Original article
Obesity markers associated to albuminuria in a primary care center in Lima, PerúMarcadores de obesidad asociados a albuminuria en un centro de atención primaria de Lima, Perú

https://doi.org/10.1016/j.endien.2017.08.002Get rights and content

Abstract

Objective

To evaluate the association between three obesity markers, body mass index (BMI), abdominal circumference (AC), waist to height ratio (WHtR), and albuminuria in adults seen in a primary health care center specialized in chronic diseases in Lima, Perú.

Methods

A cross-sectional, descriptive, retrospective study in adults who attended a primary health care center specialized in chronic diseases in 2011. Patients were divided into four categories: healthy subjects and patients with high blood pressure, with type 2 diabetes mellitus (T2DM), and with both diseases (HBP + T2DM). The main outcome was presence of albuminuria, defined as urine albumin levels higher than 30 mg/day. Exposure variables included the following obesity markers: body mass index (BMI), waist-to-height ratio (WHtR), and abdominal circumference (AC). Other covariates considered included sex and age. Crude and adjusted Poisson regressions were performed to estimate prevalence ratios (PRs) and their respective 95% confidence intervals (95% CIs). Areas under the curve were calculated for each indicator, stratified by sex.

Results

Data from 1214 patients, 41% of them male, were analyzed, and albuminuria was found in 14.2%. Albuminuria was found to be associated to AC and WHtR, but not to BMI. All three parameters assessed had similar areas under the curve. The optimum cut-off points found for BMI and AC in females were higher than conventional (32.7 kg/m2 and 93 cm respectively), while the values in males were lower than conventional (27.9 kg/m2 and 100 cm respectively). For WHtR, however, the optimum cut-off point was higher in both sexes. The higher index in females was for BMI, followed by AC and WHtR. In males, the higher index was for WHtR, followed by AC and BMI.

Conclusions

AC and WHtR were found to be directly associated to albuminuria, while BMI was not associated to albuminuria. Areas under the curve were similar for all three markers. The optimum cut-off points for BMI and AC were higher than the conventional ones in females and lower in males.

Resumen

Objetivo

Evaluar la asociación entre tres marcadores de obesidad: índice de masa corporal (IMC), perímetro abdominal (PA) e índice cintura/talla (ICT) con albuminuria, en adultos de un centro de atención primaria especializado en enfermedades crónicas de Lima, Perú.

Métodos

Estudio transversal descriptivo retrospectivo de adultos atendidos en un centro de atención primaria especializado en enfermedades crónicas en el 2011. Se incluyeron participantes con hipertensión arterial, con diabetes mellitus tipo 2 (DM2), con ambas condiciones (hipertensión arterial y DM2) y participantes sin hipertensión arterial ni DM2. El desenlace de interés fue el tener albuminuria, definido como albuminuria en orina >30 mg/día. Las variables de exposición fueron los siguientes marcadores de obesidad: IMC, ICT y PA. Otras covariables consideradas fueron sexo y edad. Se realizaron regresiones de Poisson crudas y ajustadas para estimar razones de prevalencia y sus respectivos intervalos de confianza al 95% (IC95%). Se calcularon las áreas bajo la curva para cada indicador y se hallaron los puntos de corte con óptimos con el índice de Younden, estratificando por sexo.

Resultados

Se analizaron datos de 1.214 pacientes, el 41.0% fueron varones y el 14,2% tuvo albuminuria. El PA y el ICT estuvieron significativamente asociados con tener albuminuria, mas no el IMC. Los tres parámetros evaluados tuvieron áreas bajo la curva similares. Los puntos de corte óptimos encontrados para IMC y PA en mujeres fueron mayores a los convencionales (32,7 kg/m2 y 93 cm respectivamente), en tanto que para varones los puntos de corte óptimos fueron menores a los convencionales (27,9 kg/m2 y 100 cm respectivamente). Sin embargo, para el ICT el punto de corte óptimo fue mayor al convencional en ambos sexos.

Conclusiones

Se encontró una asociación directa entre PA e ICT con albuminuria, pero no entre IMC y albuminuria. Las áreas bajo la curva fueron similares para los tres marcadores. Los puntos de corte óptimos para IMC y PA fueron mayores a los convencionales en mujeres, y menores a los convencionales en varones. El punto de corte óptimo para ICT fue mayor al convencional en ambos sexos.

Introduction

Albuminuria is defined by the National Kidney Foundation in the Kidney Disease Outcomes Quality Initiative as urine albumin >30 mg/24 h,1 and is an indicator of vascular permeability secondary to an intraglomerular hemodynamic anomaly.2, 3 Different studies have found the presence of albuminuria in the general population to be a predictor of cardiovascular diseases and of chronic kidney disease.4, 5, 6, 7

The main risk factors for the appearance and development of albuminuria are arterial hypertension (AHT), type 2 diabetes mellitus (T2DM) and obesity.4, 5, 8 However, the physiopathology of albuminuria varies among different disease conditions. In this regard, albuminuria in AHT is essentially related to endothelial dysfunction, while in T2DM it is related to damage to the glomerular filtration membrane, intraglomerular hypertension and hyperfiltration that leads to diabetic neuropathy.9, 10

Obesity is usually evaluated by means of different markers such as the body mass index (BMI), the waist-to-height ratio (WHtR) and abdominal circumference (AC). In obese individuals, albuminuria can appear as a consequence of structural alterations to the glomerular filtration barrier secondary to hyperfiltration.9, 11 Such potential damage underscores the need for screening initiatives and early interventions in order to avoid albuminuria and thus prevent cardiovascular diseases or the progression of chronic kidney disease in obese patients.

Although the association between obesity and albuminuria has been studied in European, North American and Asian populations with their particular anthropometric characteristics,12, 13, 14 few studies have evaluated and compared the usefulness of obesity markers as risk measures of albuminuria in Latin American populations. It is therefore difficult to establish precise recommendations for these populations regarding obesity control with a view to reducing the risk of albuminuria.

The present study was thus carried out to evaluate the association between three obesity markers (BMI, AC and WHtR) and albuminuria in adults seen in a primary care center specializing in chronic diseases in Lima (Peru).

Section snippets

Study design

A secondary analysis was made of the case histories database of the Diabetes and Hypertension Center (Centro de Diabetes e Hipertensión [CEDHI]) of the national Public Health system (Seguro Social [EsSalud]) in Lima (Peru). This center receives patients ≥18 years of age referred from the primary care centers belonging to the Rebagliati – EsSalud healthcare network for annual control.

Population and sample

We analyzed all the case histories of the patients attending the CEDHI between 1 January and 31 August 2011,

Descriptive analysis

We evaluated a total of 1476 case histories of patients who attended the CEDHI between January and August 2011. A total of 228 patients were excluded due to a lack of albuminuria results; a further 33 patients were excluded due to the presence of urinary infection as evidenced from the case history or urine sediment findings; and one pregnant patient was also excluded. This left a total of 1214 patients who met the eligibility criteria and who were included in the analysis.

The mean patient age

Discussion

In our study population AC and the WHtR were seen to be associated with albuminuria, though the BMI was not. In both genders, the AUC values corresponding to the BMI, AC and the WHtR were found to be similar. The optimum cut-off point (i.e., that affording the best sensitivity/specificity balance) for the BMI and AC in women was found to be greater than the conventional cut-off point, while in males the optimum cut-off point was lower than the conventional cut-off point. However, in the case of

Conflicts of interest

The authors state that they have no conflicts of interest.

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    Please cite this article as: Quintanilla AE, Taype-Rondan Á, Lazo-Porras M, Herrera-Añazco P. Marcadores de obesidad asociados a albuminuria en un centro de atención primaria de Lima, Perú. Endocrinol Diabetes Nutr. 2017;64:295–302.

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