In the Journals

Metabolically healthy obesity associated with chronic kidney disease

Patients defined as metabolically healthy obese demonstrated a higher risk for chronic kidney disease, according to findings published in the Annals of Internal Medicine.

Yoosoo Chang, MD, PhD, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea, and colleagues stated that chronic kidney disease (CKD) is a significant public health issue and associated with cardiovascular morbidity and mortality as well as end-stage renal disease.

"Its prevalence is increasing worldwide along with the growing prevalence of obesity and metabolic disease," the authors wrote. "Indeed, obesity — mediated by hypertension, insulin resistance, hyperglycemia, dyslipidemia, and other metabolic abnormalities — is a major risk factor for CKD ... metabolically healthy obese persons seem to have a favorable profile with no metabolic abnormalities."

The authors conducted a prospective cohort study of South Korean men and women aged 18 years and older, utilizing data from the Kangbuk Samsung Health Study. After excluding various patient groups, including those who had metabolic abnormalities or evidence of kidney disease at baseline, the final sample consisted of 62,249 patients.

They defined metabolic health as "a homeostasis model assessment of insulin resistance less than 2.5 and absence of a component of the metabolic syndrome." Chang and colleagues calculated and classified BMI in accordance with Asian-specific criteria, defining underweight as BMI < 18.5 kg/m2, normal weight as BMI between 18.5 and 22.9 kg/m2, overweight as BMI between 23 and 24.9 kg/m2 and obese as BMI 25 kg/m2.

The authors followed the patients from baseline through their last screening or diagnosis of CKD, whichever occurred first.

Analysis included 369,088 person-years of follow-up during which 906 patients developed CKD.

Results showed that the multivariable adjusted differences in 5-year cumulative incidence of CKD for underweight, overweight and obese patients was –4 (95% CI; –7.8 to –0.3), 3.5 (95% CI; 0.9-6.1) and 6.7 (95% CI; 3-10.4) cases per 1000 people, respectively, when compared with normal-weight participants.

"In this large cohort study of metabolically healthy Korean adults, being overweight or obese was associated with increased CKD risk compared with being normal weight," Chang and colleagues wrote. "The association between [metabolically healthy obesity] and CKD was consistently seen in all prespecified clinical subgroups, including participants without low-grade inflammation or fatty liver. Furthermore, the association could not be explained by the residual levels of metabolic factors in [metabolically healthy obese] participants. Our study ... adds to an increasing body of evidence that [metabolically healthy obesity] is not a harmless condition."

The authors recommended that physicians counsel metabolically healthy obese patients regarding their increased risk for CKD along with advice on healthy weight and lifestyle. – by Chelsea Frajerman Pardes

Disclosures: The researchers report no relevant financial disclosures.

Patients defined as metabolically healthy obese demonstrated a higher risk for chronic kidney disease, according to findings published in the Annals of Internal Medicine.

Yoosoo Chang, MD, PhD, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea, and colleagues stated that chronic kidney disease (CKD) is a significant public health issue and associated with cardiovascular morbidity and mortality as well as end-stage renal disease.

"Its prevalence is increasing worldwide along with the growing prevalence of obesity and metabolic disease," the authors wrote. "Indeed, obesity — mediated by hypertension, insulin resistance, hyperglycemia, dyslipidemia, and other metabolic abnormalities — is a major risk factor for CKD ... metabolically healthy obese persons seem to have a favorable profile with no metabolic abnormalities."

The authors conducted a prospective cohort study of South Korean men and women aged 18 years and older, utilizing data from the Kangbuk Samsung Health Study. After excluding various patient groups, including those who had metabolic abnormalities or evidence of kidney disease at baseline, the final sample consisted of 62,249 patients.

They defined metabolic health as "a homeostasis model assessment of insulin resistance less than 2.5 and absence of a component of the metabolic syndrome." Chang and colleagues calculated and classified BMI in accordance with Asian-specific criteria, defining underweight as BMI < 18.5 kg/m2, normal weight as BMI between 18.5 and 22.9 kg/m2, overweight as BMI between 23 and 24.9 kg/m2 and obese as BMI 25 kg/m2.

The authors followed the patients from baseline through their last screening or diagnosis of CKD, whichever occurred first.

Analysis included 369,088 person-years of follow-up during which 906 patients developed CKD.

Results showed that the multivariable adjusted differences in 5-year cumulative incidence of CKD for underweight, overweight and obese patients was –4 (95% CI; –7.8 to –0.3), 3.5 (95% CI; 0.9-6.1) and 6.7 (95% CI; 3-10.4) cases per 1000 people, respectively, when compared with normal-weight participants.

"In this large cohort study of metabolically healthy Korean adults, being overweight or obese was associated with increased CKD risk compared with being normal weight," Chang and colleagues wrote. "The association between [metabolically healthy obesity] and CKD was consistently seen in all prespecified clinical subgroups, including participants without low-grade inflammation or fatty liver. Furthermore, the association could not be explained by the residual levels of metabolic factors in [metabolically healthy obese] participants. Our study ... adds to an increasing body of evidence that [metabolically healthy obesity] is not a harmless condition."

The authors recommended that physicians counsel metabolically healthy obese patients regarding their increased risk for CKD along with advice on healthy weight and lifestyle. – by Chelsea Frajerman Pardes

Disclosures: The researchers report no relevant financial disclosures.