Frontiers in endocrinology · 2026
A metabolic-to-inflammatory pattern in cardiovascular-kidney-metabolic syndrome staging: a comparative cross-sectional study.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Zhang Teng, Man Zi-Yue, Zhang Shi-Meng, Mu Jian-Jun, Liao Yue-Yuan
Аннотация
BACKGROUND: Amid the cardiovascular-kidney-metabolic (CKM) syndrome public health crisis, this study aimed to explore differential pathological associations with established versus advanced CKM status and assess its consistency across Chinese and U.S. adults.
METHODS: This cross-sectional study analyzed data from two independent sources: a community survey in Shaanxi, China (n=2, 100) and the U.S. National Health and Nutrition Examination Survey (NHANES) (2011-2018; n=5, 359). Associations between three pathological axes-visceral adiposity (VA), insulin resistance/dyslipidemia pathological score (IRD-PS), and systemic low-grade inflammation pathological score (SLI-PS)-and two key CKM outcomes (established: Stages 2-4 vs. 0-1; advanced: Stages 3-4 vs. 0-2) were evaluated using Firth's penalized logistic regression to address potential quasi-complete separation in the outcome data.
RESULTS: IRD-PS exhibited the strongest association with established CKM status in both populations (Shaanxi: OR = 2.49, 95% CI 2.18, 2.86; NHANES: OR = 2.52, 95% CI 2.24, 2.82). In contrast, SLI-PS was significantly and consistently correlated with advanced CKM status (Shaanxi: OR = 1.11, 95% CI 1.03, 1.19; NHANES: OR = 1.07, 95% CI 1.01, 1.14). Statistical exploratory decomposition analysis revealed IRD-PS largely attenuated the association between VA and established CKM status, statistically accounting for 67.1% of the effect in Shaanxi and 64.5% in NHANES. In the NHANES, significant racial/ethnic heterogeneity was observed in the IRD-PS-established CKM status association (P for interaction < 0.001), with the strongest association in non-Hispanic Asian people (OR = 3.96) and the weakest in non-Hispanic Black people (OR = 2.03). These cross-sectional associations should be interpreted with caution.
CONCLUSIONS: Our findings support a conceptual model of CKM syndrome in which metabolic dysregulation is the primary correlate of the established (Stage 2+) CKM status and in which systemic inflammation is a more prominent correlate of advanced (Stage 3+) CKM status. These findings may primarily generalize to the analyzed subsamples rather than broader general populations. Given the cross-sectional design, all findings are strictly hypothesis-generating, and the proposed stage-specific pathological pattern requires formal validation in future longitudinal cohorts.
METHODS: This cross-sectional study analyzed data from two independent sources: a community survey in Shaanxi, China (n=2, 100) and the U.S. National Health and Nutrition Examination Survey (NHANES) (2011-2018; n=5, 359). Associations between three pathological axes-visceral adiposity (VA), insulin resistance/dyslipidemia pathological score (IRD-PS), and systemic low-grade inflammation pathological score (SLI-PS)-and two key CKM outcomes (established: Stages 2-4 vs. 0-1; advanced: Stages 3-4 vs. 0-2) were evaluated using Firth's penalized logistic regression to address potential quasi-complete separation in the outcome data.
RESULTS: IRD-PS exhibited the strongest association with established CKM status in both populations (Shaanxi: OR = 2.49, 95% CI 2.18, 2.86; NHANES: OR = 2.52, 95% CI 2.24, 2.82). In contrast, SLI-PS was significantly and consistently correlated with advanced CKM status (Shaanxi: OR = 1.11, 95% CI 1.03, 1.19; NHANES: OR = 1.07, 95% CI 1.01, 1.14). Statistical exploratory decomposition analysis revealed IRD-PS largely attenuated the association between VA and established CKM status, statistically accounting for 67.1% of the effect in Shaanxi and 64.5% in NHANES. In the NHANES, significant racial/ethnic heterogeneity was observed in the IRD-PS-established CKM status association (P for interaction < 0.001), with the strongest association in non-Hispanic Asian people (OR = 3.96) and the weakest in non-Hispanic Black people (OR = 2.03). These cross-sectional associations should be interpreted with caution.
CONCLUSIONS: Our findings support a conceptual model of CKM syndrome in which metabolic dysregulation is the primary correlate of the established (Stage 2+) CKM status and in which systemic inflammation is a more prominent correlate of advanced (Stage 3+) CKM status. These findings may primarily generalize to the analyzed subsamples rather than broader general populations. Given the cross-sectional design, all findings are strictly hypothesis-generating, and the proposed stage-specific pathological pattern requires formal validation in future longitudinal cohorts.