澳大利亚新南威尔士大学Kwok Leung Ong团队研究了ω-3多不饱和脂肪酸与慢性肾脏病的相关性。相关论文于2023年1月18日发表在《英国医学杂志》上。

为了评估ω-3多不饱和脂肪酸（n-3 PUFA）生物标志物（包括植物来源的α亚麻酸和海鲜来源的二十碳五烯酸、二十二碳五烯酸和二十二碳六烯酸）循环水平与慢性肾脏病（CKD）发病的前瞻性关联，研究组进行了一项汇总分析。

截至2020年5月，来自12个国家的19项研究组成了一个联盟，基于估计的肾小球滤过率，对测定的n-3 PUFA生物标志物数据和CKD事件进行前瞻性研究。每个参与队列均采用预先指定且一致的暴露因素、结果、协变量和模型进行了从头分析。使用逆方差加权荟萃分析，在队列中汇总结果。

CKD事件的主要结局定义为新发病估计肾小球滤过率<60 mL/min/1.73 m²。在敏感性分析中，CKD事件定义为新发病的估计肾小球滤过率<60 mL/min/1.73 m²且<基线率的75%。

共有25570名参与者被纳入主要结果分析，4944名（19.3%）在随访期间发生CKD（加权中位11.3年）。在多变量校正模型中，海鲜n-3 PUFA总量较高与CKD发病风险较低相关（每五分位数的相对风险为0.92；P=0.009，I²=9.9%）。

在分类分析中，与最低五分之一的参与者相比，海鲜n-3 PUFA水平最高的五分之一参与者发生CKD的风险降低13%（0.87，P=0.005，I²=0.0%）。植物来源α亚麻酸水平与CKD事件无关（1.00，P=0.94，I²=5.8%）。在敏感性分析中获得了类似的结果。根据年龄（≥60 vs <60岁）、估计肾小球滤过率（60-89 vs ≥90 mL/min/1.73 m²）、基线时高血压、糖尿病和冠心病等分组，各亚组之间的相关性似乎一致。

研究结果表明，较高的海鲜来源n-3 PUFA水平与较低的CKD发病风险相关，尽管植物来源的n-3 PUFAs未发现这种关联。这些结果支持海鲜来源的n-3 PUFA在预防CKD中的有利作用。

附：英文原文

Title: Association of omega 3 polyunsaturated fatty acids with incident chronic kidney disease: pooled analysis of 19 cohorts

Author: Kwok Leung Ong, Matti Marklund, Liping Huang, Kerry-Anne Rye, Nicholas Hui, Xiong-Fei Pan, Casey M Rebholz, Hyunju Kim, Lyn M Steffen, Anniek C van Westing, Johanna M Geleijnse, Ellen K Hoogeveen, Yun-Yu Chen, Kuo-Liong Chien, Amanda M Fretts, Rozenn N Lemaitre, Fumiaki Imamura, Nita G Forouhi, Nicholas J Wareham, Anna Birukov, Susanne Jger, Olga Kuxhaus, Matthias B Schulze, Vanessa Derenji de Mello, Jaakko Tuomilehto, Matti Uusitupa, Jaana Lindstrm, Nathan Tintle, William S Harris, Keisuke Yamasaki, Yoichiro Hirakawa, Toshiharu Ninomiya, Toshiko Tanaka, Luigi Ferrucci, Stefania Bandinelli, Jyrki K Virtanen, Ari Voutilainen, Tharusha Jayasena, Anbupalam Thalamuthu, Anne Poljak, Sonia Bustamante, Perminder S Sachdev, Mackenzie K Senn, Stephen S Rich, Michael Y Tsai, Alexis C Wood, Markku Laakso, Maria Lankinen, Xiaowei Yang, Liang Sun, Huaixing Li, Xu Lin, Christoph Nowak, Johan rnlv, Ulf Risérus, Lars Lind, Mélanie Le Goff, Cécilia Samieri, Catherine Helmer, Frank Qian, Renata Micha, Adrienne Tin, Anna Kttgen

Issue&Volume: 2023/01/18

Abstract:

Objective To assess the prospective associations of circulating levels of omega 3 polyunsaturated fatty acid (n-3 PUFA) biomarkers (including plant derived α linolenic acid and seafood derived eicosapentaenoic acid, docosapentaenoic acid, and docosahexaenoic acid) with incident chronic kidney disease (CKD).

Design Pooled analysis.

Data sources A consortium of 19 studies from 12 countries identified up to May 2020.

Study selection Prospective studies with measured n-3 PUFA biomarker data and incident CKD based on estimated glomerular filtration rate.

Data extraction and synthesis Each participating cohort conducted de novo analysis with prespecified and consistent exposures, outcomes, covariates, and models. The results were pooled across cohorts using inverse variance weighted meta-analysis.

Main outcome measures Primary outcome of incident CKD was defined as new onset estimated glomerular filtration rate <60 mL/min/1.73 m2. In a sensitivity analysis, incident CKD was defined as new onset estimated glomerular filtration rate <60 mL/min/1.73 m2 and <75% of baseline rate.

Results 25570 participants were included in the primary outcome analysis and 4944 (19.3%) developed incident CKD during follow-up (weighted median 11.3 years). In multivariable adjusted models, higher levels of total seafood n-3 PUFAs were associated with a lower incident CKD risk (relative risk per interquintile range 0.92, 95% confidence interval 0.86 to 0.98; P=0.009, I2=9.9%). In categorical analyses, participants with total seafood n-3 PUFA level in the highest fifth had 13% lower risk of incident CKD compared with those in the lowest fifth (0.87, 0.80 to 0.96; P=0.005, I2=0.0%). Plant derived α linolenic acid levels were not associated with incident CKD (1.00, 0.94 to 1.06; P=0.94, I2=5.8%). Similar results were obtained in the sensitivity analysis. The association appeared consistent across subgroups by age (≥60 v <60 years), estimated glomerular filtration rate (60-89 v ≥90 mL/min/1.73 m2), hypertension, diabetes, and coronary heart disease at baseline.

Conclusions Higher seafood derived n-3 PUFA levels were associated with lower risk of incident CKD, although this association was not found for plant derived n-3 PUFAs. These results support a favourable role for seafood derived n-3 PUFAs in preventing CKD.

DOI: 10.1136/bmj-2022-072909

Source: https://www.bmj.com/content/380/bmj-2022-072909