Metabolically Healthy Obesity and Risk of Incident CKD

Abstract

Background and objectives Metabolically healthy obesity (MHO) is a unique obesity phenotype that apparently protects people from the metabolic complications of obesity. The association between MHO phenotype and incident CKD is unclear. Thus, this study investigated the association between MHO phenotype and incident CKD.Design, setting, participants, & measurements A total of 3136 Japanese participants were enrolled in an 8-year follow-up cohort study in 2001. Metabolically healthy status was assessed by common clinical markers: BP, triglycerides, HDL cholesterol, and fasting plasma glucose concentrations. Body mass index $25.0 kg/m 2 was defined as obesity. CKD was defined by proteinuria or eGFR of ,60 ml/min per 1.73 m 2 . To calculate the odds ratio for incident CKD, logistic regression analyses were performed.Results The crude incidence proportions of CKD were 2.6% (56 of 2122 participants) in participants with the metabolically healthy nonobesity phenotype, 2.6% (8 of 302) in those with the MHO phenotype, 6.7% (30 of 445) in those with the metabolically abnormal nonobesity phenotype, and 10.9% (29 of 267) in those with the metabolically abnormal obesity phenotype. Compared with metabolically healthy nonobesity phenotype, the odds ratios for incident CKD were 0.83 (95% confidence interval [95% CI], 0.36 to 1.72; P=0.64) for MHO, 1.44 (95% CI, 0.80 to 2.57; P=0.22) for metabolically abnormal nonobesity, and 2.80 (95% CI, 1.45 to 5.35; P=0.02) for metabolically abnormal obesity phenotype after adjustment for confounders, including age, sex, smoking statues, alcohol use, creatinine, uric acid, systolic BP, HDL cholesterol, and impaired fasting glucose or diabetes.Conclusion MHO phenotype was not associated with higher risk of incident CKD.

Late-night-dinner is associated with poor glycemic control in people with type 2 diabetes: The KAMOGAWA-DM cohort study

“…As for alcohol, the people who drank alcohol daily were defined as alcohol drinker. As for smoking, smoking status was defined by current use of cigarette [21,22]. Skipping breakfast was determined based on a negative answer to the question: "Do you have breakfast regularly?"…”

Obesity modulates the association between systolic blood pressure and albuminuria

“…In the absence of metabolic comorbidities (elevated triglycerides, low HDL cholesterol, hypertension, or impaired glucose tolerance), higher BMI was actually associated with a lower risk of ESRD 33 and no increase in the risk of incident CKD 34 . These findings support the concept of 'metabolically healthy obesity' and contrast with previous reports that obesity is a predictor of ESRD and CKD even in analyses adjusted for other metabolic factors 1,2,4 .…”

“…In the absence of metabolic syndromecomorbidities (elevated triglycerides, low HDL cholesterol, hypertension, or impaired glucose tolerance), higher BMI was actually associated with a lower risk of ESRD 33 and no increase in the risk of incident CKD 34 . These findings support the concept of 'metabolically healthy .…”

Kidney Disease and Obesity

“…This 'hyperfiltration theory' leaves numerous dilemmas related to the fact that not all obese patients develop kidney disease and that there is no correlation between the degree of obesity and extension of glomerular structural alterations. Metabolically healthy obese individuals generally do not develop glomerulopathy associated with obesity 6 . Accordingly, besides obesity, some genetic and environmental factors may also be involved in the onset and progression of CKD.…”

“…Ovakva "hiperfiltracijska teorija" ostavlja brojne dvojbe vezane za činjenicu da svi pretili bolesnici ne obole od bubrežne bolesti i da stupanj pretilosti nije u povezanosti s prošireno-šću strukturnih promjena glomerula. Metabolički zdravi pretili bolesnici obično ne obole od glomerulopatije udružene s debljinom 6 . Dakle, uz debljinu utjecaj na nastanak i progresiju KBB-a mogli bi imati i neki genski i okolišni čimbenici.…”