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Epidemiology and Population Health

Overweight, obesity and intentional weight loss in chronic kidney disease: NHANES 1999–2006

International Journal of Obesity volume 36, pages 1585–1590 (2012)Cite this article

Subjects

Abstract

OBJECTIVE:

Obesity and chronic kidney disease (CKD) have emerged as major public health problems. We aimed to examine: (a) lifestyle and behavioral factors, (b) factors related to pursuing weight loss and (c) weight loss modalities pursued by CKD and non-CKD individuals who are overweight and obese.

METHODS:

Cross-sectional analysis of 10 971 overweight and obese adult participants in the National Health and Nutrition Examination Surveys conducted between 1999 and 2006. We examined the differences in lifestyle and behavioral factors between CKD and non-CKD participants and factors associated with pursuing weight loss using survey regression models.

RESULTS:

The total daily energy intake of the CKD population was lower than the non-CKD group (1987 kcal per day versus 2063 kcal per day, P=0.02) even after adjusting for relevant covariates. However, the percentage of energy derived from protein was similar between the groups. Sixty six percent of the CKD population did not meet the minimum recommended leisure time physical activity goals compared with 57% among non-CKD (P<0.001). Fifty percent of CKD participants pursued weight loss (vs fifty-five percent of non-CKD individuals, P=0.01), but the presence of CKD was not independently associated with the pursuit of weight loss in the multivariate model. Among participants pursuing weight loss, modalities including dietary interventions utilized by CKD and non-CKD participants were similar. Eight percent of CKD participants used medications to promote weight loss.

CONCLUSIONS:

Among the overweight and obese population, lifestyle and behavioral factors related to obesity and weight loss are similar between CKD and non-CKD participants. Insufficient data exist on the beneficial effects of intentional weight loss in CKD and these data show that a significant proportion of the CKD population use diets that may have high-protein content and medications to promote weight loss that may be harmful. Future clinical trials evaluating the efficacy and optimal modalities to treat obesity in the CKD population are warranted.

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References

  1. Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P et al. Prevalence of chronic kidney disease in the United States. JAMA 2007; 298: 2038–2047.

    Article  CAS  Google Scholar 

  2. Centers for Disease Control and Prevention (CDC). Vital signs: state-specific obesity prevalence among adults --- United States, 2009. MMWR Morb Mortal Wkly Rep 2010; 59: 951–955.

    Google Scholar 

  3. Wahba IM, Mak RH . Obesity and obesity-initiated metabolic syndrome: mechanistic links to chronic kidney disease. Clin J Am Soc Nephrol 2007; 2: 550–562.

    Article  CAS  Google Scholar 

  4. Wang Y, Chen X, Song Y, Caballero B, Cheskin LJ . Association between obesity and kidney disease: a systematic review and meta-analysis. Kidney Int 2008; 73: 19–33.

    Article  CAS  Google Scholar 

  5. Ritz E, Koleganova N, Piecha G . Is there an obesity-metabolic syndrome related glomerulopathy? Curr Opin Nephrol Hypertens 2011; 20: 44–49.

    Article  Google Scholar 

  6. Thomas G, Sehgal AR, Kashyap SR, Srinivas TR, Kirwan JP, Navaneethan SD . Metabolic syndrome and kidney disease: a systematic review and meta-analysis. Clin J Am Soc Nephrol 2011; 6: 2364–2373.

    Article  Google Scholar 

  7. Kramer H, Shoham D, McClure LA, Durazo-Arvizu R, Howard G, Judd S et al. Association of waist circumference and body mass index with all-cause mortality in CKD: The REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study. Am J Kidney Dis 2011; 58: 177–185.

    Article  Google Scholar 

  8. Austin GL, Ogden LG, Hill JO . Trends in carbohydrate, fat, and protein intakes and association with energy intake in normal-weight, overweight, and obese individuals: 1971–2006. Am J Clin Nutr 2011; 93: 836–843.

    Article  CAS  Google Scholar 

  9. Seo DC, Li K . Leisure-time physical activity dose-response effects on obesity among US adults: results from the 1999–2006 National Health and Nutrition Examination Survey. J Epidemiol Community Health 2010; 64: 426–431.

    Article  Google Scholar 

  10. Duncan DT, Wolin KY, Scharoun-Lee M, Ding EL, Warner ET, Bennett GG . Does perception equal reality? Weight misperception in relation to weight-related attitudes and behaviors among overweight and obese US adults. Int J Behav Nutr Phys Act 2011; 8: 20.

    Article  Google Scholar 

  11. Goodpaster BH, Delany JP, Otto AD, Kuller L, Vockley J, South-Paul JE et al. Effects of diet and physical activity interventions on weight loss and cardiometabolic risk factors in severely obese adults: a randomized trial. JAMA 2010; 304: 1795–1802.

    Article  CAS  Google Scholar 

  12. Look AHEAD Research Group Wing RR . Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med 2010; 170: 1566–1575.

    Google Scholar 

  13. Yassine HN, Marchetti CM, Krishnan RK, Vrobel TR, Gonzalez F, Kirwan JP . Effects of exercise and caloric restriction on insulin resistance and cardiometabolic risk factors in older obese adults--a randomized clinical trial. J Gerontol A Biol Sci Med Sci 2009; 64: 90–95.

    Article  Google Scholar 

  14. National Institutes of Health. http://www.nhlbi.nih.gov/guidelines/obesity/prctgd_c.pdf 2000; 2011: 94.

  15. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro 3rd AF, Feldman HI et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150: 604–612.

    Article  Google Scholar 

  16. Selvin E, Manzi J, Stevens LA, Van Lente F, Lacher DA, Levey AS et al. Calibration of serum creatinine in the National Health and Nutrition Examination Surveys (NHANES) 1988–1994, 1999–2004. Am J Kidney Dis 2007; 50: 918–926.

    Article  CAS  Google Scholar 

  17. Moshfegh AJ, Rhodes DG, Baer DJ, Murayi T, Clemens JC, Rumpler WV et al. The US Department of Agriculture Automated Multiple-Pass Method reduces bias in the collection of energy intakes. Am J Clin Nutr 2008; 88: 324–332.

    Article  CAS  Google Scholar 

  18. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 2000; 32: S498–S504.

    Article  CAS  Google Scholar 

  19. National Kidney Foundation. http://www.kidney.org/professionals/kdoqi/guidelines/nut_a24.html 2000; 2011.

  20. Fouque D, Pelletier S, Mafra D, Chauveau P . Nutrition and chronic kidney disease. Kidney Int 2011; 80: 348–357.

    Article  CAS  Google Scholar 

  21. Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation 2007; 116: 1081–1093.

    Article  Google Scholar 

  22. Beddhu S, Baird BC, Zitterkoph J, Neilson J, Greene T . Physical activity and mortality in chronic kidney disease (NHANES III). Clin J Am Soc Nephrol 2009; 4: 1901–1906.

    Article  Google Scholar 

  23. Lim PS, Cheng YM, Wei YH . Increase in oxidative damage to lipids and proteins in skeletal muscle of uremic patients. Free Radic Res 2002; 36: 295–301.

    Article  CAS  Google Scholar 

  24. Chiu YW, Kopple JD, Mehrotra R . Correction of metabolic acidosis to ameliorate wasting in chronic kidney disease: goals and strategies. Semin Nephrol 2009; 29: 67–74.

    Article  CAS  Google Scholar 

  25. Robinson ES, Fisher ND, Forman JP, Curhan GC . Physical activity and albuminuria. Am J Epidemiol 2010; 171: 515–521.

    Article  Google Scholar 

  26. Kosmadakis GC, John SG, Clapp EL, Viana JL, Smith AC, Bishop NC et al. Benefits of regular walking exercise in advanced pre-dialysis chronic kidney disease. Nephrol Dial Transplant 2011; e-pub ahead of print 27 July 2011.

  27. Hawkins MS, Sevick MA, Richardson CR, Fried LF, Arena VC, Kriska AM . Association between physical activity and kidney function: National Health and Nutrition Examination Survey. Med Sci Sports Exerc 2011; 43: 1457–1464.

    Article  Google Scholar 

  28. White SL, Dunstan DW, Polkinghorne KR, Atkins RC, Cass A, Chadban SJ . Physical inactivity and chronic kidney disease in Australian adults: the AusDiab study. Nutr Metab Cardiovasc Dis 2011; 21: 104–112.

    Article  Google Scholar 

  29. Yaemsiri S, Slining MM, Agarwal SK . Perceived weight status, overweight diagnosis, and weight control among US adults: the NHANES 2003–2008 Study. Int J Obes (Lond) 2010; 35: 1063–1070.

    Article  Google Scholar 

  30. Wee CC, Davis RB, Phillips RS . Stage of readiness to control weight and adopt weight control behaviors in primary care. J Gen Intern Med 2005; 20: 410–415.

    Article  Google Scholar 

  31. Anderson LA, Eyler AA, Galuska DA, Brown DR, Brownson RC . Relationship of satisfaction with body size and trying to lose weight in a national survey of overweight and obese women aged 40 and older, United States. Prev Med 2002; 35: 390–396.

    Article  Google Scholar 

  32. Kruger J, Galuska DA, Serdula MK, Jones DA . Attempting to lose weight: specific practices among U. S adults Am J Prev Med 2004; 26: 402–406.

    Article  Google Scholar 

  33. Kraschnewski JL, Boan J, Esposito J, Sherwood NE, Lehman EB, Kephart DK et al. Long-term weight loss maintenance in the United States. Int J Obes (Lond) 2010; 34: 1644–1654.

    Article  CAS  Google Scholar 

  34. Al-Qaoud TM, Nitsch D, Wells J, Witte DR, Brunner EJ . Socioeconomic Status and Reduced Kidney Function in the Whitehall II Study: role of obesity and metabolic syndrome. Am J Kidney Dis 2011; 58: 389–397.

    Article  Google Scholar 

  35. Navaneethan SD, Yehnert H, Moustarah F, Schreiber MJ, Schauer PR, Beddhu S . Weight loss interventions in chronic kidney disease: A systematic review and meta-analysis. Clin J Am Soc Nephrol 2009; 4: 1565–1574.

    Article  Google Scholar 

  36. Afshinnia F, Wilt TJ, Duval S, Esmaeili A, Ibrahim HN . Weight loss and proteinuria: systematic review of clinical trials and comparative cohorts. Nephrol Dial Transplant 2010; 25: 1173–1183.

    Article  Google Scholar 

  37. MacLaughlin HL, Cook SA, Kariyawasam D, Roseke M, van Niekerk M, Macdougall IC . Nonrandomized trial of weight loss with orlistat, nutrition education, diet, and exercise in obese patients with CKD: 2-year follow-up. Am J Kidney Dis 2010; 55: 69–76.

    Article  Google Scholar 

  38. Zoccali C, Seck SM, Mallamaci F . Obesity and the epidemiology and prevention of kidney disease: waist circumference versus body mass index. Am J Kidney Dis 2011; 58: 157–159.

    Article  Google Scholar 

  39. Fouque D, Laville M . Low protein diets for chronic kidney disease in non diabetic adults. Cochrane Database Syst Rev 2009; 3: CD001892.

    Google Scholar 

  40. Kramer H, Tuttle KR, Leehey D, Luke A, Durazo-Arvizu R, Shoham D et al. Obesity management in adults with CKD. Am J Kidney Dis 2009; 53: 151–165.

    Article  Google Scholar 

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Acknowledgements

This publication was made possible by Grant Number RR024990 (to SDN) from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH) and NIH Roadmap for Medical Research. JPK is supported by the National Institutes of Health - RO1 DK089547-01. JDS is supported by NIH/NIDDK (R01 DK085185-01A1) and investigator initiated-grant support from PhRMA foundation, Genzyme and Roche Organ Transplant Research Foundation.

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Authors and Affiliations

  1. Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA

    S D Navaneethan, M J Schreiber & J D Schold

  2. Cleveland Clinic Lerner College of Medicine of CWRU, Cleveland Clinic, Cleveland, OH, USA

    S D Navaneethan & J P Kirwan

  3. Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA

    J P Kirwan

  4. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA

    S Arrigain & J D Schold

  5. Department of Nephrology, MetroHealth Medical Center, Cleveland, OH, USA

    A R Sehgal

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  1. S D Navaneethan
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  4. M J Schreiber
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Correspondence to S D Navaneethan.

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The contents of this study are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH. Information on NCRR is available at http://www.ncrr.nih.gov/. Information on Re-engineering the Clinical Research Enterprise can be obtained from http://nihroadmap.nih.gov/clinicalresearch/overview.

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Navaneethan, S., Kirwan, J., Arrigain, S. et al. Overweight, obesity and intentional weight loss in chronic kidney disease: NHANES 1999–2006. Int J Obes 36, 1585–1590 (2012). https://doi.org/10.1038/ijo.2012.7

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