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Volume 52, Issue 1, Pages 39-48 (July 2008)


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Overweight, Obesity, and the Development of Stage 3 CKD: The Framingham Heart Study

Meredith C. Foster, BA12, Shih-Jen Hwang, PhD12, Martin G. Larson, ScD3, Judith H. Lichtman, PhD, MPH4, Nisha I. Parikh, MD, MPH5, Ramachandran S. Vasan, MD5, Daniel Levy, MD12, Caroline S. Fox, MD, MPH126Corresponding Author Informationemail address

Received 20 November 2007; accepted 3 March 2008. published online 28 April 2008.

Background

Prior research yielded conflicting results about the magnitude of the association between body mass index (BMI) and chronic kidney disease (CKD).

Study Design

Prospective cohort study.

Settings & Participants

Framingham Offspring participants (n = 2,676; 52% women; mean age, 43 years) free of stage 3 CKD at baseline who participated in examination cycles 2 (1978-1981) and 7 (1998-2001).

Predictor

BMI.

Outcome

Stage 3 CKD (estimated glomerular filtration rate < 59 mL/min/1.73 m2 for women and < 64 mL/min/1.73 m2 for men).

Measurements

Age-, sex-, and multivariable-adjusted (diabetes, systolic blood pressure, hypertension treatment, current smoking status, and high-density lipoprotein cholesterol level) logistic regression models were used to examine the relationship between BMI at baseline and incident stage 3 CKD and incident dipstick proteinuria (trace or greater).

Results

At baseline, 36% of the sample was overweight and 12% was obese; 7.9% (n = 212) developed stage 3 CKD during 18.5 years of follow-up. Relative to participants with normal BMI, there was no association between overweight individuals and stage 3 CKD incidence in age- and sex-adjusted models (odds ratio [OR], 1.29; 95% confidence interval [CI], 0.93 to 1.81; P = 0.1) or multivariable models (OR, 1.06; 95% CI, 0.75 to 1.50; P = 0.8). Obese individuals had a 68% increased odds of developing stage 3 CKD (OR, 1.68; 95% CI, 1.10 to 2.57; P = 0.02), which became nonsignificant in multivariable models (OR, 1.09; 95% CI, 0.69 to 1.73; P = 0.7). Similar findings were observed when BMI was modeled as a continuous variable or quartiles. Incident proteinuria occurred in 14.4%; overweight and obese individuals were at increased odds of proteinuria in multivariable models (OR, 1.43; 95% CI, 1.09 to 1.88; OR, 1.56; 95% CI, 1.08 to 2.26, respectively).

Limitations

BMI is measure of generalized obesity and not abdominal obesity. Participants are predominantly white, and these findings may not apply to different ethnic groups.

Conclusions

Obesity is associated with increased risk of developing stage 3 CKD, which was no longer significant after adjustment for known cardiovascular disease risk factors. The relationship between obesity and stage 3 CKD may be mediated through cardiovascular disease risk factors.

1 Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, MA

2 National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD

3 Department of Mathematics and Statistics, Boston University, Boston, MA

4 Division of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT

5 Boston University School of Medicine, Boston, MA

6 Department of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.

Corresponding Author InformationAddress correspondence to Caroline S. Fox, MD, MPH, Framingham Heart Study, 73 Mt Wayte Ave, Ste 2, Framingham, MA 01702.

 Originally published online as doi:10.1053/j.ajkd.2008.03.003 on April 25, 2008.

PII: S0272-6386(08)00575-1

doi:10.1053/j.ajkd.2008.03.003


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