Adolescent Obesity Associated With End-Stage Renal Disease

Adolescent obesity may contribute to the development of end-stage renal disease (ESRD) in adulthood, according to a study published on Oct. 29 in the Archives of Internal Medicine.

The study, which included nearly 1.2 million adolescents age 17 who underwent medical examination for conscription in the Israeli military between 1967 and 1997, found that overweight and obese 17-year-olds, as compared to those with normal body mass index (BMI), have an increased risk of ESRD, and that this risk increased among those with and without ESRD caused by diabetes. Over the course of nearly 30.5 million follow-up person-years, there were 874 cases of ESRD, for an incidence rate of 2.87 cases per 100,000 person years.

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Among underweight adolescents (mean BMI: 16.79 for boys and 16.59 for girls) and normal-weight adolescents (mean BMI: 20.90 for boys and 20.92 for girls), the incidence rates of ESRD were 2.30 and 2.32 cases per 100,000 patient-years, respectively. The incidence rates among overweight subjects (mean BMI: 26.20 for boys and 26.76 for girls) and obese subjects (mean BMI: 30.57 for boys and 31.86 for girls) were 6.08 and 13.40 cases per 100,000 person-years, respectively. In a multivariate analysis adjusted for gender, country of origin, systolic blood pressure and period of enrollment, being overweight or obese during adolescence was associated with an increased risk of all-cause treated ESRD. Elevated BMI during adolescence was also associated with an increased future risk of diabetic and nondiabetic ESRD.

In an accompanying editorial, Kristen L. Johansen, MD, from the San Francisco Veterans Affairs Medical Center, noted that the association of obesity with ESRD presents both good news and bad news. "The good news is that obesity represents a potentially modifiable risk factor, and control of weight … could prevent or slow the development of some cases of ESRD," she said. "The bad news is that it is not easy to address obesity. The strong association between obesity at age 17 years and the incidence of ESRD many years later underscores the fact that overweight adolescents generally go on to become overweight adults."

According to Johansen, the study highlights the importance of instilling healthy habits and lifestyles early in life before the onset of chronic diseases and development of lifelong habits.

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