Abstract
BackgroundFew studies have examined the impact of childhood obesity on later kidney disease, and consequently, our understanding is very limited.Study DesignLongitudinal population-based cohort.Setting & ParticipantsThe Medical Research Council National Survey of Health and Development, a socially stratified sample of 5,362 singletons born in 1 week in March 1946 in England, Scotland, and Wales, of which 4,340 were analyzed.PredictorEarly-life overweight latent classes (never, prepubertal only, pubertal onset, or always), derived from repeated measurements of body mass index between ages 2 and 20 years.Outcomes & MeasurementsThe primary outcome was chronic kidney disease (CKD), defined as creatinine- or cystatin C–based estimated glomerular filtration rate (eGFRcr and eGFRcys, respectively) <60 mL/min/1.73 m2 or urine albumin-creatinine ratio (UACR) ≥3.5 mg/mmol measured at age 60-64 years. Associations were explored through regression analysis, with adjustment for socioeconomic position, smoking, physical activity level, diabetes, hypertension, and overweight at ages 36 and 53 years.Results2.3% of study participants had eGFRcr <60 mL/min/1.73 m2, 1.7% had eGFRcys <60 mL/min/1.73 m2, and 2.9% had UACR ≥3.5 mg/mmol. Relative to being in the never-overweight latent class, being in the pubertal-onset– or always-overweight latent classes was associated with eGFRcys-defined CKD (OR, 2.04; 95% CI, 1.09-3.82). Associations with CKD defined by eGFRcr (OR, 1.27; 95% CI, 0.71-2.29) and UACR (OR, 1.33; 95% CI, 0.70-2.54) were less marked, but in the same direction. Adjustment for lifestyle and health factors had little impact on effect estimates.LimitationsA low prevalence of CKD resulted in low statistical power. No documentation of chronicity for outcomes. All-white study population restricts generalizability.ConclusionsBeing overweight in early life was found to be associated with eGFRcys-defined CKD in later life. The associations with CKD defined by eGFRcr and UACR were less marked, but in the same direction. Reducing or preventing overweight in the early years of life may significantly reduce the burden of CKD in the population.
Highlights
Few studies have examined the impact of childhood obesity on later kidney disease, and our understanding is very limited
Childhood Overweight and chronic kidney disease (CKD) at Age 60-64 such studies determined that childhood obesity is associated with an elevated risk of kidney disease, as well as its progression and mortality,[8] but all these studies were conducted in patients already with kidney disease rather than the general population
In the longitudinal latent class analysis, all metrics suggested that 4 early-life overweight latent classes were required for both males and females
Summary
Few studies have examined the impact of childhood obesity on later kidney disease, and our understanding is very limited. Childhood Overweight and CKD at Age 60-64 such studies determined that childhood obesity is associated with an elevated risk of kidney disease, as well as its progression and mortality,[8] but all these studies were conducted in patients already with kidney disease rather than the general population. A more recent study of 1.2 million Israelis found overweight and obesity at age 17 years to be associated with a significantly increased risk of all-cause end-stage renal disease in a 25-year period.[9]. We previously have found overweight in adulthood, overweight starting in early adulthood, to be associated with reduced kidney function later in life in the Medical Research Council (MRC) National Survey of Health and Development (NSHD).[10] In the present study, we extend our previous work to explore whether the increase in risk associated with overweight stretches back even farther, into early life. We used repeated measurements of body mass index (BMI) between ages 2 and 20 years to model earlylife overweight trajectories, which we related to measures of chronic kidney disease (CKD) at age 60-64 years
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