Metabolic phenotypes of obese, overweight, and normal weight individuals and risk of chronic kidney disease: a systematic review and meta-analysis.

Shahab Alizadeh,Mohammad Kazem Radaei,Mohammad Alizadeh,Loghman Sharifi,Elnaz Daneshzad,Hossein Radfar,Hamed Esmaeili

doi:10.20945/2359-3997000000149

Abstract

Chronic kidney disease (CKD) risk is inconsistent in the normal-weight, overweight, and obese individuals due to the heterogeneity of metabolic status. This meta-analysis aimed to examine the combined effects of body mass index (BMI) and metabolic status on CKD risk. The MEDLINE, EMBASE, and Web of Knowledge databases were systematically searched up to March 2019 to identify all eligible studies investigating the CKD risk (defined as GFR < 60 mL/min per 1.73 m2 and/or microalbuminuria or proteinuria) associated with the body size phenotypes which are known as metabolically unhealthy normal-weight (MUNW), metabolically healthy overweight (MHOW), metabolically unhealthy overweight, metabolically healthy obese (MHO) and metabolically unhealthy obese (MUHO). The classification of subjects in included studies as metabolically unhealthy was based on the presence of three components of metabolic syndrome. BMI categorization was based on the criteria of included studies. The risk estimates and 95% confidence intervals (CIs) were extracted and pooled using random effects analysis. A total of 9 prospective cohort studies with 128773 participants and 4797 incident cases were included in the meta-analysis. Compared with healthy normal-weight individuals as reference, MUNW and MHO subjects showed an increased risk for CKD events with a pooled RR of 1.58 (95% CI = 1.28-1.96) in MUNW and 1.55 (95% CI = 1.34-1.79) in MHO persons. Also, MHOW was at increased risk for CKD (RR = 1.34, 95% CI = 1.20-1.51). MUHO individuals were at the highest risk for the development of CKD (RR = 2.13, 95% CI = 1.66-2.72). Individuals with metabolic abnormality, although at normal-weight, have an increased risk for CKD. Healthy overweight and obese individuals had higher risk; refuting the notion that metabolically healthy overweight and obese phenotypes are benign conditions.

Highlights

Chronic kidney disease (CKD), which nearly doubled as a cause of death around the world between 1990 and 2010 and was the 18th highest cause of death worldwide in 2010 [1], is a worldwide health problem with increasing incidence and prevalence, high costs and poor outcomes [2]
9 prospective cohort studies were included in the quantitative syuthesis of 9 studies, comprising 128773 participants and 4797 incident cases, were included in the quantitative meta-analysis based on the inclusion criteria for CKD risk related to the different phenotypes of body size
In the assessment of metabolic abnormality, the classification of subjects in these studies as metabolically unhealthy was based on the presence of metabolic syndrome [28,38,40,41,42,43,44], and by the presence of metabolic syndrome combined with insulin resistance [37,39]

Summary

Introduction

Chronic kidney disease (CKD), which nearly doubled as a cause of death around the world between 1990 and 2010 and was the 18th highest cause of death worldwide in 2010 [1], is a worldwide health problem with increasing incidence and prevalence, high costs and poor outcomes [2]. Individuals with MHO display a favorable metabolic profile that is characterized by a high level of insulin sensitivity, favorable lipid profiles, a low incidence of hypertension, satisfactory fat distribution, and a low level of systemic inflammatory responses [23,24]. Another body size phenotype, which is known as metabolically unhealthy and normal-weight (MUNW), include normal-weight individuals who based on standard weight tables are not obese (BMI < 25 kg/m2), but express metabolic abnormalities like an increased levels of adiposity and insulin resistance and a higher susceptibility to type 2 diabetes and cardiovascular diseases (CVD) [25,26].

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Results

Conclusion