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Weight issues during adolescence increase ESRD risk


Being overweight and obese during adolescence appears related to an increased risk of all-cause treated end-stage renal disease during a 25-year period, according to an Israeli study.

Asaf Vivante, MD, of the Israeli Defense Forces Medical Corps and the Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel Hashomer, Israel, and colleagues examined the association between BMI in adolescence and the risk for all-cause, diabetic and nondiabetic ESRD.

Medical data for almost 1.2 million adolescents (age 17) who were examined for fitness for Israeli military service between January 1967 and December 1997 were linked to the Israeli ESRD registry in a nationwide population-based retrospective study.

“In this long-term nationwide population-based study, overweight and obesity at age 17 years were strongly and positively associated with the incidence of future treated ESRD, although the absolute risk for ESRD remained low,” the authors wrote.

The study results indicated that 874 participants (713 men, 161 women) developed treated ESRD, for an overall incidence rate of 2.87 cases per 100,000 person-years.

Compared with normal-weight adolescents, those adolescents who were overweight and obese had an increased future risk for treated ESRD, with incidence rates of 6.08 and 13.40 cases per 100,000 person-years, respectively, the data showed.

The researchers also estimated the association between BMI and treated diabetic ESRD. Compared with normal-weight adolescents, overweight adolescents at age 17 had six times the risk for diabetic ESRD, and obese adolescents at age 17 had 19 times the risk for diabetic ESRD, according to the data.

“Although the results for diabetic ESRD were remarkable … our results also indicate a substantial association between elevated BMI and non-diabetic ESRD,” the authors noted.

In an invited commentary, Kirsten L. Johansen, MD, of the San Francisco Veterans Affairs Medical Center, wrote that the “association of obesity with ESRD is good news and bad news. The good news is that obesity represents a potentially modifiable risk factor, and control of weight and the hypertension and inactivity that often accompany excess adiposity could prevent or slow the development of some cases of ESRD and may potentially reduce the morbidity and mortality associated with [chronic kidney disease].

“The bad news is that it is not easy to address obesity,” Johansen continues. “Although there is no evidence that it is ever too late to improve outcomes by increasing physical activity or shedding excess weight, the results … highlight the potential advantages of starting early before chronic disease has developed and unhealthy lifestyles have become lifelong habits.”

The study appeared Oct. 29 on the website of the Archives of Internal Medicine. The study abstract is available at


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