Early-Life Overweight Trajectory and CKD in the 1946 British Birth Cohort Study

• Published in: American journal of kidney diseases Vol. 62; no. 2; pp. 276 - 284
• Main Authors: Silverwood, Richard J., PhD, Pierce, Mary, MD, Hardy, Rebecca, PhD, Thomas, Claudia, PhD, Ferro, Charles, MD, Savage, Caroline, FMedSci, Sattar, Naveed, FRCP (Glas), PhD, Kuh, Diana, PhD, Nitsch, Dorothea, MD, MSc
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2013; Elsevier; W.B. Saunders
• Subjects: Adolescent; Age Factors; Biological and medical sciences; Child; Child, Preschool; Childhood obesity; chronic kidney disease; Cohort Studies; estimated glomerular filtration rate; Female; Follow-Up Studies; Humans; Kidneys; Longitudinal Studies; Male; Medical sciences; Metabolic diseases; Nephrology; Nephrology. Urinary tract diseases; Obesity; Original Investigation; Overweight - epidemiology; Renal Insufficiency, Chronic - epidemiology; Time Factors; United Kingdom - epidemiology; Urinary system involvement in other diseases. Miscellaneous; Young Adult; estimated glomerular filtration rate; chronic kidney disease; Childhood obesity; Human; Kidney disease; Obesity; Nephrology; Urinary system disease; Nutrition disorder; Chronic kidney disease; Urology; Overweight; Glomerular filtration rate; Cohort study; Renal failure; Birth cohort; Early; Child; Nutritional status
• ISSN: 0272-6386; 1523-6838
• DOI: 10.1053/j.ajkd.2013.03.032

Background Few studies have examined the impact of childhood obesity on later kidney disease, and consequently, our understanding is very limited. Study Design Longitudinal population-based cohort. Setting & Participants The Medical Research Council National Survey of Health and Development, a socially stratified sample of 5,362 singletons born in 1 week in March 1946 in England, Scotland, and Wales, of which 4,340 were analyzed. Predictor Early-life overweight latent classes (never, prepubertal only, pubertal onset, or always), derived from repeated measurements of body mass index between ages 2 and 20 years. Outcomes & Measurements The primary outcome was chronic kidney disease (CKD), defined as creatinine- or cystatin C–based estimated glomerular filtration rate (eGFRcr and eGFRcys , respectively) <60 mL/min/1.73 m2 or urine albumin-creatinine ratio (UACR) ≥3.5 mg/mmol measured at age 60-64 years. Associations were explored through regression analysis, with adjustment for socioeconomic position, smoking, physical activity level, diabetes, hypertension, and overweight at ages 36 and 53 years. Results 2.3% of study participants had eGFRcr <60 mL/min/1.73 m2 , 1.7% had eGFRcys <60 mL/min/1.73 m2 , and 2.9% had UACR ≥3.5 mg/mmol. Relative to being in the never-overweight latent class, being in the pubertal-onset– or always-overweight latent classes was associated with eGFRcys -defined CKD (OR, 2.04; 95% CI, 1.09-3.82). Associations with CKD defined by eGFRcr (OR, 1.27; 95% CI, 0.71-2.29) and UACR (OR, 1.33; 95% CI, 0.70-2.54) were less marked, but in the same direction. Adjustment for lifestyle and health factors had little impact on effect estimates. Limitations A low prevalence of CKD resulted in low statistical power. No documentation of chronicity for outcomes. All-white study population restricts generalizability. Conclusions Being overweight in early life was found to be associated with eGFRcys -defined CKD in later life. The associations with CKD defined by eGFRcr and UACR were less marked, but in the same direction. Reducing or preventing overweight in the early years of life may significantly reduce the burden of CKD in the population.