1. 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 06/12/58 1

2. Contents Background/Rationale Objective Methods Results Discussion &Conclusions 06/12/58 2

3. 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) 06/12/58 3 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

4. 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 06/12/58 4

5. Clinical complications of renal failure Parathyroid gland disturbances –renal bone disease Active vitamin D deficiency Atherosclerosis and arteriosclerosis Polyneuropathy No diuresis –overhydration..and many others Malnutrition/wasting Immunodeficiency Myocardial fibrosis and cardiomyopathy Loss of erythropoietin – anaemia 06/12/58 5

6. Gab of knowledge 06/12/58 6 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. Fabiana et al.,2008

7. Methods Analytic study was conducted all information were collected from medical records of all patients diagnosed with type of DM HT and DM with HT complications was based on Renal insufficiency was the main outcome of this study. 06/12/58 7 Objective To investigate the association between WHtR, WC, and BMI and Renal insufficiency among DM and HT patients

8. 06/12/58 8 The inclusion flow chart for study participants 174,578 patients were randomized 61,602 patients were DM,HT and DM with HT in year 2012 Study participants (n=61,602) 112,976 were excluded Year 2010,2011; No data. Methods 3,373,089 patients who visiting Hospitals in care

9. Modification of Diet in Renal Disease (MDRD) in Thailand 06/12/58 9 Methods Go AS et., 2004

10. 06/12/58 10 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). Statistic Analysis Methods

11. Results 06/12/58 11 Basic characteristic of the individual included in the study

12. 06/12/58 12 Basic characteristic of the individual included in the study

13. 06/12/58 13 Basic characteristic of the individual included in the study Other basic characteristic presented in table 2

14. 06/12/58 14 Factors associated with CRI Univariate Analysis Table 3. Crude odds ratios of having renal insufficiency and their 95% confidence intervals for each factor

15. 06/12/58 15 Table 3. Crude odds ratios of having renal insufficiency and their 95% confidence intervals for each factor (cont.)

16. 06/12/58 16 Table 3. Crude odds ratios of having renal insufficiency and their 95% confidence intervals for each factor (cont.)

17. 06/12/58 17 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

18. 06/12/58 18 Table 4. Adjust odds ratios of BMI for having renal insufficiency and their 95% confidence intervals for each factor (cont.)

19. 06/12/58 19 Table 4. Adjust odds ratios of BMI for having renal insufficiency and their 95% confidence intervals for each factor (cont.)

20. 06/12/58 20 Fig. 2 Forest plot of adjusted odds ratio for compare having BMI for each factor

21. 06/12/58 21 WC for adjustment other factors Table 5. Adjust odds ratios of Waist Circumference having renal insufficiency and their 95% confidence intervals for each factor

22. 06/12/58 22 Table 5. Adjust odds ratios of Waist Circumference having renal insufficiency and their 95% confidence intervals for each factor (cont.)

23. 06/12/58 23 Fig. 3 Forest plot of adjusted odds ratio for compare having WC for each factor

24. 06/12/58 24 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

25. 06/12/58 25 Table 6. Adjust odds ratios of Waist-to-hight having renal insufficiency and their 95% confidence intervals for each factor (cont.)

26. 06/12/58 26 Fig. 4 Forest plot of adjusted odds ratio for compare having WHtR for each factor

27. Discussion 06/12/58 27 BMI BMI is a less specific measure less able to differentiate between visceral and subcutaneous fat, as well as between central and peripheral fat Essam et al., 2008

28. 06/12/58 28 Waist circumference Waist circumference, provides information about body shape and fat distribution Computed tomography Discussion

29. 06/12/58 29 Critically, excess visceral and peripheral fat, more so than subcutaneous fat, is associated with CVD and CVD risk factors. Fox et al., 2007 Waist-to-Hight

30. 06/12/58 30

31. 06/12/58 31 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.

32. 06/12/58 32