Cohort study finds association between high BMI and risk of low serum bicarbonate
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A retrospective cohort study published in Kidney Medicine identified an association between higher BMI and a greater risk of developing “a low serum bicarbonate,” an identifier for metabolic acidosis.
“Given the independent risk of [chronic kidney disease] CKD associated with obesity and the metabolic syndrome, it is important to clarify the extent to which obesity predisposes patients to developing low bicarbonate,” Douglas C. Lambert, MD, of Northwell Health’s department of general internal medicine, and colleagues wrote. “This information may suggest appropriate clinical interventions to reduce the already high burden of disease among overweight and obese individuals.”
Lambert and colleagues conducted a study of 96,147 adult patients who had visited outpatient clinics in the Bronx, NY, between 2010 and 2015. Bicarbonate baselines of less than 15 mEq/L or greater than 40 mEq/L or baseline BMI of less than 15 kg/m2 or greater than 60 kg/m2 were exclusionary factors.
The final analysis included 96,147 patients. The mean age was 50.3 years. Most patients (64%) were women and Hispanic (36%). An overweight BMI classification (25 to <30 kg/m2) was found in most patients, followed by obese class 1 (BMI 30 to <35 kg/m2) and normal weight (BMI 18.5 to <25 kg/m2). Investigators used mixed effects models to identify a connection between patients’ BMI and serum bicarbonate.
After a median follow up of 4.4 years, researchers identified a low bicarbonate development in 36% of patients and observed an association between higher BMI categories (25 kg/m2) with greater hazard ratios for low bicarbonate (ranging from 1.10 to 1.20) compared with patients who had a normal BMI.
“If confirmed by future studies, our findings suggest that weight loss and measures to reduce acid production, such as increased consumption of fruits and vegetables, may be important population-level interventions to reduce risk factors for chronic kidney disease development and mortality in those with overweight and obesity,” Lambert and colleagues wrote.
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