Increased body mass index may be associated with greater risk of end-stage renal disease in whites compared to blacks: a nested case–control studyReportar como inadecuado

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BMC Nutrition

, 1:24

First Online: 19 November 2015Received: 23 June 2015Accepted: 08 October 2015DOI: 10.1186-s40795-015-0022-x

Cite this article as: Akwo, E.A., Cavanaugh, K.L., Ikizler, T.A. et al. BMC Nutr 2015 1: 24. doi:10.1186-s40795-015-0022-x


BackgroundThe relationship between body mass index BMI and end-stage renal disease ESRD may differ between blacks and whites due to underlying metabolic differences.

MethodsWe conducted a nested case–control study of 631 incident ESRD cases and 1,897 matched controls within the Southern Community Cohort Study. Current weight, height, and weight at age 21 were reported at enrollment. Occurrence of ESRD was ascertained by linkage with the United States Renal Data System. With normal BMI 18.5–24.9 kg-m as reference, conditional logistic regression was used to calculate adjusted odds ratios OR and corresponding 95 % confidence intervals CI for ESRD across other BMI categories by race. In subsequent analysis, BMI at age 21 was modeled using restricted cubic splines with 5 knots. Predicted probabilities of incident ESRD were computed from the multivariable logistic models and plotted against BMI at age 21.

ResultsAmong blacks, odds of ESRD were significantly increased among those who were overweight OR: 1.41; 95 % CI: 1.09, 1.83 or obese OR: 2.56; 95 % CI: 1.88, 3.47 at age 21. Among whites, the association between ESRD and BMI at age 21 was more pronounced, with corresponding ORs of 2.13 95 % CI: 0.92, 4.93 and 7.46 95 % CI: 2.90, 19.21; p-interaction 0.05. Only among whites was high BMI at enrollment associated with ESRD risk; OR for BMI ≥ 40 kg-m, was 3.31 95 % CI: 1.08, 10.12. The plot of the predicted probabilities of incident ESRD vs BMI at age 21 showed a monotonic increase in the probability of ESRD after a BMI cutoff ≈ 25Kg-m in both whites and blacks but the slope of the curve for whites appeared greater.

ConclusionsOur results suggest racial differences in the relationship between BMI, both in early adulthood and middle age, and ESRD. These findings warrant further research into understanding the underlying metabolic differences that may explain these differences.

KeywordsBody mass index End-stage renal disease Interaction Blacks Whites AbbreviationsBMIBody mass Index

CHCCommunity health centers

CKDChronic kidney disease

ESRDEnd-stage renal disease

SCCSSouthern Community Cohort Study

OROdds ratio

USRDSUS Renal Data System

WHOWorld Health organization

95 % CI95 % confidence interval

Electronic supplementary materialThe online version of this article doi:10.1186-s40795-015-0022-x contains supplementary material, which is available to authorized users.

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Autor: Elvis A. Akwo - Kerri L. Cavanaugh - Talat Alp Ikizler - William J. Blot - Loren Lipworth


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