Childhood body mass index trajectories and associations with adult-onset chronic kidney disease in Denmark: A population-based cohort study

Abstract

Background Although excess adult adiposity is a strong risk factor for chronic kidney disease (CKD), evidence for associations with early life body size is limited. We investigated whether childhood body mass index (BMI) trajectories are associated with adult-onset CKD and end-stage kidney disease (ESKD) using a population-based cohort. Further, we examined the role of adult-onset type 2 diabetes (T2D) in these associations. Methods and findings We included 151,506 boys and 148,590 girls from the Copenhagen School Health Records Register, born 1930 to 1987 with information on measured weights and heights at ages 6 to 15 years. Five sex-specific childhood BMI trajectories were analyzed. Information on the main outcomes CKD and ESKD, as well as T2D, came from national health registers. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were estimated using Poisson regression adjusted for year of birth. During a median of 30.8 person-years of follow-up, 5,968 men and 3,903 women developed CKD and 977 men and 543 women developed ESKD. For both sexes, the rates of CKD and ESKD increased significantly with higher child BMI trajectories in comparison with the average BMI trajectory (40% to 43% of individuals) and the below-average BMI trajectory (21% to 23% of individuals) had the lowest rates. When including T2D, most associations were significant and men (IRR = 1.39, 95% CI: 1.13 to 1.72) and women (IRR = 1.54, 95% CI: 1.28 to 1.86) with the obese childhood BMI trajectory (2% of individuals) had significantly higher CKD rates than the average BMI trajectory, whereas for ESKD, the associations were positive, but nonsignificant, for men (IRR = 1.38, 95% CI: 0.83 to 2.31) but significant for women (IRR = 1.97, 95% CI: 1.25 to 3.11) with the obese BMI trajectory. A main study limitation is the use of only hospital-based CKD diagnoses. Conclusions Individuals with childhood BMI trajectories above average had higher rates of CKD and ESKD than those with an average childhood BMI trajectory. When including T2D, most associations were significant, particularly with CKD, emphasizing the potential information that the early appearance of above-average BMI growth patterns provide in relation to adult-onset CKD beyond the information provided by T2D development. Using a population-based cohort, Julie Aarestrup and colleagues investigate whether childhood body mass index trajectories are associated with adult-onset chronic kidney disease and end-stage kidney disease. Author summary Why was this study done? Worldwide, chronic kidney disease (CKD) is common and associated with numerous adverse health effects. Severe obesity in childhood is associated with impaired kidney health. Little is known on the impact of childhood body size on subsequent development of CKD. What did the researchers do and find? Using a large Danish population-based cohort of 151,506 boys and 148,590 girls, we investigated if trajectories of childhood body mass index (BMI) development were associated with adult-onset CKD. In analyses that include type 2 diabetes, men with above-average (incidence rate ratio [IRR] = 1.07, 95% confidence interval [CI]: 1.00 to 1.14), overweight (IRR = 1.25, 95% CI: 1.14 to 1.38), and obese (IRR = 1.39, 95% CI: 1.13 to 1.72) childhood BMI trajectories had higher rates of adult-onset CKD compared to those with an average childhood BMI trajectory as did women with above-average (IRR = 1.18, 95% CI: 1.08 to 1.28), overweight (IRR = 1.24, 95% CI: 1.11 to 1.38), and obese (IRR = 1.54, 95% CI: 1.28 to 1.86) childhood BMI trajectories. What do these findings mean? Our findings highlight the importance of childhood BMI development in the identification of individuals at risk of adult-onset CKD. Our study was limited by only including the more severe CKD cases. The results suggest that the high worldwide prevalence of childhood overweight and obesity may contribute to the future burden of CKD. Furthermore, these findings open up new avenues for exploration into the mechanisms that increase the risk of this common health outcome.