Adolescent overweight and obesity may increase risk of all-cause ESRD

Being overweight and obese during adolescence appears related to an increased risk of all-cause treated end-stage renal disease (ESRD) during a 25-year period, according to a report published Online First by Archives of Internal Medicine, a JAMA Network publication.

Children and adolescents with high body mass index (BMI) often become obese adults, and obese adults are at risk for chronic conditions such as diabetes, which can mean future risk of chronic kidney disease and ESRD, according to the study background.

Asaf Vivante, M.D., of the Israeli Defense Forces Medical Corps and the Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel, and colleagues examined the association between BMI in adolescence and the risk for all-cause, diabetic and nondiabetic ESRD.

Medical data for almost 1.2 million adolescents (17 years old) who were examined for fitness for Israeli military service between January 1967 and December 1997 were linked to the Israeli ESRD registry in a nationwide population-based retrospective study.

"In this long-term nationwide population-based study, overweight and obesity at age 17 years were strongly and positively associated with the incidence of future treated ESRD, although the absolute risk for ESRD remains low," the authors comment.

The study results indicate that 874 participants (713 men, 161 women) developed treated ESRD for an overall incidence rate of 2.87 cases per 100,000 person-years during more than 30 million follow-up person-years. Compared to normal-weight adolescents, those adolescents who were overweight and obese had an increased future risk for treated ESRD, with incidence rates of 6.08 and 13.40 cases per 100,000 person-years, respectively, the results show.

Researchers also estimated the association between BMI and treated diabetic ESRD and suggest that compared with normal weight adolescents, overweight adolescents at 17 years old had six times the risk for diabetic ESRD and obese adolescents at 17 years old had 19 times the risk for diabetic ESRD, according to the results.

"Although the results for diabetic ESRD were remarkable, with risks increasing six-fold and 19-fold among overweight and obese adolescents, respectively, our results also indicate a substantial association between elevated BMI and nondiabetic ESRD," the authors note.

The Skinny on Obesity, End-Stage Renal Disease

In an invited commentary, Kirsten L. Johansen, M.D., of the San Francisco Veterans Affairs Medical Center, writes: "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."

"The association of obesity with ESRD is good news and bad news. The good news is that obesity represents a potentially modifiable risk factor, and control of weight and the hypertension and inactivity that often accompany excess adiposity could prevent or slow the development of some cases of ESRD and may potentially reduce the morbidity and mortality associated with CKD [chronic kidney disease]. The bad news is that it is not easy to address obesity," Johansen continues.

"Although there is no evidence that it is ever too late to improve outcomes by increasing physical activity or shedding excess weight, the results reported by Vivante et al in this issue of the Archives highlight the potential advantages of starting early before chronic disease has developed and unhealthy lifestyles have become lifelong habits," Johansen concludes.