Mrs. Watcharasa Pitug

ID. 567110011-2

The Association between Waist-to-Hight ratio, waist circumference,and Body Mass Index as Risk Factors for Chronic Renal Insufficiency among Type 2 Diabetes and Hypertension

patients

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Contents

Background/RationaleObjectiveMethodsResultsDiscussion &Conclusions

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Background/Rationale

Chronic kidney disease (CKD) has become a global public health problem and is a common

condition in the United States(Alejandro et al.,2009 ; Essam et al.,2008 ; Adam

et al., 2007) In 2004, there were approximately 472,000 patients with treated ESRD (Alejandro et

al.,2009 )By 2030, expected to increase to more than 2

million. The estimated prevalence of earlier CKD stages (stages 1 through 4) in US adults was 24

to 28 million based on the 2000 (Adam et al., 2007)

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in Thailand 2007 : Chronic Renal Insufficiency patients 13.2% in state 3 and 0.61% in state 4 (Thawee Siriwong, 2007) and up to 13.5 in 2008

Chronic kidney disease: classification and clinical consequences

Relative risk of death in relation to kidney function(N=1,120,295 pts) CKD -KDOQI classification

Go AS et., 2004

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Clinical complications of renal failure

Parathyroid gland

disturbances –renal bone

diseaseActive vitamin D deficiency

Atherosclerosis

and arterioscleros

isPolyneuropathy

No diuresis –overhydration

..and many others

Malnutrition/wasting

Immunodeficiency

Myocardial fibrosis and

cardiomyopathy

Loss of erythropoietin –

anaemia

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Gab of knowledge

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The relationship of obesity to Renal insufficiency is somewhat controversial.

While it is established that obesity increases the risk of hypertension, diabetes and

dyslipidemiait is not clear if excess

WHtR, WC, and BMI influences Renal

insufficiencyCorrelation between waist circumference and (A) visceral and (B) subcutaneous fat areas assessed by using computed

tomography in 75 men (open circle; dotted lines) and 47 women (filled triangle; solid lines) with prevalent chronic

kidney disease.

Fabiana et al.,2008

Methods

Analytic study was conducted all information were collected from medical records of all patients diagnosed with type of DM HT and DM with HT complications was based on Renal insufficiency was the main outcome of this study.

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Objective

To investigate the association between WHtR, WC, and BMI and Renal insufficiency among DM and HT patients

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The inclusion flow chart for study participants

174,578 patients were randomized

61,602 patients were DM,HT and DM with HT in year 2012

Study participants

(n=61,602)

112,976 were excluded •Year 2010,2011;• No data.

Methods

3,373,089 patients who visiting Hospitals in care

Modification of Diet in Renal Disease (MDRD) in Thailand

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Methods

Go AS et., 2004

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Demographic characteristics were described using frequency and percentage for categorical data such as gender, age group,WC group, BMI group, Cigarette smoking use, fasting plasma glucose group, total cholesterol group, triglyceride group, HDL cholesterol group, LDL cholesterol group, hemoglobin group and hematocrit group.

Using mean, standard deviation, median, minimum, and maximum to described continuous data such as age, BMI, fasting plasma glucose level, total cholesterol level, triglyceride level, HDL cholesterol level, LDL cholesterol level, hemoglobin level and hematocrit level.

To investigate factors that associated with chronic renal insufficiency, adjusted odds ratios (ORs) and their 95% confidence intervals (95%CIs) were estimated using multiple logistic regression.

All test statistics were p-value of less than 0.05 was considered statistical significant.

All analyses were performed by using STATA version 12.0 (AtataCorp, College Station, TX).

Statistic AnalysisMethods

Results

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Basic characteristic of the individual included in the study

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Basic characteristic of the individual included in the study

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Basic characteristic of the individual included in the study

Other basic characteristic presented in table 2

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Factors associated with CRI

Univariate Analysis

Table 3. Crude odds ratios of having renal insufficiency and their 95% confidence intervals for each factor

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Table 3. Crude odds ratios of having renal insufficiency and their 95% confidence intervals for each factor (cont.)

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Table 3. Crude odds ratios of having renal insufficiency and their 95% confidence intervals for each factor (cont.)

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Multivariate Analysis

BMI for adjustment other factors

Table 4. Adjust odds ratios of BMI for having renal insufficiency and their 95% confidence intervals for each factor

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Table 4. Adjust odds ratios of BMI for having renal insufficiency and their 95% confidence intervals for each factor (cont.)

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Table 4. Adjust odds ratios of BMI for having renal insufficiency and their 95% confidence intervals for each factor (cont.)

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Fig. 2 Forest plot of adjusted odds ratio for compare having BMI for each factor

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WC for adjustment other factors

Table 5. Adjust odds ratios of Waist Circumference having renal insufficiency and their 95% confidence intervals for each factor

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Table 5. Adjust odds ratios of Waist Circumference having renal insufficiency and their 95% confidence intervals for each factor (cont.)

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Fig. 3 Forest plot of adjusted odds ratio for compare having WC for each factor

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Waist-to-hight for adjustment other factors

Table 6. Adjust odds ratios of Waist-to-hight having renal insufficiency and their 95% confidence intervals for each factor

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Table 6. Adjust odds ratios of Waist-to-hight having renal insufficiency and their 95% confidence intervals for each factor (cont.)

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Fig. 4 Forest plot of adjusted odds ratio for compare having WHtR for each factor

Discussion

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BMI

BMI is a less specific measure less able to differentiate between visceral and subcutaneous fat, as well as between central and peripheral fat

Essam et al., 2008

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Waist circumference

Waist circumference, provides information about body shape and fat distribution

Computed tomography

Discussion

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Critically, excess visceral and peripheral fat, more so than subcutaneous fat, is associated with CVD and CVD risk factors.

Fox et al., 2007

Waist-to-Hight

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Conclusions

In summary, in agreement with the findings in the general population, the present study shows that

WHtR,WC,and BMI was associated with Chronic Renal Insufficiency.

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