ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: Obesity 2018;26(4):776-781

Here, Twig et al. shed light on an important, but not well investigated facet of the complex, multi-organ system chronic disease simply termed ‘obesity’. Using the large statistical power of this impressive, nation-wide database, the authors demonstrate high hazard ratios for obesity-related kidney mortality in a relatively young cohort, which even exceed the previously reported estimates for cardiovascular mortality in the same study population (1, 2). The presented data strongly confirms that adolescent BMI confers increased risk for acute or chronic kidney disease and mortality in mid-adulthood and therefore contradicts previous notions of a potential protective role of obesity in CKD (3). Nonetheless, the underlying pathophysiology of the observed association between BMI at young ages and kidney disease mortality in later life remains unclear. Observations of lower glomerular filtration rates in obese children or increased urinary excretion of biomarkers for kidney injury in severely obese adolescents point to a potential causal relationship beyond classic cardio-metabolic disease traits, such as type 2 diabetes and hypertension (4, 5). Taken together, this raises the question whether a to-be-developed screening strategy for subclinical kidney disease in overweight and obese adolescents might be feasible approach to identify high-risk subjects, and more importantly, might provide the basis for effective secondary or tertiary prevention of end-stage renal disease in adulthood.

1. Twig G, G Yaniv, H Levine, A Leiba, N Goldberger, E Derazne, D Ben-Ami Shor, D Tzur, A Afek, A Shamiss, Z Haklai, JD Kark. Body-Mass Index in 2.3 Million Adolescents and Cardiovascular Death in Adulthood. N Engl J Med 2016; 374:2430-2440

2. Twig G, D Ben-Ami Shor, A Furer, H Levine, E Derazne, N Goldberger, Z Haklai, M Levy, A Afek, A Leiba, JD Kark. Adolescent Body Mass Index and Cardiovascular Disease-Specific Mortality by Midlife. J Clin Endocrinol Metab 2017; 102:3011-3020

3. Kalantar-Zadeh K, CM Rhee, J Chou, SF Ahmadi, J Park, JL Chen, AN Amin. The Obesity Paradox in Kidney Disease: How to Reconcile it with Obesity Management. Kidney Int Rep 2017; 2:271-281

4. Correia-Costa L, AC Afonso, F Schaefer, JT Guimarães, M Bustorff, A Guerra, H Barros, A Azevedo. Decreased renal function in overweight and obese prepubertal children. Pediatr Res 2015; 78:436-444

5. Xiao N, P Devarajan, TH Inge, TM Jenkins, M Bennett, MM Mitsnefes. Subclinical kidney injury before and 1 year after bariatric surgery among adolescents with severe obesity. Obesity (Silver Spring) 2015; 23:1234-1238