JOURNAL OF WOMEN’S HEALTH Volume 23, Number 3, 2014 ª Mary Ann Liebert, Inc. DOI: 10.1089/jwh.2013.4497

Abdominal Obesity Is Associated with Albuminuria in Women: The 2011 Korea National Health and Nutrition Examination Survey Ga Eun Nam, MD,1 Kyungdo Han, MPH,2 Yong Gyu Park, PhD,2 Yang Hyun Kim, MD,1 Kyung Shik Lee, MD,3 Kyung Hwan Cho, MD, PhD,1 Youn Seon Choi, MD, PhD,1 Seon Mee Kim, MD, PhD,1,* and Do Hoon Kim, MD, PhD1,*

Abstract

Background: The effects of obesity on the kidney, apart from diabetes or hypertension, have not drawn much attention. Moreover, only a few studies have reported the relationship between obesity status and albuminuria in Asian countries, including South Korea. Therefore, this study aimed to investigate the association between obesity status and albuminuria in Korean adults. Methods: We analyzed data from the 2011 Korea National Health and Nutrition Examination Survey. Of the 4,979 subjects included in the general-population group, 3,274 were sorted into a nondiabetic and nonhypertensive population group. Obesity status was measured by body mass index and waist circumference. Albuminuria was defined as a urine albumin-to-creatinine ratio ‡ 30 mg/g. Results: Abdominally obese women were at higher risk for albuminuria than were women without abdominal obesity both in the general population (odds ratio [OR], 95% confidence interval [CI]: 2.08 [1.04–4.16]) and in the nondiabetic and nonhypertensive population (OR [95% CI]: 6.96 [2.34–20.64]) after further adjustment for confounders. Among generally nonobese women, abdominally obese women were at higher risk for albuminuria than were women without abdominal obesity both in the general population (OR [95% CI]: 2.82 [1.51–5.29]) and in the nondiabetic and nonhypertensive population (OR [95% CI]: 5.32 [1.47–19.22]). Conclusion: Abdominal obesity is associated with an increased risk for albuminuria in Korean women, independently of diabetes or hypertension. Screening for abdominal obesity, especially in women, may therefore provide earlier identification of individuals at risk for developing renal disease and cardiovascular disease, even those who are nondiabetic and nonhypertensive. Introduction

A

lbuminuria initially was well known to be predictive of diabetic nephropathy and originally ranged from the risk-prediction curve for nephropathy in diabetic patients. Albuminuria is conventionally defined as a urine albumin-tocreatinine ratio (UACR) ‡ 30 mg/g measured from a random urine sample.1 Albuminuria is prevalent not only in patients with diabetes or hypertension but also in the general population.2 Furthermore, albuminuria is independently associated with an increased risk of future cardiovascular morbidity and mortality in diabetic and hypertensive patients and even in the

general population.3–5 Hence, early detection and management of albuminuria and its modifiable risk factors are essential to prevent adverse health outcomes. Although the underlying pathogenesis between albuminuria and cardiovascular disease (CVD) remains unclear, it is evident that urinary albumin leakage from the glomerulus reflects general vascular damage signifying subclinical atherosclerosis.6,7 More recently, several studies have shown that insulin resistance involves the mechanism that links albuminuria and CVD, demonstrating that metabolic syndrome, which is closely related to insulin resistance, is associated with renal manifestations.8

1

Department of Family Medicine, Korea University College of Medicine, Seoul, South Korea. Department of Biostatistics, Catholic University College of Medicine, Seoul, South Korea. 3 Department of Family Medicine, Wonkwang University College of Medicine, Sanbon, South Korea. *Co–corresponding authors. 2

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268 Metabolic syndrome is a concomitant condition that consists of established contributors to albuminuria, such as poor glycemic control, elevated blood pressure, and abnormal lipid profiles.9,10 Obesity, as a component of metabolic syndrome, is a widespread health problem, and the prevalence of obesity has increased rapidly worldwide, including in South Korea. But as shown recently in developed nations, the growth rate has become stable over the past decade.11 However, obesityrelated diseases, including type 2 diabetes, hypertension, dyslipidemia, chronic kidney disease (CKD), CVD, and cancer are still prevalent and lead to substantial burdens on society.12–15 Obesity has been documented to affect renal disease because of its close association with diabetes and hypertension, which are the most common causes of end-stage renal disease. However, other effects of obesity on the kidney have not received much study. In South Korea and other Asian countries, few studies have focused on fat distribution—based on both body mass index (BMI) and waist circumference (WC)—to relate obesity status and albuminuria as a predominant predictor of renal failure and CVD. The present study investigated the association between obesity status (as measured by BMI and WC) and albuminuria (as measured by UACR) in Korean adults, using nationwide representative data. Materials and Methods Survey overview and study subjects This study analyzed the data from the 2011 Korea National Health and Nutrition Examination Survey (KNHANES), a nationwide survey that has been performed since 1998 by the Division of Chronic Disease Surveillance at the Korean Center for Disease Control and Prevention (KCDC). KNHANES, designed to assess national health and nutritional levels, consists of a health interview, a nutritional assessment, and a health examination. The survey subjects were randomly selected using stratified, multistage, and cluster-sampling designs, with proportional allocation based on geographic area, sex, and age from the 2005 National Census Registry to represent the entire noninstitutionalized civilian population in Korea. Of the 6,566 subjects aged ‡19 years who participated in both a health interview and a health examination, we excluded 838 subjects who had been treated for CKD or whose estimated glomerular filtration rate (eGFR) was

Abdominal obesity is associated with albuminuria in women: the 2011 Korea National Health and Nutrition Examination Survey.

The effects of obesity on the kidney, apart from diabetes or hypertension, have not drawn much attention. Moreover, only a few studies have reported t...
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