肥胖中的高滤过：内脏脂肪、蛋白尿和钠排泄之间的恶性联系
Hyperfiltration in Obesity: The Vicious Link Between Visceral Fat, Proteinuria, and Sodium Excretion.
摘要(中文译文)
全球肥胖率的上升构成了一个重大公共卫生问题，其不良影响不仅限于代谢并发症，还涉及肾功能障碍。这一关系中的关键因素在于内脏肥胖与肾小球高滤过之间的相互作用——后者是肾损伤的早期、常为隐匿性的指标，可能先于慢性肾脏病（CKD）的发生。在这项单中心回顾性研究中，我们评估了2022年3月至2024年3月期间在那不勒斯费德里科二世大学移植、肾衰竭及慢性病理学饮食治疗门诊就诊的43名肥胖成人。记录了临床、人体测量学、生化及24小时尿液参数，以及若干经过验证的内脏肥胖指数。通过实测肌酐清除率（mClCr）三分位数评估肾小球高滤过，同时探讨其与肥胖指数、蛋白尿及尿钠排泄的关系。较高的肌酐清除率值与肥胖指数水平升高显著相关——尤其是脂质蓄积产物（LAP）、新内脏肥胖指数（NVAI）和内脏脂肪代谢评分（METS-VF）——同时也与更严重的蛋白尿、尿钠排泄及每日盐摄入量增加相关。蛋白尿≥150 mg/天的受试者与无蛋白尿者相比，NVAI值更高，尿钠和尿钾排泄增加。即使在调整年龄和BMI后，LAP与mClCr、钠排泄及蛋白尿之间仍存在显著相关性。在肥胖成人中，较高的内脏肥胖指数与肌酐清除率增加、蛋白尿及尿钠排泄增多相关。这些发现提示，内脏肥胖可能作为肥胖相关早期肾脏改变的有用标志物。有必要开展前瞻性研究以确定这些关联的因果关系及潜在机制。
Abstract
The global rise in obesity represents a major public health issue, extending its detrimental impact beyond metabolic complications to encompass renal dysfunction. A key element in this relationship lies in the interaction between visceral obesity and glomerular hyperfiltration-an early, often silent indicator of kidney injury that may precede the onset of chronic kidney disease (CKD). : In this monocentric, retrospective study, we evaluated 43 adults with obesity attending the Outpatient Clinic for Diet Therapy in Transplantation, Renal Failure and Chronic Pathology at the University of Naples Federico II between March 2022 and March 2024. Clinical, anthropometric, biochemical, and 24 h urinary parameters were recorded, along with several validated visceral adiposity indices. Glomerular hyperfiltration was assessed through measured creatinine clearance (mClCr) tertiles, while associations with adiposity indices, proteinuria, and urinary sodium excretion were explored. : Higher creatinine clearance values were significantly associated with increased levels of adiposity indices-particularly Lipid Accumulation Product (LAP), New Visceral Adiposity Index (NVAI), and Metabolic Score for Visceral Fat (METS-VF)-as well as greater proteinuria, urinary sodium excretion, and daily salt intake. Subjects with proteinuria ≥ 150 mg/day exhibited higher NVAI values and elevated sodium and potassium urinary excretion compared with those without proteinuria. Significant correlations emerged between LAP and mClCr, sodium excretion, and proteinuria, even after adjustment for age and BMI. : Higher visceral adiposity indices were associated with increased creatinine clearance, proteinuria, and urinary sodium excretion in adults with obesity. These findings suggest that visceral adiposity may represent a useful marker of early obesity-related renal alterations. Prospective studies are warranted to determine the causal relationships and mechanisms underlying these associations.
如何引用
AMA
Mariana Di Lorenzo, Maria Amicone, Andrea Memoli, Nunzia Cacciapuoti, Mariastella Di Lauro, Eleonora Riccio, et al. Hyperfiltration in Obesity: The Vicious Link Between Visceral Fat, Proteinuria, and Sodium Excretion.. Nutrients. 2026; doi:10.3390/nu18142233.
APA
Mariana Di Lorenzo, Maria Amicone, Andrea Memoli, Nunzia Cacciapuoti, Mariastella Di Lauro, Eleonora Riccio, et al (2026). Hyperfiltration in Obesity: The Vicious Link Between Visceral Fat, Proteinuria, and Sodium Excretion.. Nutrients. https://doi.org/10.3390/nu18142233
GB/T 7714
Mariana Di Lorenzo, Maria Amicone, Andrea Memoli, Nunzia Cacciapuoti, Mariastella Di Lauro, Eleonora Riccio, et al. Hyperfiltration in Obesity: The Vicious Link Between Visceral Fat, Proteinuria, and Sodium Excretion.[J]. Nutrients, 2026 doi:10.3390/nu18142233.
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