Metabolically Healthy Obesity and Risk of Incident Chronic Kidney Disease in a Korean Cohort Study

  • Youngran YANG Research Institute of Nursing Science, School of Nursing, Jeonbuk National University, Jeonbuk, Republic of Korea
Keywords: Metabolically healthy obesity; Chronic kidney disease; Obesity; Metabolic syndrome; Risk

Abstract

Abstract

Background: The incident of chronic kidney disease (CKD) of metabolically healthy obesity (MHO) has not been consistently determined.

Methods: This study used data of Anseong Ansan community-based cohort, a part of the Korean Genome and Epidemiology Study (KoGES) provided by the Korea Center for Disease Control and Prevention (KCDC). Surveys were received from the Anseung and Ansan residents every two years between 2001-2002 and 2015-2016 for a total of 7 surveys over all. The subjects were divided into 4 phenotypes based on the presenting obesity and metabolic syndrome; 1) metabolically healthy normal weight (MHNW), 2) metabolically healthy obesity (MHO), 3) metabolically abnormal normal weight (MANW), and 4) metabolically abnormal obesity (MAO). Data were analyzed using the Cox proportional hazards regression model.

Results: Of 8,865 subjects, 1,551 cases of 49,995 person-year (3.1%) developed incident CKD. At an adjusted hazard ratio (HR) of 1.13, the MHO group was not associated with a higher risk of incident CKD (95% confidence interval (CI): 0.92-1.41, P =0.234, using MHNW as the reference). The adjusted HRs of the MANW and MAO groups for incident CKD were significantly higher than those of the MHNW groups: 1.31 (95% CI: 1.05-1.64, P=0.017) for MANW and 1.49 (95% CI: 1.23-1.79, P<0.001) for MAO.

Conclusion: MHO is not associated with a high risk of CKD, and that MANW and MAO increase the risk of the incident CKD. Thus, it is important to consider metabolic health status rather than obesity when evaluating CKD risk.

 

References

1. Hill NR, Fatoba ST, Oke JL, et al. (2016). Global prevalence of chronic kidney disease–a systematic review and meta-analysis. PloS One, 11(7):e0158765.
2. Lee H, Oh KW (2013). CKD Prevalence. Health and Nutrition Division, Disease Prevention Center, Disease Control Division.
3. Perlman RL, Finkelstein FO, Liu L, et al (2005). Quality of life in chronic kidney disease (CKD): a cross-sectional analysis in the Renal Research Institute-CKD study. Am J Kidney Dis, 45(4):658–66
4. Yang HK, Lee S-H (2014). The Definition of Metabolically Healthy Obesity. Korean Diabetes J, 15(1):17-20.
5. Kramer CK, Zinman B, Retnakaran R (2013). Are metabolically healthy overweight and obesity benign conditions? A systematic review and meta-analysis. Ann Intern Med, 159(11):758-69.
6. Fan J, Song Y, Chen Y, Hui R, Zhang W (2013). Combined effect of obesity and cardio- metabolic abnormality on the risk of cardiovascular disease: a meta-analysis of prospective cohort studies. Int J Cardiol, 168(5):4761-8.
7. Payab M, Hasani-Ranjbar S, Larijani B (2014). Whether all obese subjects both in metabolic groups and non-metabolic groups should be treated or not. J Diabetes Metab Disord, 13(1):21.
8. Hashimoto Y, Tanaka M, Okada H, et al (2015). Metabolically healthy obesity and risk of incident CKD. Clin J Am Soc Nephrol, 10(4):578-83.
9. Chen S, Zhou S, Wu B, et al (2014). Association between metabolically unhealthy overweight/obesity and CKD: the role of inflammation. Diabetes Metab, 40(6):423-30.
10. Mottaghi A, Mirmiran P, Delshad H, Azizi F (2016). Effect of different obesity phenotypes on incidence of CKD in Tehranian adults. J Am Coll Nutr, 35(7):587-96.
11. Jung CH, Lee MJ, Kang YM, et al (2015). The risk of chronic kidney disease in a metabolically healthy obese population. Kidney Int, 88(4):843-50.
12. Grundy SM, Cleeman JI, Daniels SR, et al (2005). Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement: Executive Summary. Crit Pathw Cardiol, 4(4):198-203.
13. WHO Expert Consultation (2004). Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet, 363(9403):157-163.
14. Levey AS, Stevens LA, Schmid CH, et al (2009). A new equation to estimate glomerular filtration rate. Ann Intern Med, 150(9):604-612.
15. Zhang J, Jiang H, Chen J (2017). Combined effect of body mass index and metabolic status on the risk of prevalent and incident chronic kidney disease: a systematic review and meta-analysis. Oncotarget, 8(22): 35619-35629.
16. Lin L, Peng K, Du R, et al (2017). Metabolically healthy obesity and incident chronic kidney disease: the role of systemic inflammation in a prospective study. Obesity (Silver Spring), 25(3): 634-641.
17. Stengel B, Tarver-Carr ME, Powe NR, Eberhardt MS, Brancati FL (2003). Lifestyle factors, obesity and the risk of CKD. Epidemiology, 14(4):479-87.
18. Stefan N, Artunc F, Heyne N, Machann J, Schleicher ED, Haring HU (2016). Obesity and renal disease: not all fat is created equal and not all obesity is harmful to the kidneys. Nephrol Dial Transplant, 31(5), 726-730.
19. Cirillo M, Senigalliesi L, Laurenzi M, et al (1998). Microalbuminuria in nondiabetic adults: relation of blood pressure, body mass index, plasma cholesterol levels, and smoking: The Gubbio Population Study. Arch Intern Med, 158(17), 1933-1939.
20. He Y, Li F, Wang F, Ma X, Zhao X, Zeng Q (2016). The association of CKD and waist circumference and waist-to-height ratio in Chinese urban adults. Medicine, 95(25):e3769.
21. Chang IH, Han JH, Myung SC, et al. (2009). Association between metabolic syndrome and CKD in the Korean population. Nephrology (Carlton), 14(3):321-6.
22. Tanaka H, Shiohira Y, Uezu Y, Higa A, Iseki K (2006). Metabolic syndrome and chronic kidney disease in Okinawa, Japan. Kidney Int, 69(2):369-74.
23. Tozawa M, Iseki C, Tokashiki K, et al (2007). Metabolic syndrome and risk of developing CKD in Japanese adults. Hypertens Res, 30(10):937-43.
24. Thomas G, Sehgal AR, Kashyap SR, Srinivas TR, Kirwan JP, Navaneethan SD (2011). Metabolic syndrome and kidney disease: a systematic review and meta-analysis. Clin J Am Soc Nephrol, 6(10):2364-73.
25. Yoon YS, Park HS, Yun KE, Kim SB (2009). Obesity and metabolic syndrome-related chronic kidney disease in nondiabetic, nonhypertensive adults. Metab Clin Exp, 58(12):1737-42.
26. Samuelsson O, Attman P, Knight-Gibson C, Larsson R, Mulec H, Weiss L, Alaupovic P (1998). Complex apolipoprotein B-containing lipoprotein particles are associated with a higher rate of progression of human chronic renal insufficiency. J Am Soc Nephrol, 9(8), 1482-1488.
27. Eun JS, Lee YH, Lee MS. (2007). Association between metabolic syndrome and Chronic Kidney Diseases, Korean Public Health Research, 33(1), 39-46.
Published
2019-11-03
How to Cite
1.
YANG Y. Metabolically Healthy Obesity and Risk of Incident Chronic Kidney Disease in a Korean Cohort Study. Iran J Public Health. 48(11):2007-2015.
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Original Article(s)