Body mass index change and estimated glomerular filtration rate decline in a middle-aged population: health check-based cohort in Japan
Background Obesity is a growing public health problem worldwide. We evaluated the mediators and association between changes in obesity metrics and renal outcomes in the general population.Methods Using the Japanese nationwide health check-based cohort from April 2011 to March 2019, we selected indiv...
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BMJ Publishing Group
2020-09-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/9/e037247.full |
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| author | Rajiv Saran Yukari Yamada Tatsuyoshi Ikenoue Shingo Fukuma Jennifer Bragg-Gresham Edward Norton Daichi Kohmoto |
| author_facet | Rajiv Saran Yukari Yamada Tatsuyoshi Ikenoue Shingo Fukuma Jennifer Bragg-Gresham Edward Norton Daichi Kohmoto |
| author_sort | Rajiv Saran |
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| description | Background Obesity is a growing public health problem worldwide. We evaluated the mediators and association between changes in obesity metrics and renal outcomes in the general population.Methods Using the Japanese nationwide health check-based cohort from April 2011 to March 2019, we selected individuals aged 40–74 years, with a baseline estimated glomerular filtration rate (eGFR) ≥45 mL/min/1.73 m2, whose body mass index (BMI) change was assessed. The primary outcome was combined 30% decline in eGFR, eGFR <15 mL/min/1.73 m2 and end-stage renal disease.Results During 245 147 person-years’ follow-up among 50 604 participants (mean eGFR, 83.7 mL/min/1.73 m2; mean BMI, 24.1 kg/m2), 645 demonstrated eGFR decline (incidence rate 2.6/1000 person-years, 95% CI: 2.4 to 2.8). We observed continued initial changes in BMI for over 6 years and a U-shaped association between BMI change and eGFR decline. Compared with 0% change in BMI, adjusted HRs for changes of −10%, −4%, 4% and 10% were 1.53 (95% CI: 1.15 to 2.04), 1.14 (95% CI: 1.01 to 1.30), 1.16 (95% CI: 1.02 to 1.32) and 1.87 (95% CI: 1.25 to 2.80), respectively. The percentage of excess risk of BMI increase (>4%) mediated by three risk factors (blood pressure, haemoglobin A1c and total cholesterol), was 13.3%.Conclusion In the middle-aged Japanese population, both, increase and decrease in BMI were associated with subsequent eGFR decline. Changes in risk factors mediated a small proportion of the association between BMI increase and eGFR decline. Our findings support the clinical significance of monitoring BMI as a renal risk factor. |
| format | Article |
| id | doaj-art-38109a01efb84039b0a2f96e4dc13b7a |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-38109a01efb84039b0a2f96e4dc13b7a2025-01-08T08:45:08ZengBMJ Publishing GroupBMJ Open2044-60552020-09-0110910.1136/bmjopen-2020-037247Body mass index change and estimated glomerular filtration rate decline in a middle-aged population: health check-based cohort in JapanRajiv Saran0Yukari Yamada1Tatsuyoshi Ikenoue2Shingo Fukuma3Jennifer Bragg-Gresham4Edward Norton5Daichi Kohmoto6Department of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, Michigan, USAFaculty of Medicine, Kyoto University, Kyoto, JapanHuman Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, JapanDepartment of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, JapanDepartment of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, Michigan, USADepartment of Health Management and Policy, University of Michigan, Ann Arbor, Michigan, USAHuman Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, JapanBackground Obesity is a growing public health problem worldwide. We evaluated the mediators and association between changes in obesity metrics and renal outcomes in the general population.Methods Using the Japanese nationwide health check-based cohort from April 2011 to March 2019, we selected individuals aged 40–74 years, with a baseline estimated glomerular filtration rate (eGFR) ≥45 mL/min/1.73 m2, whose body mass index (BMI) change was assessed. The primary outcome was combined 30% decline in eGFR, eGFR <15 mL/min/1.73 m2 and end-stage renal disease.Results During 245 147 person-years’ follow-up among 50 604 participants (mean eGFR, 83.7 mL/min/1.73 m2; mean BMI, 24.1 kg/m2), 645 demonstrated eGFR decline (incidence rate 2.6/1000 person-years, 95% CI: 2.4 to 2.8). We observed continued initial changes in BMI for over 6 years and a U-shaped association between BMI change and eGFR decline. Compared with 0% change in BMI, adjusted HRs for changes of −10%, −4%, 4% and 10% were 1.53 (95% CI: 1.15 to 2.04), 1.14 (95% CI: 1.01 to 1.30), 1.16 (95% CI: 1.02 to 1.32) and 1.87 (95% CI: 1.25 to 2.80), respectively. The percentage of excess risk of BMI increase (>4%) mediated by three risk factors (blood pressure, haemoglobin A1c and total cholesterol), was 13.3%.Conclusion In the middle-aged Japanese population, both, increase and decrease in BMI were associated with subsequent eGFR decline. Changes in risk factors mediated a small proportion of the association between BMI increase and eGFR decline. Our findings support the clinical significance of monitoring BMI as a renal risk factor.https://bmjopen.bmj.com/content/10/9/e037247.full |
| spellingShingle | Rajiv Saran Yukari Yamada Tatsuyoshi Ikenoue Shingo Fukuma Jennifer Bragg-Gresham Edward Norton Daichi Kohmoto Body mass index change and estimated glomerular filtration rate decline in a middle-aged population: health check-based cohort in Japan BMJ Open |
| title | Body mass index change and estimated glomerular filtration rate decline in a middle-aged population: health check-based cohort in Japan |
| title_full | Body mass index change and estimated glomerular filtration rate decline in a middle-aged population: health check-based cohort in Japan |
| title_fullStr | Body mass index change and estimated glomerular filtration rate decline in a middle-aged population: health check-based cohort in Japan |
| title_full_unstemmed | Body mass index change and estimated glomerular filtration rate decline in a middle-aged population: health check-based cohort in Japan |
| title_short | Body mass index change and estimated glomerular filtration rate decline in a middle-aged population: health check-based cohort in Japan |
| title_sort | body mass index change and estimated glomerular filtration rate decline in a middle aged population health check based cohort in japan |
| url | https://bmjopen.bmj.com/content/10/9/e037247.full |
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