study on the association of abnormal HDL subcomponents distribution with inflammation and lipid disorder profiles in insulin resistance-related obesity.Objective1.To perform a cross-sectional health survey in Wanzhai Town,Zhuhai City among community residents aged 40 and over for understanding the prevalence of NCD(obesity,CKD,metabolic syndrome,insulin resistance,hypertension,diabetes and hyperuricemia),and founding a basis for establishing epidemic database beneficial follow-up study.2.To investigate the epidemiology of MS and the prevalence of NCD in MS population,and study the multi-component distribution of MS in different genders and the risk factors related to metabolic syndrome.3.To investigate the epidemiology of CKD and its risk factors,exploring the association of MS and its components with CKD in the participants and the prevalence of CKD in NCD population.Also,to investigate the relationship between MS components and CKD in NCD population,exploring the correlation of MS and CKD in some special NCD population.MethodsA cross-sectional survey was conducted among residents of permanent communities aged 40 and over in southern China.Among the 1969 subjects,the average age was 58.96 ± 10.61 years,Epidemiological data were collected by questionnaire,physical examination,blood and urine samples.Use EpiData statistical software to input data for two people and check it.IBM SPSS 20 statistical software was used to complete the relevant analysis and statistics.Results1 In 1969 participants,the prevalence of overweight/obesity,overweight,obesity,central obesity,CKD,MS,insulin resistance,hypertension,hyperuricemia and diabetes were 51.7%,37.43%,14.27%,65.46%,20.67%,38.55%,35.85%,54.65%,31.54%and 12.80%respectively.2 In MS and non-MS population,the top three single components were central obesity(95.0%vs 46.9%),hypertension(78.4%vs 39.9%),overweight/obesity(74.8%vs 37.9%).The prevalence of NCD in MS population was significantly higher than that in non-MS population(P<0.001).3 The prevalence of high blood pressure,abdominal obesity,high serum TG,high fasting plasma glucose and low serum HDL-C were 68.3%,65.5%,34.0%,26.1%and 15.7%respectively.The highest prevalence was high blood pressure followed by abdominal obesity.4 Among the participants,38.5%subjects had three or more components of metabolic syndrome.The prevalence of hypertension+abdominal obesity+high triglyceride was the highest(9.8%)among all the combination models of the MS components.The most common combination of MS components in female MS patients was hypertension+abdominal obesity+high altitude abdominal blood glucose(7.5%).5 MS is closely related to gender,age,systolic blood pressure,waist circumference,fasting plasma glucose,TG,serum HDL-C and serum uric acid.HDL-C is the protective factor.6 Among the 1969 subjects,407(20.7%)were CKD patients,152 of them were male(prevalence 21.3%)and 255 were female(prevalence 20.3%).BMI,WC,waist to hip ratio,waist to height ratio,BAI,systolic pressure,diastolic pressure,serum creatinine,serum uric acid,ACR,fasting plasm glucose,CRP,serum triglyceride,HOMA-IR levels in CKD group were significantly higher than those in non-CKD group(P<0.05).eGFR and HDL-C of non-CKD group were significantly higher than those of MS group.There was no significant difference in LDL between CKD and non-CKD groups(P>0.05).7 MS and MS components were related to the prevalence of CKD,and were the risk factors of CKD.The OR value of MS subjects with CKD was 3.34(95%CI,2.66-4.19)compared with those without MS.The OR value of subjects with elevated blood pressure was 6.02(95%CI,4.23-8.57)compared with subjects without elevated blood pressure.8 In both adjusted and unadjusted models,hypertension,hypertriglyceridemia and high fasting plasma glucose are the independent risk factors of chronic kidney disease.Hypertension is of OR=2.58(95%CI,1.75-3.82;P<0.01),TG OR=1.30(95%CI,1.00-1.69;P=0.05)and FPG OR=1.47(95%CI,1.47-1.95;P=0.01).9 According to the number of MS component,all the subjects were divided into six subgroups with respectively 0,1,2,3,4,5 components.The prevalence of CKD was respectively 5.04%,12.26%,17.16%,30.00%,35.02%and 48.39%in the six groups.The prevalence of CKD increased along with the increase of the number of MS components.10 The prevalence of CKD increased along with the increase of arterial blood pressure grade.The prevalence of CKD was 40.3%in subjects with hypertension Level 3,30.0%in subjects with hypertension Level 2,about 20%in subjects with hypertension level 1,and 7.6%in subjects without hypertension(Figure 3-3)11 BMI is related to the prevalence of CKD.With the increase of BMI level,the prevalence of CKD increases.About 1/3 of obese subjects had CKD and about 1/5 of overweight subjects had CKD(Figure 3-4).12 In the population without hypertension and diabetes,prevalence compared with the subjects without metabolic syndrome,CKD was more common in the subjects with metabolic syndrome,9.5%vs 4.6%(P=0.03),OR=2.42(95%CI,1.37-4.29).13 The abnormal distribution of high-density lipoprotein(HDL)subcomponents was found in insulin resistance and obesity.The abnormal distribution of HDL subcomponents was related to IR related obesity,lipid metabolism disorder and inflammatory response.Conclusions1.Multiple non-communicable diseases(NCD),including CKD,hypertension,diabetes,MS,hyperuricemia and obesity,are very common in the community population.The prevalence of NCD in MS population was significantly higher than that in non-MS population.2.Among the components of MS,high blood pressure and abdominal obesity were the single components with the highest detection rate,while the combination of high blood pressure+abdominal obesity+high triglyceride was the highest combination patterns of MS components(9.8%).The most common combination pattern in female MS patients was high blood pressure+abdominal obesity+high fasting plasma glucose(7.5%).3.The waist circumference,age,blood pressure,fasting plasma glucose and serum triglyceride levels of CKD group were significantly higher than those of non-CKD group(P<0.05).The serum HDL-C level in non-CKD population was significantly higher than that in MS population.4.The prevalence of CKD in MS population was higher than that without MS(33.10%vs 12.80%;P<0.001).MS was the risk factor of CKD,and the OR value of CKD in MS subjects was 3.34(95%CI,2.66-4.19)compared with those without MS.5.In the unadjusted and adjusted model,high blood pressure,high serum triglyceride and high fasting plasma glucose were all independent risk factors of chronic kidney disease.6.The prevalence of CKD increased along with the increase of the components of metabolic syndrome.7.Along with the increase of BMI grade,the prevalence of CKD is increasing.The prevalence of CKD was increased either in obese subjects or overweight subjects.8.Even in community population without hypertension and diabetes mellitus,CKD prevalence is increased in subjects with MS,compared to subjects without MS.9.HDL subfraction may play a role in the metabolic disorder and the mechanism of inflammation in IR patients with obesity...