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Body Mass Index in 1.2 Million Adolescents and Risk for End-Stage Renal Disease
Study Questions:
Is body mass index (BMI) during adolescence associated with risk for end-stage renal disease (ESRD) in the future?
Methods:
Data from adolescents, ages 17 years, who had undergone a medical examination for military service between January 1, 1967, and December 31, 1997, were linked to the Israeli ESRD registry. All incident cases of treated ESRD between January 1, 1980, and May 31, 2010, were included. BMI calculated at age 17 years was defined with the US Centers for Disease Control and Prevention BMI for age and sex classifications. Only Jewish recruits, for whom military service is compulsory, were included. Eligible individuals found to be positive for hematuria or proteinuria at enrollment dipstick screening were excluded, as were individuals with any diagnosis suggestive of a possible future risk for ESRD including vasculitis, hypertension, diabetes mellitus, and prior or current renal disease.
Results:
A total of 1,194,705 adolescents were included in this nationwide population-based retrospective cohort study. During 30,478,675 follow-up person-years, 874 participants (713 male and 161 female) developed treated ESRD, for an overall incidence rate of 2.87 cases per 100,000 person-years. Adolescents who were overweight (BMI in the 85th-95th percentile) had an increased future risk for treated ESRD, with incidence rates of 6.08 per 100,000 person-years compared to normal-weight adolescents. For adolescents who were obese (BMI ≥95th percentile), the incidence rate was 13.40 cases per 100,000 person-years compared to normal-weight adolescents. After adjustment for sex, country of origin, systolic blood pressure, and period of enrollment in the study, being overweight was associated with a hazard ratio of 3.00 (95% confidence interval [CI], 2.50-3.60), whereas being obese was associated with a hazard ratio (HR) of 6.89 (95% CI, 5.52-8.59) for all-cause treated ESRD. For diabetic-related ESRD, being overweight or obese were strong, independent risk factors (HR, 5.96; 95% CI, 4.41-8.06 for overweight, and HR, 19.37; 95% CI, 14.13-26.55 for obese). A similar pattern was observed for nondiabetic ESRD (HR, 2.17; 95% CI, 1.71-2.74 for overweight, and HR, 3.41; 95% CI, 2.42-4.79 for obese).
Conclusions:
The investigators concluded that adolescents who were overweight or obese at age 17 years were at significantly increased risk for ESRD over a 25-year follow-up period. Elevated BMI constituted a substantial risk for both diabetic and nondiabetic ESRD.
Perspective:
This large-scale study used long-term follow-up data to demonstrate the significant association of increased BMI with risk for ESRD. A long-term health implication of overweight and obese adolescents suggests the continued need for aggressive preventive measures during childhood.
Keywords: Follow-Up Studies, Vasculitis, Overweight, Proteinuria, Risk Factors, Incidence, Renal Dialysis, Registries, Renal Insufficiency, Body Mass Index, Hematuria, Cardiovascular Diseases, Military Personnel, Confidence Intervals, Hypertension, United States, Diabetes Mellitus
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