Skip to main content
SpringerLink
Log in

Epidemiology of Obesity, the Metabolic Syndrome, and Chronic Kidney Disease

  • Hypertension and Metabolic Disarray: Diabetes Mellitus, Insulin Resistance, and Obesity (E Reisin, Section Editor)
  • Published:
Current Hypertension Reports Aims and scope Submit manuscript

Abstract

The prevalence of obesity and metabolic syndrome (MetS) has increased over the past several decades and is expected to continue to increase. Although the individual components of MetS have previously been associated with chronic kidney disease (CKD) and end-stage renal disease (ESRD), until recently there were few data on the relationship between MetS itself and incident CKD and ESRD. A recent meta-analysis demonstrated an association between MetS and CKD. When pooling 10 prospective cohort studies, MetS was associated with an increased odds ratio for an estimated glomerular filtration rate (eGFR) less than 60 mL/ min per 1.73 m2 (OR, 1.55; 95% CI, 1.34–1.80). Additionally, published data suggest an association between MetS and albuminuria. Evidence suggests that lifestyle modifications such as weight reduction, reduced dietary fat intake and cholesterol, and pharmacologic treatments may reduce the burden of MetS and thus the risk for CKD, albuminuria, and ESRD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Flegal KM, Carroll MD, Ogden CL, et al. Prevalence and trends in obesity among US adults, 1999–2008. JAMA. 2010;303(3):235–41.

    Article  PubMed  CAS  Google Scholar 

  2. Kelly T, Yang W, Chen CS, et al. Global burden of obesity in 2005 and projections to 2030. Int J Obes (Lond). 2008;32(9):1431–7.

    Article  CAS  Google Scholar 

  3. Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120(16):1640–5.

    Article  PubMed  CAS  Google Scholar 

  4. • Scholze J, Alegria E, Ferri C, et al.: Epidemiological and economic burden of metabolic syndrome and its consequences in patients with hypertension in Germany, Spain and Italy; a prevalence-based model. BMC Public Health 2010, 10:529. This reference reported current and future prevalence estimates of MetS in Germany, Spain, and Italy, suggesting that MetS is not only recognized elsewhere as a unique phenotype, but is highly prevalent in multiple world regions.

    Article  Google Scholar 

  5. Wild SH, Byrne CD: The global burden of the metabolic syndrome and its consequences for diabetes and cardiovascular disease. In The Metabolic Syndrome. Edited by Byrne, CD and Wild, SH. Chichester, UK: John Wiley & Sons, Ltd.; 2006:1–41.

  6. Perneger TV, Whelton PK, Klag MJ. History of hypertension in patients treated for end-stage renal disease. J Hypertens. 1997;15(4):451–6.

    Article  PubMed  CAS  Google Scholar 

  7. Brancati FL, Whelton PK, Randall BL, et al. Risk of end-stage renal disease in diabetes mellitus: a prospective cohort study of men screened for MRFIT. Multiple Risk Factor Intervention Trial. JAMA. 1997;278(23):2069–74.

    Article  PubMed  CAS  Google Scholar 

  8. Muntner P, Coresh J, Smith JC, et al. Plasma lipids and risk of developing renal dysfunction: the atherosclerosis risk in communities study. Kidney Int. 2000;58(1):293–301.

    Article  PubMed  CAS  Google Scholar 

  9. Allison DB, Fontaine KR, Manson JE, et al. Annual deaths attributable to obesity in the United States. JAMA. 1999;282(16):1530–8.

    Article  PubMed  CAS  Google Scholar 

  10. Must A, Spadano J, Coakley EH, et al. The disease burden associated with overweight and obesity. JAMA. 1999;282(16):1523–9.

    Article  PubMed  CAS  Google Scholar 

  11. Visscher TL, Seidell JC. The public health impact of obesity. Ann Rev Public Health. 2001;22:355–75.

    Article  CAS  Google Scholar 

  12. Flegal KM, Carroll MD, Ogden CL, et al. Prevalence and trends in obesity among US adults, 1999–2000. JAMA. 2002;288(14):1723–7.

    Article  PubMed  Google Scholar 

  13. Gu D, Reynolds K, Wu X, et al. Prevalence of the metabolic syndrome and overweight among adults in China. Lancet. 2005;365(9468):1398–405.

    Article  PubMed  Google Scholar 

  14. Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes. 1988;37(12):1595–607.

    Article  PubMed  CAS  Google Scholar 

  15. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998;15(7):539–53.

    Article  PubMed  CAS  Google Scholar 

  16. Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112(17):2735–52.

    Article  PubMed  Google Scholar 

  17. Alberti KG, Zimmet P, Shaw J. The metabolic syndrome–a new worldwide definition. Lancet. 2005;366(9491):1059–62.

    Article  PubMed  Google Scholar 

  18. Stern MP, Williams K, Gonzalez-Villalpando C, et al. Does the metabolic syndrome improve identification of individuals at risk of type 2 diabetes and/or cardiovascular disease? Diabetes Care. 2004;27(11):2676–81.

    Article  PubMed  Google Scholar 

  19. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA. 2002;287(3):356–9.

    Article  PubMed  Google Scholar 

  20. Ford ES, Giles WH, Mokdad AH. Increasing prevalence of the metabolic syndrome among u.s. Adults. Diabetes Care. 2004;27(10):2444–9.

    Article  PubMed  Google Scholar 

  21. • Liu Y, Tong G, Tong W, et al.: Can body mass index, waist circumference, waist-hip ratio and waist-height ratio predict the presence of multiple metabolic risk factors in Chinese subjects? BMC Public Health 2011;11:35. In this study, BMI, waist circumference, and waist-height ratio all significantly and similarly predicted the presence of multiple metabolic risk factors in Chinese subjects. However, waist-to-hip ratio did not. Thus, the best measure of obesity is somewhat controversial.

    Article  CAS  Google Scholar 

  22. Gallagher D, Visser M, Sepulveda D, et al. How useful is body mass index for comparison of body fatness across age, sex, and ethnic groups? Am J Epidemiol. 1996;143(3):228–39.

    PubMed  CAS  Google Scholar 

  23. Fox CS, Larson MG, Leip EP, et al. Predictors of new-onset kidney disease in a community-based population. JAMA. 2004;291(7):844–50.

    Article  PubMed  CAS  Google Scholar 

  24. Munkhaugen J, Lydersen S, Wideroe TE, et al. Prehypertension, obesity, and risk of kidney disease: 20-year follow-up of the HUNT I study in Norway. Am J Kidney Dis. 2009;54(4):638–46.

    Article  PubMed  Google Scholar 

  25. Muntner P, Winston J, Uribarri J, et al. Overweight, obesity, and elevated serum cystatin C levels in adults in the United States. Am J Med. 2008;121(4):341–8.

    Article  PubMed  CAS  Google Scholar 

  26. Knight EL, Verhave JC, Spiegelman D, et al. Factors influencing serum cystatin C levels other than renal function and the impact on renal function measurement. Kidney Int. 2004;65(4):1416–21.

    Article  PubMed  CAS  Google Scholar 

  27. Noori N, Hosseinpanah F, Nasiri AA, et al. Comparison of overall obesity and abdominal adiposity in predicting chronic kidney disease incidence among adults. J Ren Nutr. 2009;19(3):228–37.

    Article  PubMed  CAS  Google Scholar 

  28. de Boer IH, Sibley SD, Kestenbaum B, et al. Central obesity, incident microalbuminuria, and change in creatinine clearance in the epidemiology of diabetes interventions and complications study. J Am Soc Nephrol. 2007;18(1):235–43.

    Article  PubMed  Google Scholar 

  29. •• Thomas G, Sehgal AR, Kashyap SR, et al.: Metabolic syndrome and kidney disease: a systematic review and meta-analysis. Clin J Am Soc Nephrol 2011, 6(10):2364–2373. This meta-analysis pooled 11 studies (N = 30,146) and concluded that MetS and its components are associated with development of eGFR <60 mL/min per 1.73 m 2 and albuminuria.

    Article  PubMed  Google Scholar 

  30. Hsu CY, McCulloch CE, Iribarren C, et al. Body mass index and risk for end-stage renal disease. Ann Intern Med. 2006;144(1):21–8.

    PubMed  Google Scholar 

  31. Reynolds K, Gu D, Muntner P, et al. A population-based, prospective study of blood pressure and risk for end-stage renal disease in China. J Am Soc Nephrol. 2007;18(6):1928–35.

    Article  PubMed  Google Scholar 

  32. Perry Jr HM, Miller JP, Fornoff JR, et al. Early predictors of 15-year end-stage renal disease in hypertensive patients. Hypertension. 1995;25(4 Pt 1):587–94.

    PubMed  Google Scholar 

  33. Kramer HJ, Saranathan A, Luke A, et al. Increasing body mass index and obesity in the incident ESRD population. J Am Soc Nephrol. 2006;17(5):1453–9.

    Article  PubMed  Google Scholar 

  34. • Kramer H, Shoham D, McClure LA, 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(2):177–185. This study examined the association between measures of adiposity and mortality in adults with CKD. The researchers found that in CKD, BMI may not be a useful predictor of mortality risk, whereas waist circumference does predict mortality risk associated with obesity.

    Article  PubMed  Google Scholar 

  35. Teta D. Weight loss in obese patients with chronic kidney disease: who and how? J Ren Care. 2010;36 Suppl 1:163–71.

    Article  PubMed  Google Scholar 

  36. Kramer H, Tuttle KR, Leehey D, et al. Obesity management in adults with CKD. Am J Kidney Dis. 2009;53(1):151–65.

    Article  PubMed  Google Scholar 

  37. Eckel RH. Clinical practice. Nonsurgical management of obesity in adults. N Engl J Med. 2008;358(18):1941–50.

    Article  PubMed  CAS  Google Scholar 

  38. NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med. 1991;115(12):956–61.

    Google Scholar 

  39. •• Navaneethan SD, Yehnert H, Moustarah F, et al.: Weight loss interventions in chronic kidney disease: a systematic review and meta-analysis. Clin J Am Soc Nephrol 2009, 4(10):1565–1574. This systematic review analyzed the impact of weight loss interventions in patients with CKD. It reported that in CKD patients, nonsurgical weight loss interventions reduce proteinuria and prevent further decline in renal function. This suggests that weight loss may offer renal benefits in addition to the cardiovascular benefits.

    Article  PubMed  Google Scholar 

  40. Agrawal V, Krause KR, Chengelis DL, et al. Relation between degree of weight loss after bariatric surgery and reduction in albuminuria and C-reactive protein. Surg Obes Relat Dis. 2009;5(1):20–6.

    Article  PubMed  Google Scholar 

  41. Muntner P, Anderson A, Charleston J, et al. Hypertension awareness, treatment, and control in adults with CKD: results from the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis. 2010;55(3):441–51.

    Article  PubMed  CAS  Google Scholar 

  42. Klag MJ, Whelton PK, Randall BL, et al. End-stage renal disease in African-American and white men. 16-year MRFIT findings. JAMA. 1997;277(16):1293–8.

    Article  PubMed  CAS  Google Scholar 

  43. Vupputuri S, Batuman V, Muntner P, et al. Effect of blood pressure on early decline in kidney function among hypertensive men. Hypertension. 2003;42(6):1144–9.

    Article  PubMed  CAS  Google Scholar 

  44. Ravid M, Savin H, Jutrin I, et al. Long-term stabilizing effect of angiotensin-converting enzyme inhibition on plasma creatinine and on proteinuria in normotensive type II diabetic patients. Ann Intern Med. 1993;118(8):577–81.

    PubMed  CAS  Google Scholar 

  45. Viberti G, Mogensen CE, Groop LC, et al. Effect of captopril on progression to clinical proteinuria in patients with insulin-dependent diabetes mellitus and microalbuminuria. European Microalbuminuria Captopril Study Group. JAMA. 1994;271(4):275–9.

    Article  PubMed  CAS  Google Scholar 

  46. Lewis EJ, Hunsicker LG, Bain RP, et al. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. The Collaborative Study Group. N Engl J Med. 1993;329(20):1456–62.

    Article  PubMed  CAS  Google Scholar 

  47. Maschio G, Alberti D, Janin G, et al. Effect of the angiotensin-converting-enzyme inhibitor benazepril on the progression of chronic renal insufficiency. The Angiotensin-Converting-Enzyme Inhibition in Progressive Renal Insufficiency Study Group. N Engl J Med. 1996;334(15):939–45.

    Article  PubMed  CAS  Google Scholar 

  48. Ruggenenti P, Perna A, Benini R, et al. Effects of dihydropyridine calcium channel blockers, angiotensin-converting enzyme inhibition, and blood pressure control on chronic, nondiabetic nephropathies. Gruppo Italiano di Studi Epidemiologici in Nefrologia (GISEN). J Am Soc Nephrol. 1998;9(11):2096–101.

    PubMed  CAS  Google Scholar 

  49. Guasch A, Parham M, Zayas CF, et al. Contrasting effects of calcium channel blockade versus converting enzyme inhibition on proteinuria in African Americans with non-insulin-dependent diabetes mellitus and nephropathy. J Am Soc Nephrol. 1997;8(5):793–8.

    PubMed  CAS  Google Scholar 

  50. Levin A, Hemmelgarn B, Culleton B, et al. Guidelines for the management of chronic kidney disease. CMAJ. 2008;179(11):1154–62.

    Article  PubMed  Google Scholar 

  51. USRDS: USRDS 2009 Annual Data Report: Atlas of End-Stage Renal Disease in the United States Bethesda, MD: National Institutes of Health. National Institute of Diabetes and Digestive and Kidney Diseases, 2010.

  52. Salpeter SR, Greyber E, Pasternak GA, et al.: Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus. Cochrane Database Syst Rev 2010, (4):CD002967.

  53. Patel A, MacMahon S, Chalmers J, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358(24):2560–72.

    Article  PubMed  CAS  Google Scholar 

  54. Hunsicker LG, Adler S, Caggiula A, et al. Predictors of the progression of renal disease in the Modification of Diet in Renal Disease Study. Kidney Int. 1997;51(6):1908–19.

    Article  PubMed  CAS  Google Scholar 

  55. Chen J, Muntner P, Hamm LL, et al. The metabolic syndrome and chronic kidney disease in US adults. Ann Intern Med. 2004;140(3):167–74.

    PubMed  Google Scholar 

  56. Strippoli GF, Navaneethan SD, Johnson DW, et al. Effects of statins in patients with chronic kidney disease: meta-analysis and meta-regression of randomised controlled trials. BMJ. 2008;336(7645):645–51.

    Article  PubMed  CAS  Google Scholar 

  57. Fried LF, Orchard TJ, Kasiske BL. Effect of lipid reduction on the progression of renal disease: a meta-analysis. Kidney Int. 2001;59(1):260–9.

    Article  PubMed  CAS  Google Scholar 

  58. NKF: KDOQI Clinical Practice Guidelines for Managing Dyslipidemias in Chronic Kidney Disease. Available at http://www.kidney.org/professionals/kdoqi/guidelines_lipids/iii.htm#guide4. Accessed October 2011.

  59. Lea J, Cheek D, Thornley-Brown D, et al. Metabolic syndrome, proteinuria, and the risk of progressive CKD in hypertensive African Americans. Am J Kidney Dis. 2008;51(5):732–40.

    Article  PubMed  CAS  Google Scholar 

  60. Sarafidis PA, Lasaridis AN. Insulin resistance and endothelin: another pathway for renal injury in patients with the cardiometabolic syndrome? J Cardiometab Syndr. 2008;3(3):183–7.

    Article  PubMed  Google Scholar 

  61. Sarafidis PA, Ruilope LM. Insulin resistance, hyperinsulinemia, and renal injury: mechanisms and implications. Am J Nephrol. 2006;26(3):232–44.

    Article  PubMed  Google Scholar 

  62. Chung S, Park CW. Role of peroxisome proliferator-activated receptor alpha in diabetic nephropathy. Diabetes Metab J. 2011;35(4):327–36.

    Article  PubMed  Google Scholar 

  63. Tesauro M, Canale MP, Rodia G, et al. Metabolic syndrome, chronic kidney, and cardiovascular diseases: role of adipokines. Cardiol Res Pract. 2011;2011:653182.

    PubMed  Google Scholar 

  64. Kasiske BL, O’Donnell MP, Garvis WJ, et al. Pharmacologic treatment of hyperlipidemia reduces glomerular injury in rat 5/6 nephrectomy model of chronic renal failure. Circ Res. 1988;62(2):367–74.

    PubMed  CAS  Google Scholar 

  65. Harrison D, Griendling KK, Landmesser U, et al. Role of oxidative stress in atherosclerosis. Am J Cardiol. 2003;91(3A):7A–11.

    Article  PubMed  CAS  Google Scholar 

  66. Lucove J, Vupputuri S, Heiss G, et al. Metabolic syndrome and the development of CKD in American Indians: The Strong Heart Study. Am J Kidney Dis. 2008;51:21–8.

    Article  PubMed  CAS  Google Scholar 

  67. Tozawa M, Iseki C, Tokashiki K, et al. Metabolic syndrome and risk of developing chronic kidney disease in Japanese adults. Hypertens Res. 2007;30:937–43.

    Article  PubMed  CAS  Google Scholar 

  68. Watanabe H, Obata H, Watanabe T, et al. Metabolic syndrome and risk of development of chronic kidney disease: The Niigata Preventive Medicine Study. Diabetes Metab Res Rev. 2010;26:26–32.

    Article  PubMed  Google Scholar 

  69. Bonnet F, Marre M, Halimi JM, et al. Waist circumference and the metabolic syndrome predict the development of elevated albuminuria in non-diabetic subjects: The DESIR Study. J Hypertens. 2006;24:1157–63.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Epidemiology, University of Alabama at Birmingham, 1665 University Boulevard, Suite 230J, Birmingham, AL, 35294, USA

    Rikki M. Tanner & Paul Muntner

  2. Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, USA

    Todd M. Brown

Authors
  1. Rikki M. Tanner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Todd M. Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paul Muntner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paul Muntner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tanner, R.M., Brown, T.M. & Muntner, P. Epidemiology of Obesity, the Metabolic Syndrome, and Chronic Kidney Disease. Curr Hypertens Rep 14, 152–159 (2012). https://doi.org/10.1007/s11906-012-0254-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11906-012-0254-y

Keywords

Search

Navigation