Adolescent Obesity Linked to Early Chronic Kidney Disease

Importance

Despite increasing obesity rates in adolescents, data on early renal sequelae are lacking.

Aim

To evaluate the association between adolescent body mass index (BMI) and early chronic kidney disease (ECD) in young adulthood (45 years of age).

Design, configuration and participants

This cohort study linked screening data from mandatory medical assessments of Israeli adolescents to data from a national health system’s CKD registry. Adolescents from 16 to 20 years of age; born since January 1, 1975; medically evaluated for mandatory military service until December 31, 2019; and insured by Maccabi Health Services were evaluated.

Individuals with renal pathology, albumin, hypertension, dysglycemia, or missing blood pressure or BMI data were excluded. Body mass index was calculated as weight in kilograms divided by height in meters squared and categorized by age and sex percentiles, according to the US Centers for Disease Control and Prevention.

Follow-up began at the time of medical evaluation or January 1, 2000 (whichever was later), and ended at early onset of CKD, death, last insured day, or August 23, 2020. (whatever came first). Data analysis was carried out from December 19, 2021, to September 11, 2023.

Main results and measures

Early chronic kidney disease (CKD), defined as stage 1 to 2 CKD due to moderately or severely increased albumin, with an estimated glomerular filtration rate of 60 mL/min/1.73 m 2 or greater.

Results

Of the 629,168 adolescents evaluated, 593,660 were included in the analysis (mean [SD] at the beginning of the study, 17.2 [0.5] years; 323,293 [54.5%] men, 270,367 [45, 5%] women). During a mean (DDH) follow-up of 13.4 (5.5) years for men and 13.4 (5.6) years for women, adolescents from 1963 (0.3%) developed early CKD.

Among men, the adjusted hazard ratios were 1.8 (95% CI, 1.5-2.2), for adolescents with high-normal BMI, 4.0 (95% CI, 3.3-5, 0) for those with overweight, 6.7 (95% CI, 5.4-84), for those with mild obesity, and 9.4 (95% CI, 6.6 and 13.5) for those with severe obesity .

Among women, the hazard ratios were 1.4 (95% CI, 1.2-1.6) for those with high normal BMI, 2.3 (95% CI, 1.9-2.0, 8) for those who are overweight, 2.7 (95% CI, 2.13.6) for those who have mild obesity, and 4.3 (95% CI, 2.86.5) for those who have severe obesity . Results were similar when the cohort was limited to individuals who were apparently healthy as adolescents, individuals surveyed up to 30 years of age, or those free of diabetes and hypertension at the end of follow-up.

Conclusions and relevance

In this cohort study, high BMI in late adolescence was associated with early CHD in young adulthood. The risk was also present in apparently healthy individuals with highly normal BMI and before 30 years of age, and a higher risk was observed among those with severe obesity. These findings underscore the importance of mitigating adolescent obesity rates and managing risk factors for kidney disease in adolescents with high BMI.

Comments

A new study finds that adolescent obesity significantly increases the risk of developing early chronic kidney disease in young adulthood. Even those with a high normal BMI are at risk. Severe obesity poses the greatest risk, but even mild obesity and overweight contribute significantly to this increased risk for both men and women. Reducing obesity rates in adolescents is crucial to better manage the risk of kidney disease and subsequent cardiovascular problems. This study emphasizes the need for preventive measures and management of risk factors associated with chronic kidney disease in adolescents with high BMI.

Adolescent obesity significantly increases the risk of developing early chronic kidney disease (CKD) in young adulthood, according to a large cohort study led by researchers at the Hebrew University of Jerusalem (HU) and Sheba Tel HaShomer Medical Center.

The new study, published in the prestigious journal JAMA Pediatrics , highlights the importance of reducing obesity rates in adolescents to better manage the risk of kidney disease in adolescents with a high body mass index (BMI). While people with severe obesity appear to be at greatest risk, the researchers also found cause for concern for apparently healthy people with a high-normal BMI less than 30.

Despite rising rates of obesity in adolescents, data indicating a link to the early onset of chronic kidney disease was lacking, reports the research team led by Avishai M. Tsur, MD, of the Department of Military Medicine at the Hebrew University, Faculty of Medicine and resident of Sheba Tel HaShomer Medical Center. "These findings are a harbinger of an increasing and potentially preventable likelihood of developing chronic kidney disease and subsequent cardiovascular disease," the researchers say.

The study, conducted by colleagues at leading health institutions in Israel and the United States, including Johns Hopkins and Harvard University, included data from 593,660 Israeli adolescents ages 16 to 20, born after January 1, 1975, who They underwent medical evaluations for mandatory military service.

With a mean follow-up of 13.4 years, 1,963 adolescents (0.3%) in total developed early chronic kidney disease:

• For men, the risk of developing CKD increased more with severe obesity (hazard ratio [HR], 9.4). It was also detected in mild obesity (HR, 6.7) and in those who were overweight (HR, 4.0) or had a high normal BMI in adolescence (HR, 1.8).
   
• Among women, the risk was highest with severe obesity (HR, 4.3). It was also associated with those who were mildly obese (HR, 2.7), overweight (HR, 2.3), or had a high normal BMI (HR, 1.4).

The findings of this cohort study underscore the importance of mitigating obesity rates in adolescents and controlling risk factors associated with the development of CKD.