Body Mass Index in 1.2 Million Adolescents and Risk for End-Stage Renal Disease Body Mass Index and End-stage Renal Disease

Vivante A, Golan E, Tzur D, et al. — Mon, 26 Nov 2012 00:00:00 GMT

Background

The relationship between adolescent body mass index (BMI) and future risk for end-stage renal disease (ESRD) is not fully understood, nor is it known the extent to which this association is limited to diabetic ESRD. We evaluated the association between BMI in adolescence and the risk for all-cause, diabetic, and nondiabetic ESRD.

Methods

Medical data about 1 194 704 adolescents aged 17 years who had been examined for fitness for military service between January 1, 1967, and December 31, 1997, were linked to the Israeli ESRD registry in this nationwide population-based retrospective cohort study. Incident cases of treated ESRD between January 1, 1980, and May 31, 2010, were included. Cox proportional hazards models were used to estimate the hazard ratio (HR) for treated ESRD among study participants for their BMI at age 17 years, defined in accord with the US Centers for Disease Control and Prevention BMI for age and sex classification.

Results

During 30 478 675 follow-up person-years (mean [SD], 25.51 [8.77] person-years), 874 participants (713 male and 161 female) developed treated ESRD, for an overall incidence rate of 2.87 cases per 100 000 person-years. Compared with adolescents of normal weight, overweight adolescents (85th to 95th percentiles of BMI) and obese adolescents (≥95th percentile of BMI) had an increased future risk for treated ESRD, with incidence rates of 6.08 and 13.40 cases per 100 000 person-years, respectively. In a multivariate model adjusted for sex, country of origin, systolic blood pressure, and period of enrollment in the study, overweight was associated with an HR of 3.00 (95% CI, 2.50-3.60) and obesity with an HR of 6.89 (95% CI, 5.52-8.59) for all-cause treated ESRD. Overweight (HR, 5.96; 95% CI, 4.41-8.06) and obesity (HR, 19.37; 95% CI, 14.13-26.55) were strong and independent risk factors for diabetic ESRD. Positive associations of overweight (HR, 2.17; 95% CI, 1.71-2.74) and obesity (HR, 3.41; 95% CI, 2.42-4.79) with nondiabetic ESRD were also documented.

Conclusions

Overweight and obesity in adolescents were associated with significantly increased risk for all-cause treated ESRD during a 25-year period. Elevated BMI constitutes a substantial risk factor for diabetic and nondiabetic ESRD.

The Skinny on Obesity and End-Stage Renal Disease Comment on “Body Mass Index in 1.2 Million Adolescents and Risk for End-Stage Renal Disease” The Skinny on Obesity and End-Stage Renal Disease

Johansen KL. — Mon, 26 Nov 2012 00:00:00 GMT

According to the Centers for Disease Control and Prevention, childhood obesity in the United States has tripled in the past 30 years to the point that more than one-third of children and adolescents in 2008 were overweight or obese. Obese adolescents are more likely than their normal-weight counterparts to have risk factors for cardiovascular disease and to be obese as adults, and more than one-third of all adults in 2008 were obese. A study by Vivante et al in this issue of the Archives adds the development of end-stage renal disease (ESRD) to the list of adverse outcomes associated with adolescent overweight and obesity. Previous studies have described a relationship between obesity and ESRD among adults, but the study by Vivante et al is unique in its population-based design, with universal, mandatory screening of all 17-year-old residents before military service. Because urinalysis and a thorough medical history were obtained from all the participants and because those with proteinuria, hematuria, or a diagnosis related to kidney disease were excluded from the study, preexisting subclinical disease was effectively ruled out as the source of the association between overweight and obesity and subsequent ESRD. Nevertheless, Vivante et al reported a 3-fold higher risk for incident ESRD during approximately 25 follow-up years for overweight adolescents and an almost 7-fold higher risk for obese youth.

JAMA Internal Medicine: Adolescent Medicine Topic Collection

Body Mass Index in 1.2 Million Adolescents and Risk for End-Stage Renal Disease Body Mass Index and End-stage Renal Disease

The Skinny on Obesity and End-Stage Renal Disease Comment on “Body Mass Index in 1.2 Million Adolescents and Risk for End-Stage Renal Disease” The Skinny on Obesity and End-Stage Renal Disease