An association between microalbuminuria and obesity in healthy adolescents – preliminary results from the “Respect for Health” study

Česká verzia

Authors: K. Šebeková ¹; R. Kollárová ¹; A. Stecová ²; V. Potičný ³; Z. Gerová ⁴
Authors place of work: Ústav molekulárnej biomedicíny Lekárskej fakulty UK Bratislava, Slovenská republika, prednosta MUDr. Ing. Mgr. Peter Celec, PhD., MPH ¹; Medirex a. s., Bratislava, Slovenská republika, výkonná riaditeľka Centrálneho laboratória Ing. Eleonóra Janíková ²; Zdravotný odbor Bratislavského samosprávneho kraja Bratislava, Slovenská republika, riaditeľ MUDr. Valerián Potičný, MPH ³; Regionálny úrad verejného zdravotníctva hlavného mesta Slovenska Bratislava, Bratislava, Slovenská republika, vedúci odboru MUDr. Alžbeta Béderová, CSc. ⁴
Published in the journal: Vnitř Lék 2012; 58(7 a 8): 83-91
Category: 80th Birthday MUDr. Miroslav Mydlík, DrSc.

Summary

Background:
Microalbuminuria is a marker of present/future cardiovascular and/or renal disease. The roots of these diseases extend back into childhood. Data on renal excretion of albumin (albumin/creatinine ratio – ACR) and the prevalence of microalbuminuria in apparently healthy adolescents are scares.

Methods and results:
We determined ACR and the prevalence of microalbuminuria in 15-to-19-years-old adolescents (n = 846, 482 boys), in association with markers of obesity. ACR (0.43; 0.29–0.67 mg albumin/mmol creatinine vs 0.35; 0.25–0.51 mg albumin/mmol creatinine, p < 0.001), and the prevalence of microalbuminuria (3.6 % vs 1.2 %, χ²: p = 0.024) were higher in girls than in boys. In underweight subjects, particularly boys, ACR was significantly higher if compared with the overweight//obese subjects. ACR correlated inversely with the markers of peripheral and central obesity.

Conclusions:
Prevalence of microalbuminuria in general population of adolescents was relatively low. Paradoxically, in the boys ACR showed an inverse relationship to markers of nutritional status. Our data suggest the need of specific interpretation of data on ACR in the adolescents, and the need of further analysis of this (in the adults risk) marker in population of adolescents with regard to other important determinants of ACR, such as actual blood pressure, insulin sensitivity, etc.

Key words:
adolescents – microalbuminuria – obesity

Zdroje

1. de Wilde JA, van Dommelen P, Middelkoop BJ et al. Trends in overweight and obesity prevalence in Dutch, Turkish, Moroccan and Surinamese South Asian children in the Netherlands. Arch Dis Child 2009; 94: 795–800.

2. Tzotzas T, Kapantais E, Tziomalos K et al. Epidemiological survey for the prevalence of overweight and abdominal obesity in Greek adolescents. Obesity (Silver Spring) 2008; 16: 1718–1722.

3. Dabelea D. The accelerating epidemic of childhood diabetes. Lancet 2009; 373: 1999–2000.

4. Calle EE, Thun MJ, Petrelli JM et al. Body--mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med 1999; 341: 1097–1105.

5. Adams KF, Schatzkin A, Harris TB et al. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med 2006; 355: 763–778.

6. Kissebah AH, Vydelingum N, Murray R et al. Relation of body fat distribution to metabolic complications of obesity. J Clin Endocrinol Metab 1982; 54: 254–260.

7. Vague J. The degree of masculine differentiation of obesities: a factor determining predisposition to diabetes, atherosclerosis, gout, and uric calculous disease. Am J Clin Nutr 1956; 4: 20–34.

8. Prentice AM, Jebb SA. Beyond body mass index. Obes Rev 2001; 2: 141–147.

9. Kahn HS, Imperatore G, Cheng YJ. A population-based comparison of BMI percentiles and waist-to-height ratio for identifying cardiovascular risk in youth. J Pediatr 2005; 146: 482–488.

10. Pouliot MC, Despres JP, Lemieux S et al. Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol 1994; 73: 460–468.

11. Kunesova M, Hainer V, Hergetova H et al. Simple anthropometric measurements – relation to body fat mass, visceral adipose tissue and risk factors of atherogenesis. Sb Lek 1995; 96: 257–267.

12. Hatipoglu N, Mazicioglu MM, Kurtoglu S et al. Neck circumference: an additional tool of screening overweight and obesity in childhood. Eur J Pediatr 2000; 169: 733–739.

13. Praga M, Hernandez E, Morales E et al. Clinical features and long-term outcome of obesity--associated focal segmental glomerulosclerosis. Nephrol Dial Transplant 2001; 16: 1790–1798.

14. Kambham N, Markowitz GS, Valeri AM et al. Obesity-related glomerulopathy: an emerging epidemic. Kidney Int 2001; 59: 1498–1509.

15. Weisinger JR, Kempson RL, Eldridge FL et al. The nephrotic syndrome: a complication of massive obesity. Ann Intern Med 1974; 81: 440–447.

16. Culleton BF, Larson MG, Parfrey PS et al. Proteinuria as a risk factor for cardiovascular disease and mortality in older people: a prospective study. Am J Med 2000; 109: 1–8.

17. Sebekova K, Klassen A, Bahner U et al. Overweight and obesity – risk factors in the development and progression of renal disease. Vnitř Lék 2004; 50: 544–549.

18. Mogensen CE. Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes. N Engl J Med 1984; 310: 356–360.

19. Viberti GC, Jarrett RJ, Keen H. Microalbuminuria as prediction of nephropathy in diabetics. Lancet 1982; 2: 611.

20. Viberti GC, Hill RD, Jarrett RJ et al. Microalbuminuria as a predictor of clinical nephropathy in insulin-dependent diabetes mellitus. Lancet 1982; 1: 1430–1432.

21. Gerstein HC, Mann JF, Yi Q et al. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA 2001; 286: 421–426.

22. Sarnak MJ, Levey AS, Schoolwerth AC et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation 2003; 108: 2154–2169.

23. Chobanian AV, Bakris GL, Black HR et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003; 42: 1206–1252.

24. Hillege HL, Janssen WM, Bak AA et al. Microalbuminuria is common, also in a nondiabetic, nonhypertensive population, and an independent indicator of cardiovascular risk factors and cardiovascular morbidity. J Intern Med 2001; 249: 519–526.

25. Yuyun MF, Khaw KT, Luben R et al. Microalbuminuria, cardiovascular risk factors and cardiovascular morbidity in a British population: the EPIC-Norfolk population-based study. Eur J Cardiovasc Prev Rehabil 2004; 11: 207–213.

26. Bigazzi R, Bianchi S, Baldari D et al. Microalbuminuria predicts cardiovascular events and renal insufficiency in patients with essential hypertension. J Hypertens 1998; 16: 1325–1333.

27. Deckert T, Feldt-Rasmussen B, Borch-Johnsen K et al. Albuminuria reflects widespread vascular damage. The Steno hypothesis. Diabetologia 1989; 32: 219–226.

28. Tsioufis C, Dimitriadis K, Chatzis D et al. Relation of microalbuminuria to adiponectin and augmented C-reactive protein levels in men with essential hypertension. Am J Cardiol 2005; 96: 946–951.

29. Klausen K, Borch-Johnsen K, Feldt-Rasmussen B et al. Very low levels of microalbuminuria are associated with increased risk of coronary heart disease and death independently of renal function, hypertension, and diabetes. Circulation 2004; 110: 32–35.

30. Arnlov J, Evans JC, Meigs JB et al. Low-grade albuminuria and incidence of cardiovascular disease events in nonhypertensive and nondiabetic individuals: the Framingham Heart Study. Circulation 2005; 112: 969–975.

31. Borch-Johnsen K, Feldt-Rasmussen B, Strandgaard S et al. Urinary albumin excretion. An independent predictor of ischemic heart disease. Arterioscler Thromb Vasc Biol 1999; 19: 1992–1997.

32. Jones CA, Francis ME, Eberhardt MS et al. Microalbuminuria in the US population: third National Health and Nutrition Examination Survey. Am J Kidney Dis 2002; 39: 445–459.

33. Gerstein HC, Mann JF, Pogue J et al. Prevalence and determinants of microalbuminuria in high-risk diabetic and nondiabetic patients in the Heart Outcomes Prevention Evaluation Study. The HOPE Study Investigators. Diabetes Care 2000; 23 (Suppl 2): B35–B39.

34. Barzilay JI, Peterson D, Cushman M et al. The relationship of cardiovascular risk factors to microalbuminuria in older adults with or without diabetes mellitus or hypertension: the cardiovascular health study. Am J Kidney Dis 2004; 44: 25–34.

35. Atkins RC, Polkinghorne KR, Briganti EM et al. Prevalence of albuminuria in Australia: the AusDiab Kidney Study. Kidney Int 2004; 92 (Suppl): S22–S24.

36. Tsioufis C, Tsiachris D, Dimitriadis K et al. Leontio Lyceum ALbuminuria (3L Study) epidemiological study: aims, design and preliminary findings. Hellenic J Cardiol 2009; 50: 476–483.

37. Nguyen S, Mc Culloch C, Brakeman P et al. Being overweight modifies the association between cardiovascular risk factors and microalbuminuria in adolescents. Pediatrics 2008; 121: 37–45.

38. Rademacher E, Mauer M, Jacobs DR Jr et al. Albumin excretion rate in normal adolescents: relation to insulin resistance and cardiovascular risk factors and comparisons to type 1 diabetes mellitus patients. Clin J Am Soc Nephrol 2008; 3: 998–1005.

39. Csernus K, Lanyi E, Erhardt E et al. Effect of childhood obesity and obesity-related cardiovascular risk factors on glomerular and tubular protein excretion. Eur J Pediatr 2005; 164: 44–49.

40. Sebekova K, Somoza V, Jarcuskova M et al. Plasma advanced glycation end products are decreased in obese children compared with lean controls. Int J Pediatr Obes 2009; 4: 112–118.

41. Burgert TS, Dziura J, Yeckel C et al. Microalbuminuria in pediatric obesity: prevalence and relation to other cardiovascular risk factors. Int J Obes (Lond) 2006; 30: 273–280.

42. Mazaraki A, Tsioufis C, Dimitriadis K et al. Adherence to the Mediterranean diet and albuminuria levels in Greek adolescents: data from the Leontio Lyceum ALbuminuria (3L study). Eur J Clin Nutr 2011; 65: 219–225.

43. Mokha JS, Srinivasan SR, Dasmahapatra P et al. Utility of waist-to-height ratio in assessing the status of central obesity and related cardiometabolic risk profile among normal weight and overweight/obese children: the Bogalusa Heart Study. BMC Pediatr 2010; 10: 73.

44. Nafiu OO, Burke C, Lee J et al. Neck circumference as a screening measure for identifying children with high body mass index. Pediatrics 2010; 126: e306–e310.

45. Tsioufis C, Mazaraki A, Dimitriadis K et al. Microalbuminuria in the paediatric age: current knowledge and emerging questions. Acta Paediatr 2010; 100: 1180–1184.

46. Davies AG, Postlethwaite RJ, Price DA et al. Urinary albumin excretion in school children. Arch Dis Child 1984; 59: 625–630.

47. Serra-Majem L, Garcia-Closas R, Ribas L et al. Food patterns of Spanish schoolchildren and adolescents: The enKid Study. Public Health Nutr 2011; 4: 1433–1438.

48. Bangstad HJ, Dahl-Jorgensen K, Kjaersgaard P et al. Urinary albumin excretion rate and puberty in non-diabetic children and adolescents. Acta Paediatr 1993; 82: 857–862.

49. Hogg RJ. Adolescents with proteinuria and//or the nephrotic syndrome. Adolesc Med Clin 2005; 16: 163–172.

50. Davis DD, Ruiz AL, Yanes LL et al. Testosterone supplementation in male obese Zucker rats reduces body weight and improves insulin sensitivity but increases blood pressure. Hypertension 2012; 59: 726–731.

51. Gerber LM, Schwartz JE, Pickering TG. Albumin-to-creatinine ratio predicts change in ambulatory blood pressure in normotensive persons: a 7.5-year prospective study. Am J Hypertens 2006; 19: 220–226.

52. Chang JB, Chen YH, Chu NF. Relationship between single voided urine protein/creatinine ratio and 24-hour urine protein excretion rate among children and adolescents in Taiwan. Zhonghua Yi Xue Za Zhi (Taipei) 2000; 63: 828–832.

53. Lambers Heerspink HJ, Brantsma AH, de Zeeuw D et al. Albuminuria assessed from first--morning-void urine samples versus 24-hour urine collections as a predictor of cardiovascular morbidity and mortality. Am J Epidemiol 2008; 168: 897–905.

54. Sanchez-Bayle M, Rodriguez-Cimadevilla C, Asensio C et al. Urinary albumin excretion in Spanish children. Nino Jesus Group. Pediatr Nephrol 1995; 9: 428–430.