title: Normal body mass index with central obesity has increased risk of coronary artery calcification in Korean patients with chronic kidney disease.
abstract: In chronic kidney disease (CKD), overweight and mild obesity have shown the lowest cardiovascular (CV) risk. However, central obesity has been directly associated with CV risk in these patients. This bidirectional relationship of body mass index (BMI) and central obesity prompted us to evaluate CV risk based on a combination of BMI and waist-to-hip ratio (WHR) in nondialysis CKD patients. We included 1078 patients with CKD stage 2 through 5 (nondialysis) enrolled in a nationwide prospective cohort of Korea. Patients were divided into 3 groups by BMI (normal BMI, 18.5-22.9; overweight, 23.0-27.4; and obese, 27.5 and over kg/m2) and were dichotomized by a sex-specific median WHR (0.92 in males and 0.88 in females). Coronary artery calcification (CAC) was determined by multislice computed tomography. CAC (score above 10 Agatston units) was found in 477 patients. Multivariate logistic regression analysis indicated that BMI was not independently associated with CAC. However, WHR showed an independent linear and significant association with CAC (odds ratio, 1.036; 95% confidence interval, 1.007-1.065 per 0.01 increase). Furthermore, when patients were categorized into 6 groups according to a combination of BMI and WHR, normal BMI but higher WHR had the highest risk of CAC compared with the normal BMI with lower WHR group (2.104; 1.074-4.121). Thus, a normal BMI with central obesity was associated with the highest risk of CAC, suggesting that considering BMI and WHR, 2 surrogates of obesity, can help to discriminate CV risk in Korean nondialysis CKD patients.
authors.affiliation: Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam-si, Republic of Korea.
authors.forename: Mi Jung
authors.initials: MJ
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jung Tak
authors.initials: JT
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Kyoung Sook
authors.initials: KS
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Young Eun
authors.initials: YE
authors.lastname: Kwon
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Seung Hyeok
authors.initials: SH
authors.lastname: Han
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Shin-Wook
authors.initials: SW
authors.lastname: Kang
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Kyu Hun
authors.initials: KH
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Seoul National University, Seoul, Republic of Korea.
authors.forename: Kook-Hwan
authors.initials: KH
authors.lastname: Oh
authors.affiliation: Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Sue Kyung
authors.initials: SK
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Seoul National University, Seoul, Republic of Korea.
authors.forename: Dong Wan
authors.initials: DW
authors.lastname: Chae
authors.affiliation: Department of Internal Medicine, Kangbuk Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea.
authors.forename: Kyubeck
authors.initials: K
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Eulji University, Eulji General Hospital, Seoul, Republic of Korea.
authors.forename: Young-Hwan
authors.initials: YH
authors.lastname: Hwang
authors.affiliation: Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
authors.forename: Soo Wan
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Inje University, Pusan Paik Hospital, Busan, Republic of Korea.
authors.forename: Yeong Hoon
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Inje University, Pusan Paik Hospital, Busan, Republic of Korea.
authors.forename: Sun Woo
authors.initials: SW
authors.lastname: Kang
authors.affiliation: Medical Research Collaborating Center, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Joongyub
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Seoul National University, Seoul, Republic of Korea.
authors.forename: Curie
authors.initials: C
authors.lastname: Ahn
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: yoosy0316@yuhs.ac.
authors.forename: Tae-Hyun
authors.initials: TH
authors.lastname: Yoo
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003324:Coronary Artery Disease / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D056128:Obesity, Abdominal / Q000150:complications*; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D056910:Republic of Korea; D018570:Risk Assessment; D061205:Vascular Calcification / Q000209:etiology*; D049629:Waist-Hip Ratio
keywords: body mass index; cardiovascular disease; central obesity; chronic kidney disease; coronary artery calcification; waist-to-hip ratio