High BMI in Adolescence Linked to Early CKD in Young Adulthood, Shows New Research

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Data from a large cohort study showed high body mass index (BMI) in late adolescence was associated with early chronic kidney disease (CKD) in young adulthood, and the risk rose with increasing severity of obesity.

Findings also showed that the risk of early CKD was present in seemingly healthy participants with high-normal BMI and before 30 years of age, reported researchers in JAMA Pediatrics.

“These findings suggest that adolescent obesity is a major risk factor for early CKD in young adulthood; this underscores the importance of mitigating adolescent obesity rates and managing risk factors for kidney disease in adolescents with high BMI,” wrote first author Avishai M. Tsur, MD, MHA, of Sheba Medical Center in Ramat Gan, Tel Aviv, Israel, and colleagues.

Tsur and coauthors reported that adolescent obesity rates have been steadily increasing in the US, with 1 in 5 adolescents having a BMI at or above the 95th percentile for age and sex on the US Centers for Disease Control and Prevention growth charts.

“Although the link between obesity and [CKD] in adults is well established, the evidence linking adolescent obesity and early CKD, particularly during young adulthood, is limited,” stated investigators. “Moreover, it is unclear whether this association is independent of other obesity-related comorbidities, such as type 2 diabetes and hypertension.”

To further examine the association between BMI and early CKD in young adulthood, researchers retrospectively analyzed data on 593 660 Israeli adolescents (mean age at study entry, 17.2 years; 54.5% men) aged 16 to 20 years who were born after January 1, 1975, who had medical assessments for mandatory military service. Persons with kidney pathology, albuminuria, hypertension (HTN), dysglycemia, or missing blood pressure or BMI data were excluded.

“Follow-up started at the time of medical evaluation or January 1, 2000 (whichever came last), and ended at early CKD onset, death, the last day insured, or August 23, 2020 (whichever came first),” wrote Tsur and colleagues.

The main study outcome was a diagnosis of early CKD—defined for the purpose of the study as stage 1 to 2 CKD by moderately or severely increased albuminuria—measured as an estimated glomerular filtration rate of ≥60 mL/min/1.73 m².

FINDINGS

During a mean follow-up of 13.4 years, 1963 (0.3%) adolescents developed early CKD, according to the results.

Among men, researchers found that the risk for developing CKD increased the most among adolescents with severe obesity (adjusted hazard ratio [aHR] 9.4, 95% CI, 6.6-13.5), followed by those with mild obesity (aHR 6.7, 95% CI 5.4-8.4), overweight (aHR 4, 95% CI 3.3-5.0) and high-normal BMI (aHR 1.8, 95% CI 1.5-2.2).

Results were similar when the cohort was limited to participants who were seemingly healthy, those surveyed up to 30 years, or those who were free of diabetes and HTN at the end of the follow-up period.

“Our results underscore the long-term sequelae of adolescent obesity, which may be well evident by the late third or early fourth decades of life, even among persons with high-normal BMI in adolescence and without other apparent risk factors for CKD,” concluded investigators.

Source: Tsur AM, Akavian I, Landau R, et al. Adolescent body mass index and early chronic kidney disease in young adulthood. JAMA Pediatr. Published online December 11, 2023. doi:10.1001/jamapediatrics.2023.5420