Racial and Ethnic Disparities in the Obesity Paradox

Kleine, Carola-Ellen; Moradi, Hamid Reza; Streja, Elani; Kalantar-Zadeh, Kamyar

doi:10.1053/j.ajkd.2018.06.024

Cited by 24 publications

(18 citation statements)

References 46 publications

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“…Obesity and its co-morbidities are a major cause of morbidity and mortality in the United States [3]. It is linked to a variety of other poor health outcomes including cardiovascular disease (CVD), hypertension (HTN), type 2 diabetes mellitus (T2DM), hyperlipidemia, stroke, certain cancers, sleep apnea, liver and gall bladder disease, osteoarthritis, and gynecological problems [6][7][8][9][10]. Each of these problems results in poor health outcomes for the affected individual in the long term: outcomes that are costly to the individual, costly to their families, and ultimately costly to the U.S. healthcare system [10].…”

Section: Introductionmentioning

confidence: 99%

Obesity and Morbidity Risk in the U.S. Veteran

et al. 2020

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The obesity epidemic in the United States has been well documented and serves as the basis for a number of health interventions across the nation. However, those who have served in the U.S. military (Veteran population) suffer from obesity in higher numbers and have an overall disproportionate poorer health status when compared to the health of the older non-Veteran population in the U.S. which may further compound their overall health risk. This study examined both the commonalities and the differences in obesity rates and the associated co-morbidities among the U.S. Veteran population, utilizing data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS). These data are considered by the Centers for Disease Control and Prevention (CDC) to be the nation’s best source for health-related survey data, and the 2018 version includes 437,467 observations. Study findings show not only a significantly higher risk of obesity in the U.S. Veteran population, but also a significantly higher level (higher odds ratio) of the associated co-morbidities when compared to non-Veterans, including coronary heart disease (CHD) or angina (odds ratio (OR) = 2.63); stroke (OR = 1.86); skin cancer (OR = 2.18); other cancers (OR = 1.73); chronic obstructive pulmonary disease (COPD) (OR = 1.52), emphysema, or chronic bronchitis; arthritis (OR = 1.52), rheumatoid arthritis, gout, lupus, or fibromyalgia; depressive disorders (OR = 0.84), and diabetes (OR = 1.61) at the 0.95 confidence interval level.

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Section: Introductionmentioning

confidence: 99%

Obesity and Morbidity Risk in the U.S. Veteran

et al. 2020

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“…Future studies with a comprehensive assessment are suggested to assure the current findings, and deeply examine the mechanism. The future research should be conducted in larger population with different races and ethnicities as obesity paradox varies across race-ethnic populations [53]. Regardless of the limitations, the current study demonstrates strength with its objective measures of body composition, and clinical and biochemical values.…”

Section: Discussionmentioning

confidence: 95%

Impact of Percent Body Fat on All-Cause Mortality among Adequate Dialysis Patients with and without Insulin Resistance: A Multi-Center Prospective Cohort Study

et al. 2019

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The association between body fat and mortality in hemodialysis patients remains controversial. We examined the effect of percent body fat (PBF) on all-cause mortality among adequate hemodialysis patients with and without insulin resistance (IR). A prospective cohort study was conducted on 365 adequate hemodialysis patients (equilibrated Kt/V ≥ 1.2) from seven hospitals. Patients’ characteristics and clinical and biochemical parameters were assessed at baseline between September 2013 and April 2017. Patients were followed up for all-cause mortality until April 2018. The median value of homeostatic model assessment (HOMA-IR) was used to classify IR. Cox proportional hazard models were utilized to examine predictors of all-cause mortality. During 1.4 (1.0–3.2) years of follow-up, 46 patients died. In patients with IR (HOMA-IR ≥ 5.18), PBF was significantly higher in the survival group than in the death group (31.3 ± 9.0 vs. 25.4 ± 8.2, p = 0.005). After controlling for confounding factors, PBF was significantly associated with lower risk for all-cause mortality in patients with IR (hazard ratio, 0.94; 95% confidence interval, 0.89–1.00; p = 0.033). The association was not observed in patients without IR. In conclusion, percent body fat shows a protective effect on survival in hemodialysis patients with IR.

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“…Even in living kidney donors who are determined to be healthy individuals, obese donors had a 1.86 times higher risk of ESRD over 20 years following nephrectomy compared to nonobese donors, and overweight donors exhibited incrementally a 7% higher risk of ESRD 52 for every 1 kg/m 2 higher body mass index above 27 kg/m 2 . Nevertheless, in persons with more advanced CKD, including dialysis patients, a paradoxically greater longevity has been reported with larger body size, known as the obesity paradox or reverse epidemiology, possibly reflecting a more resilient nutritional profile and muscle mass 53 . Hence, any unintentional edema-free weight loss warrants timely work-up, and dietary interventions may be considered in those with more advanced CKD.…”

Section: Epidemiology Of Solitary Kidneymentioning

confidence: 99%

Current Management of Patients With Acquired Solitary Kidney

Tantisattamo

Dafoe

Reddy

et al. 2019

Kidney International Reports

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Persons with acquired solitary kidney, including those who have had a unilateral nephrectomy for living kidney donation, renal malignancies, or trauma, have decreased renal mass that leads to increased intraglomerular pressure and glomerular hyperfiltration. These physiologic adaptations of solitary kidney may exacerbate other preexisting and genetic conditions that could create a predisposition to or worsen glomerular pathologies, leading to unfavorable renal outcomes. Hence, these persons may benefit from special care and lifestyle modifications, including nutritional interventions. There is a lack of consensus and evidence for proper surveillance and management after nephrectomy, and misconceptions in both directions of having a "normal" versus "abnormal" kidney status may cause confusion among patients and healthcare providers pertaining to long-term kidney health monitoring and management. We have reviewed available data on the impact of lifestyle modifications, particularly nutritional measures, and pharmacologic interventions, on short-and long-term outcomes after nephrectomy. We recommend avoidance of excessively high dietary protein intake (>1 g/kg per day) and high dietary sodium intake (>4 grams/d), adequate dietary fiber intake from plant-based foods, a target body mass index of <30 kg/m 2 (in non-athletes and non-bodybuilders), and judicious management of risk factors of progressive chronic kidney disease (CKD), and future studies should help to better determine optimal care practices for these persons.

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Racial and Ethnic Disparities in the Obesity Paradox

Cited by 24 publications

References 46 publications

Obesity and Morbidity Risk in the U.S. Veteran

Obesity and Morbidity Risk in the U.S. Veteran

Impact of Percent Body Fat on All-Cause Mortality among Adequate Dialysis Patients with and without Insulin Resistance: A Multi-Center Prospective Cohort Study

Current Management of Patients With Acquired Solitary Kidney

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