Obesity in young adults adds to risk of CKD progression
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Worldwide obesity has nearly tripled since 1975, according to the WHO, and is heightening the risk of people developing chronic kidney disease, sources told Healio/Nephrology News & Issues.
Source: Source: Langone Medical Center
More of that risk is now being seen in young adults.
“I do a lot of transitional care in our dialysis unit, working with young patients moving to adult nephrology,” Anna Burgner, MD, an assistant professor of medicine in the division of nephrology and hypertension in the department of medicine at Vanderbilt University Medical Center and director of the dialysis program, told Healio/Nephrology News & Issues. “We are seeing more patients in the 18-year-old to 21-year-old range with type 2 diabetic nephropathy. Many of these young adults are overweight,” Burgner, an Associate Editor for Healio/Nephrology News & Issues, said.
More than 340 million children and adolescents aged 5 to 19 years were overweight or obese in 2016, the WHO reported; in 2020, 39 million children (younger than 5 years) were overweight or obese.
Long-term impact
While obesity has become more commonplace among young adults, it has not been clear what the long- term ramifications are for kidney injury. A study published in the Journal of Renal Nutrition involved a meta-analysis of long-term risk of obesity on kidney disease.
“Childhood obesity is considered one of the important risk factors for many long-term morbidities. However, the long-term consequences of childhood obesity on kidney function are largely unknown,” Farzad Pourghazi, MD, and colleagues from the Obesity and Eating Habits Research Center at the Tehran University of Medical Sciences in Tehran and the Translational Health Research Institute, School of Medicine, Western Sydney University in Sydney, wrote. “This systematic review was designed to sum up evidence for the long-term consequences of childhood obesity on kidney function in midlife.”
After screening 6,843 published articles, eight prospective cohort studies were reviewed.
“Out of eight included studies, six reported a statistically significant positive association between higher BMI levels in early life and greater renal disease risk in later life,” Pourghazi and colleagues wrote.
“This fact may cause motivation among public health executives to establish policies for more serious population-based obesity prevention.”
a co-author on the paper, told Healio/Nephrology News & Issues that poor choices in readily available “fast foods” are leading to higher obesity rates among youth.
“Obesity is the reason for many short and long-term complications such as cardiometabolic risk factors, chronic kidney disease, hypertension, diabetes, cancers, low self-esteem, cognitive development problems, osteoarthritis and many other complications,” Qorbani said.
Strategies
The role of obesity in the progression of CKD was explored at a workshop held in 2021 and sponsored by the National Kidney Foundation and the Obesity Society. In summarizing the results from the workshop, Allon Friedman, MD, a professor of medicine at Indiana University School of Medicine who trained at the U.S. Department of Agriculture-Human Nutrition Research Center and helped to lead the symposium, said interventions to address obesity in the earlier stages of CKD “might result in better long-term outcomes by helping prevent the development of more overt kidney disease and its associated complications.
“There are many people with advanced CKD and obesity who would also benefit. Thus, nephrologists and obesity medicine experts must appreciate that different strategies may be required depending on CKD stage and severity of obesity,” Friedman and colleagues wrote in the American Journal of Kidney Diseases.
The workshop organizers said the intent was to “develop a clearer delineation of the issues, challenges and knowledge gaps facing the nephrology and obesity medicine communities in advancing the care of obesity in people with CKD and to identify ways to begin to advance the understanding and effective management of these frequently coexisting and closely linked disorders.”
Friedman told Healio/Nephrology News & Issues that the risks are significant for younger patients who are overweight.
“I think the concern that nephrologists will be seeing people with CKD at younger ages is valid in light of the growing prevalence of obesity and type 2 diabetes mellitus in younger age groups,” Friedman, who studies the overlap between obesity and kidney disease at Indiana University School of Medicine, said.
But even identifying the root cause of obesity and its potential impact on CKD can be challenging. “At a basic level, identifying which individuals with obesity have CKD remains a major obstacle,” Friedman and colleagues wrote in American Journal of Kidney Diseases. “The absence of clear and established criteria for treating obesity in people with CKD and evidence that routine screening for kidney disease in people with obesity improves clinical outcomes were also felt to be major limitations to embracing obesity treatment in this population,” they wrote.
Friedman told Healio/Nephrology News & Issues that identifying a level of BMI that has an impact on CKD is difficult. “The data suggest that the risk for development and progression of CKD begins at overweight/obesity and rises in parallel with BMI,” he said.
Reversing the trend of obesity – and its impact on CKD – poses challenges for young adults because of other personal issues they encounter as part of growing up, Burgner said. “Oftentimes [teenagers] are still developing emotionally, so they may struggle with the intersection of newfound independence and tasks like taking medications, going to doctor appointments, etc.,” Burgner said. “That can become overwhelming and make it difficult to set priorities.”
- References:
- A primary health care approach for improved health, functioning and reduced obesity-associated disability. https://www.who.int/news-room/events/detail/2022/12/06/default-calendar/who-guideline-integrated-management-of-children-in-all-their-diversity-with-obesity. Accessed March 22, 2023.
- Friedman A, et al. Am. Jrnl Kid Dis.2021;doi:10.1053/j.ajkd.2022.06.007.
- Pourghazi F, et al. Jrnl. of Ren Nut. 2023; doi:10.1053/j.jrn.2023.03.003.
- For more information:
- Anna Burgner, MD, can be reached at anna.burgner@vumc.org.
- Allon Friedman, MD, can be reached at allfried@iu.edu.
- Mostafa Qorbani, MD, can be reached at mqorbani1379@yahoo.com.
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