Changes in obese metabolic phenotypes over time and risk of incident chronic kidney disease

Nam, Ki Heon; Yun, Hae‐Ryong; Joo, Young Su; Kim, Joohwan; Lee, Sangmi; Lee, Changhyun; Park, Kyoung Sook; Park, Sun-Hee; Chang, Tae Ik; Kang, Ea Wha; Yoo, Tae‐Hyun; Kang, Shin Wook; Han, Seung Hyeok

doi:10.1111/dom.13458

Cited by 30 publications

(34 citation statements)

References 56 publications

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“…As for the MHO related risk factors, cumulative evidence con rmed the association between MHO and renal dysfunction. Some reported that subjects with persistent MHO had 2-fold more increase risk of chronic kidney disease [37], whereas others claimed that metabolic abnormalities, but not obesity caused the mild decrease eGFR [38]. In our study, we found that MHO was associated with higher cumulative incidence of mildly reduced eGFR in both women and men.…”

Section: Discussionsupporting

confidence: 43%

Metabolic Healthy Obesity is associated with higher incidence of mild decrease estimate glomerular rate in rural Northeast Chinese

Guo

et al. 2020

Preprint

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Background Metabolic healthy obesity (MHO), as one phenotype of obesity, seems associate with lower risk of cardiovascular disease. However, MHO has close relationship with higher incidence of metabolic syndrome and diabetes. This study aims to investigate the prevalence of MHO at baseline, changes of obese metabolic phenotype at follow-up and its relationship with incidence of mildly reduced estimated glomerular filtration rate (eGFR) in rural Northeast Chinese. Methods The Chronic Kidney Disease Epidemiology (CKD-EPI) equation was used to calculate eGFR. 4903 participants aged ≥ 35 years with eGFR > 90 ml/min/1.73 m2 at baseline were enrolled and successfully followed up. All participants completed the questionnaires, anthropometric measurements, and blood test during baseline and follow-up. Mild renal dysfunction defined as mildly reduced eGFR between 60–90 ml/min/1.73 m2. Results The prevalence of MHO was 20.04% in baseline (18.97% for women and 21.11% for men) which was secondary to metabolic abnormal obesity (MAO) (24.4%, 27.2% for women and 21.5% for men). 38.4% of women and 38.90% of men experienced phenotype changes during follow-up. The cumulative incidence of mildly reduced eGFR in MHO was 20.1% (17.7% for women and 22.3% for men) which was also secondary to MAO (20.8%, 18.6% for women and 23.5% for men). After adjusted possible confounders, MHO was associated with higher incidence of mildly reduced eGFR among women [OR (95%CI) = 1.64 (1.18, 2.25)] and men [OR (95%CI) = 1.62 (1.24, 2.11)] whereas MAO was related with higher incidence of mildly reduced eGFR among men only [OR (95%CI) = 1.74 (1.32, 2.29)]. Conclusion MHO was associated with higher incidence of mildly reduced eGFR in both gender; however, there was a specific relationship between MAO and mildly reduced eGFR in men only. Therefore, it is necessary to monitoring kidney function among both MHO and MAO subjects.

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Section: Discussionsupporting

confidence: 43%

Metabolic Healthy Obesity is associated with higher incidence of mild decrease estimate glomerular rate in rural Northeast Chinese

Guo

et al. 2020

Preprint

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“…Of the excluded studies, 127 were duplicate publications; 177 had irrelevant exposure or outcome; 23 did not divide subjects according to BMI categories and metabolic health status; 4 were review studies; 1 did not use MHNW participants as control group; 1 was a study with overlapped subjects, and 7 were crosssectional reports. The primary eligibility process yielded 8 studies (28,(38)(39)(40)(41)(42)(43)(44) and crosscheck of the references of reviews and included studies, and other databases search yielded 1 additional study (37). Finally, a total 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.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Finally, a total 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. Of these, four were from South Korea (28,37,38,42), one was from Iran (39), two were from China (40,43), one in USA (44) and one was from Japan (41). The sample size of the included studies varied from 1881 to 62249 participants and the follow-up duration ranged from 3.2 to 14 years.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Three studies (37,39,42) had estimated GFR by the Modification of Diet in Renal Disease (MDRD) Study equation, one study by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation (38), one study by the Japanese Society of Nephrology equation 41, and one study by a modified Chinese equation (40). 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). The definition of metabolic syndrome was also based on criteria by the National Cholesterol Education Program's Adult Treatment Panel (NCEP ATPIII) and International Diabetes Federation (IDF) criteria.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Metabolically healthy obese and metabolically unhealthy obese phenotypes and CKD risk A total of 9 prospective studies (28,(37)(38)(39)(40)(41)(42)(43)(44), involving 122417 participants and 3570 cases, were included in the analysis of CKD risk in relation to MHO phenotype. In addition, there were 8 studies (28,(38)(39)(40)(41)(42)(43)(44) with 2841 cases and 60792 participants regarding the association between MUHO phenotype and risk of incident CKD. The results showed that the MHO phenotype was associated with a 55% increased risk of CKD, compared to the MHNW phenotype (RR = 1.55, 95% CI = 1.34-1.79) (Supplemental file 4).…”

Section: Metabolically Unhealthy Normal-weight (Munw) Phenotype and Cmentioning

confidence: 99%

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

Alizadeh¹,

Esmaeili²,

Alizadeh³

et al. 2019

Archives of Endocrinology and Metabolism

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Objective: 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. Materials and methods: 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 m 2 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. Results: 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). Conclusions: 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.

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Metabolic health is a determining factor for incident colorectal cancer in the obese population: A nationwide population‐based cohort study

et al. 2020

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Background The association of the risk of colorectal cancer (CRC) with obesity or obesity‐induced metabolic disturbances remains controversial. We assessed the association of metabolic health status with incident CRC among subjects with obesity. Methods This study included 319,397 subjects from the Korean National Health Insurance Service‐National Health Screening Cohort. Transitions in metabolic health status and obesity were examined during 2009–2010 and 2011–2012. We categorized subjects with obesity into four separate groups according to their dynamic metabolic health status: metabolically healthy obesity (MHO), MHO to metabolically unhealthy obesity (MUO), MUO to MHO, and stable MUO. Subjects were followed up from 2009 to 2015 for incident CRC. Results The stable MHO group showed no increased risk of incident CRC (hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.83–1.14). However, the MHO to MUO group had a higher risk of incident CRC than the stable metabolically healthy nonobese (MHNO) group (HR, 1.34; 95% CI, 1.15–1.57). Among patients with MUO at baseline, those in the subgroup who transitioned to MHO group were not at increased risk of CRC (HR, 1.06; 95% CI, 0.91–1.25), whereas those who remained in the stable MUO group had a higher risk of incident CRC than those in the stable MHNO group (HR, 1.29; 95% CI, 1.19–1.41). Conclusions The transition of metabolic health was a determining factor for CRC among subjects with obesity. Hence, maintenance or recovery of metabolic health should be addressed to prevent CRC in individuals with obesity.

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Changes in obese metabolic phenotypes over time and risk of incident chronic kidney disease

Abstract: MHO subjects are at increased risk for incident CKD.

Cited by 30 publications

References 56 publications

Metabolic Healthy Obesity is associated with higher incidence of mild decrease estimate glomerular rate in rural Northeast Chinese

Metabolic Healthy Obesity is associated with higher incidence of mild decrease estimate glomerular rate in rural Northeast Chinese

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

Metabolic health is a determining factor for incident colorectal cancer in the obese population: A nationwide population‐based cohort study

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