Adherence to a Healthy Lifestyle and All-Cause Mortality in CKD

Ricardo, Ana C.; Madero, Magdalena; Yang, Wei; Anderson, Cheryl A.M.; Menezes, Matthew; Fischer, Michael J.; Turyk, Mary E.; Daviglus, Martha L.; Lash, James P.

doi:10.2215/cjn.00600112

Cited by 46 publications

(63 citation statements)

References 38 publications

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“…72 In contrast, a recent study showed that adherence to a healthy lifestyle (using a weighted healthy lifestyle score) was associated with a lower all-cause mortality in CKD. 73 However, only a few studies have studied the effects of a healthy lifestyle on kidney function. 74 Small studies suggested improvements in estimated GFR and/or albuminuria with low-calorie diets, especially when weight loss has been significant.…”

Section: Treatment Of Obesity In Ckdmentioning

confidence: 99%

Obesity in CKD—What Should Nephrologists Know?

Stenvinkel

Zoccali

İkizler

2013

Journal of the American Society of Nephrology

200

172

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Obesity, the epidemic of the 21st century, carries a markedly increased risk for comorbid complications, such as type 2 diabetes, cancer, hypertension, dyslipidemia, cardiovascular disease, and sleep apnea. In addition, obesity increases the risk for CKD and its progression to ESRD. Paradoxically, even morbid obesity associates with better outcomes in studies of ESRD patients on maintenance dialysis. Because the number of obese CKD and maintenance dialysis patients is projected to increase markedly in developed as well as low-and middle-income countries, obesity is a rapidly emerging problem for the international renal community. Targeting the obesity epidemic represents an unprecedented opportunity for health officials to ameliorate the current worldwide increase in CKD prevalence. Nephrologists need more information about assessing and managing obesity in the setting of CKD. Specifically, more precise estimation of regional fat distribution and the amount of muscle mass should be introduced into regular clinical practice to complement more commonly used practical markers, such as body mass index. Studies examining the effects of obesity on kidney disease progression and other clinical outcomes along with weight management strategies are much needed in this orphan area of research. 24: 172724: -173624: , 201324: . doi: 10.1681 Obesity has emerged as the largest pandemic in near history, with important implications of not only cardiovascular disease (CVD) but also CKD. Recent data from the United States indicate that the incidence and prevalence rates of obesity in maintenance dialysis patients largely exceed the corresponding figures in the general population. 1 A large European population survey documented that a high body mass index (BMI) ranks as one of the strongest risk factors for new-onset CKD. 2 The dimension of the obesity epidemic and the impact of the same epidemic on the kidney demand efforts for understanding the epidemiology and the mechanisms of CKD associated with excess adiposity. It also sets as an absolute public health priority for the development of treatment policies integrated across specialties and general practice to halt this much concerning problem. In this scenario, it is fundamental that nephrologists are updated on current knowledge about obesity in the setting of CKD. However, little attention is still paid to this issue in major nephrology journals. The suboptimal attention to the problem by major sources of dissemination of specialty information suggests that nephrologists may have scarce knowledge of how obesity should be assessed, its epidemiology, mechanisms whereby excess fat mass is conducive to CKD, and management of obesity in the catabolic uremic milieu. 3 J Am Soc Nephrol DEFINITION AND ASSESSMENT OF OBESITYThe most common method for defining obesity is based on BMI (i.e., a person's weight as obese. It should be emphasized that population norms of BMI could be different based on ethnic and racial background (i.e., the proportion of Asian people with a high ...

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Section: Treatment Of Obesity In Ckdmentioning

confidence: 99%

Obesity in CKD—What Should Nephrologists Know?

Stenvinkel

Zoccali

İkizler

2013

Journal of the American Society of Nephrology

200

172

View full text Add to dashboard Cite

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“…Indeed, a previous study found that, despite the greater prevalence of metabolic syndrome in obese CKD patients compared with nonobese CKD patients, there were no survival differences (30). In the study by Ricardo et al (2), there was also no increased mortality with obesity in CKD.…”

mentioning

confidence: 92%

“…Ricardo et al (2) found that a higher healthy eating index was associated with lower mortality, but this finding was nonsignificant when fully adjusted. However, caution is warranted in interpreting fully adjusted models.…”

mentioning

confidence: 98%

“…In this issue of CJASN, Ricardo et al (2) have evaluated the association of lifestyle factors with mortality in nondialysis CKD in the National Health and Nutrition Examination Survey (NHANES) III cohort. Ricardo et al (2) defined healthy lifestyle by diet, body mass index (BMI), physical activity, and smoking.…”

mentioning

confidence: 99%

“…Interventions that increase muscle mass and decrease fat mass are likely to be beneficial in the CKD and dialysis populations. The work by Ricardo et al (2) should stimulate interest in lifestyle interventions in CKD and dialysis patients.…”

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confidence: 99%

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Risk Factor Paradox in CKD and ESRD

Beddhu

Abraham

2013

Clinical Journal of the American Society of Nephrology

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Compared with the general population, cardiovascular (CV) events and mortality are higher in the ESRD population. However, the role of conventional CV risk factors in increased risk of CV events and mortality in the ESRD population has been controversial. In particular, obesity, hypertension, and dyslipidemia are not associated with increased mortality in the hemodialysis population (1). This risk factor paradox raises troubling questions. If obesity is good and hypertension and dyslipidemia are not bad, should we even bother with a healthy lifestyle in dialysis patients? Are these risk factors different in the nondialysis CKD population?In this issue of CJASN, Ricardo et al. (2) have evaluated the association of lifestyle factors with mortality in nondialysis CKD in the National Health and Nutrition Examination Survey (NHANES) III cohort. Ricardo et al. (2) defined healthy lifestyle by diet, body mass index (BMI), physical activity, and smoking. They found that, similar to the general population studies, adherence to a healthy lifestyle was associated with lower all-cause mortality. When individual components of the lifestyle scores were examined, the greatest reduction in mortality was related to nonsmoking. Physical activity was also independently associated with lower risk of death. In studying the association of body size with mortality, a higher risk of mortality was observed in those individuals with lower BMI (18.5 to ,22 kg/m 2 ) compared with those individuals with healthy BMI (22 to ,25 kg/m 2 ). However, compared with the healthy BMI group, those individuals who were overweight (BMI of 25 to ,30 kg/m 2 ) or obese (BMI.30 kg/m 2 ) did not have increased mortality. No significant association was also observed with diet and all-cause mortality in the fully adjusted model. This study has several major strengths. Ricardo et al. (2) examined a question of considerable clinical relevance. Furthermore, the complex survey design of NHANES is such that the sample is representative of the noninstitutionalized US civilian population, and the correct use of sampling units and survey weights allows the results to be extrapolated to the noninstitutionalized US civilian population. Furthermore, the data collection in NHANES follows stringent standards. However, because this study is an observational study, caution is warranted in interpreting the findings, and strong causal inferences should not be drawn.

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