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 Mrs. Watcharasa Pitug ID. 567110011-2 23/07/61

Contents Background/Rationale Objective Methods Results Discussion &Conclusions 23/07/61

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) 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 23/07/61

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 23/07/61

Clinical complications of renal failure Loss of erythropoietin –anaemia Parathyroid gland disturbances –renal bone disease Myocardial fibrosis and cardiomyopathy Active vitamin D deficiency Immunodeficiency Atherosclerosis and arteriosclerosis Malnutrition/wasting ..and many others Polyneuropathy No diuresis –overhydration 23/07/61

Gab of knowledge Fabiana et al.,2008 The relationship of obesity to Renal insufficiency is somewhat controversial. While it is established that obesity increases the risk of hypertension, diabetes and dyslipidemia it is not clear if excess WHtR, WC, and BMI influences Renal insufficiency Correlation 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. 23/07/61 Fabiana et al.,2008

Objective To investigate the association between WHtR, WC, and BMI and Renal insufficiency among DM and HT patients Methods Analytic study was conducted all information were collected from medical records of all patients diagnosed with Hypertension during 2012. The type of DM HT and DM with HT complications was based on Renal insufficiency was the main outcome of this study. 23/07/61

The inclusion flow chart for study participants Methods The inclusion flow chart for study participants 3,373,089 patients who visiting Hospitals in care 174,578 patients were randomized 112,976 were excluded Year 2010,2011; No data. 61,602 patients were DM,HT and DM with HT in year 2012 Study participants (n=61,602) 23/07/61

Modification of Diet in Renal Disease (MDRD) in Thailand Methods Modification of Diet in Renal Disease (MDRD) in Thailand Go AS et., 2004 23/07/61

Statistic Analysis Methods 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). 23/07/61

Basic characteristic of the individual included in the study Results Basic characteristic of the individual included in the study 23/07/61

Basic characteristic of the individual included in the study 23/07/61

Basic characteristic of the individual included in the study Other basic characteristic presented in table 2 23/07/61

Factors associated with CRI Univariate Analysis Table 3. Crude odds ratios of having renal insufficiency and their 95% confidence intervals for each factor 23/07/61

Table 3. Crude odds ratios of having renal insufficiency and their 95% confidence intervals for each factor (cont.) 23/07/61

Table 3. Crude odds ratios of having renal insufficiency and their 95% confidence intervals for each factor (cont.) 23/07/61

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 23/07/61

Table 4. Adjust odds ratios of BMI for having renal insufficiency and their 95% confidence intervals for each factor (cont.) 23/07/61

Table 4. Adjust odds ratios of BMI for having renal insufficiency and their 95% confidence intervals for each factor (cont.) 23/07/61

Fig. 2 Forest plot of adjusted odds ratio for compare having BMI for each factor 23/07/61

WC for adjustment other factors Table 5. Adjust odds ratios of Waist Circumference having renal insufficiency and their 95% confidence intervals for each factor 23/07/61

Table 5. Adjust odds ratios of Waist Circumference having renal insufficiency and their 95% confidence intervals for each factor (cont.) 23/07/61

Fig. 3 Forest plot of adjusted odds ratio for compare having WC for each factor 23/07/61

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 23/07/61

Table 6. Adjust odds ratios of Waist-to-hight having renal insufficiency and their 95% confidence intervals for each factor (cont.) 23/07/61

Fig. 4 Forest plot of adjusted odds ratio for compare having WHtR for each factor 23/07/61

Discussion BMI BMI is a less specific measure less able to differentiate between visceral and subcutaneous fat, as well as between central and peripheral fat 23/07/61 Essam et al., 2008

Waist circumference Computed tomography Discussion Waist circumference Computed tomography Waist circumference, provides information about body shape and fat distribution 23/07/61

Waist-to-Hight Critically, excess visceral and peripheral fat, more so than subcutaneous fat, is associated with CVD and CVD risk factors. 23/07/61 Fox et al., 2007

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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. 23/07/61

Thanks for your attention 23/07/61