INTRODUCTION This cross-sectional study investigates the association between insulin resistance (IR) and serum uric acid (sUA) and relative fat (RFM) and lean mass (RLM) profiles in children with chronic kidney disease (CKD). MATERIAL AND METHODS RLM and RFM were assessed by bioimpedance spectroscopy in 41 children and adolescents. Normal weight obesity (NWO) was defined as normal height-age body mass index and RFM >85th percentile, according to age and sex. Homeostatic model assessment of insulin resistance (HOMA-IR) level >95th percentile, according to sex and pubertal stage, and sUA >7 mg/dl were used to define IR and hyperuricemia, respectively. RESULTS High RFM (15 patients) and NWO (7 patients) were associated with higher HOMA-IR in total (p < 0.001) and normal-weight patients (p = 0.004), respectively. RFM was positively and RLM negatively correlated to HOMA-IR (rs = 0.500, p = 0.001 and rs = -0.539, p < 0.001, respectively) and sUA (rs = 0.370, p = 0.017 and rs = -0.325, p = 0.038, respectively), while sUA was positively correlated to HOMA-IR (rs = 0.337, p = 0.031). Hyperuricemia (16 patients) was positively associated with higher RFM and HOMA-IR (p = 0.001 and p = 0.010, respectively). The correlation between sUA and HOMA-IR lost significance after adjustment for RFM. In logistic regression analysis, a 5% increase in RFM was associated with IR (11 patients) independently of the age, sex, sUA, and CKD stage in both total (OR 2.174, 95% CI 1.115-4.225) and normal-weight (OR 3.504, 95% CI 1.110-11.123) patients. CONCLUSION Children with high RFM, including those presenting NWO, are at risk for IR regardless of CKD stage. RFM is probably the mediator of the link between sUA and IR.

中文翻译：

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慢性肾病患儿相对脂肪量、尿酸和胰岛素抵抗之间的关系。

引言 本横断面研究调查了慢性肾病 (CKD) 儿童的胰岛素抵抗 (IR) 与血清尿酸 (sUA) 和相对脂肪 (RFM) 和瘦体重 (RLM) 之间的关联。材料与方法 RLM 和 RFM 通过生物阻抗谱在 41 名儿童和青少年中进行评估。根据年龄和性别，正常体重肥胖 (NWO) 被定义为正常身高年龄体重指数和 RFM > 85%。根据性别和青春期阶段，胰岛素抵抗 (HOMA-IR) 水平 >95% 的稳态模型评估和 sUA >7 mg/dl 分别用于定义 IR 和高尿酸血症。结果 高 RFM（15 名患者）和 NWO（7 名患者）分别与较高的 HOMA-IR（p < 0.001）和正常体重患者（p = 0.004）相关。RFM 与 HOMA-IR（rs = 0.500，p = 0.001 和 rs = -0.539，p < 0.001，分别）和 sUA（rs = 0.370，p = 0.017 和 rs = -0.325，p = 0.03）呈正相关且 RLM 呈负相关，分别），而 sUA 与 HOMA-IR 呈正相关（rs = 0.337，p = 0.031）。高尿酸血症（16 名患者）与较高的 RFM 和 HOMA-IR 呈正相关（分别为 p = 0.001 和 p = 0.010）。调整 RFM 后，sUA 和 HOMA-IR 之间的相关性失去了显着性。在逻辑回归分析中，RFM 增加 5% 与 IR（11 名患者）相关，与年龄、性别、sUA 和 CKD 分期无关，无论是总体重（OR 2.174，95% CI 1.115-4.225）还是正常体重（ OR 3.504, 95% CI 1.110-11.123) 患者。结论 具有高 RFM 的儿童，包括那些呈现 NWO 的儿童，无论 CKD 分期如何，都有发生 IR 的风险。