NEWS & VIEWS CHRONIC KIDNEY DISEASE
Obesity in children with end-stage renal disease Rafael T. Krmar and Peter Bárány
A recent publication by Bonthuis et al. shows a high prevalence of overweight or obesity in children with end-stage renal disease, particularly in renal transplant recipients. Underweight is more prevalent in infants than in other age groups. This study highlights the need to evaluate and implement interventional strategies in this patient population. Krmar, R. T. & Bárány, P. Nat. Rev. Nephrol. 9, 707–708 (2013); published online 22 October 2013; doi:10.1038/nrneph.2013.223
Recent changes in lifestyle and nutritional habits have resulted in a global increase in the prevalence of BMI-defined obesity in the general population. Coupled with obesity, there is an increase in the prevalence of comorbidities, such as hypertension, dyslipidaemia, type 2 diabetes mellitus and metabolic syndrome. In addition, obesity is an independent risk factor for new-onset cardiovascular disease and is associated with a higher risk of mortality compared with individuals of normal weight.1 Studies have shown a similar trend in the prevalence of obesity in children. Although obese children rarely develop cardiovascular disease, those who remain obese into adulthood have a significant risk of developing hypertension, dyslipidaemia, type 2 diabetes mellitus and increased carotid-artery intima-media thickness, a surrogate marker of early atherosclerosis.2 At the other end of the spectrum is the equally serious effect of underweight, which is associated with increased mortality compared with normal-weight adults;3 a trend that is also seen in children.4 In an observational study based on data from the European Society for Paediatric Nephrology/European Renal Association— Eu rop e an D i a ly s is and Tr anspl ant Association (ESPN/ERA-EDTA) registry,5 Bonthuis et al. report the prevalence of underweight, and overweight or obese patients in the European paediatric population receiving renal replacement therapy (RRT), as well as the evolution of BMI and its associated risk factors, after the start of RRT.5 In this study, the prevalence of underweight patients was 3.5%, whereas 20.8% of patients were overweight and 12.5% were obese. There were differences in prevalence across ages, namely the prevalence of being underweight was remarkably higher in patients aged ≤2 years (15.8%) than in
adolescents, who were more likely to be overweight or obese (40.8%). The authors also highlight differences in the prevalence of increased BMI across participating countries; children from the UK and Spain showed the highest prevalence of overweight and obesity in both the dialysis and the transplant population. An important observation was that in renal transplant recipients and infants undergoing dialysis, those who are short for their age are more likely to become overweight (height standard deviation score for chronological age and increased BMI were inversely correlated), underscoring the potential role of the complex maladaptive metabolic response described in children with end-stage renal disease. On the basis of these observations the investigators concluded that infant-age (
Obesity in children with end-stage renal disease Rafael T. Krmar and Peter Bárány
A recent publication by Bonthuis et al. shows a high prevalence of overweight or obesity in children with end-stage renal disease, particularly in renal transplant recipients. Underweight is more prevalent in infants than in other age groups. This study highlights the need to evaluate and implement interventional strategies in this patient population. Krmar, R. T. & Bárány, P. Nat. Rev. Nephrol. 9, 707–708 (2013); published online 22 October 2013; doi:10.1038/nrneph.2013.223
Recent changes in lifestyle and nutritional habits have resulted in a global increase in the prevalence of BMI-defined obesity in the general population. Coupled with obesity, there is an increase in the prevalence of comorbidities, such as hypertension, dyslipidaemia, type 2 diabetes mellitus and metabolic syndrome. In addition, obesity is an independent risk factor for new-onset cardiovascular disease and is associated with a higher risk of mortality compared with individuals of normal weight.1 Studies have shown a similar trend in the prevalence of obesity in children. Although obese children rarely develop cardiovascular disease, those who remain obese into adulthood have a significant risk of developing hypertension, dyslipidaemia, type 2 diabetes mellitus and increased carotid-artery intima-media thickness, a surrogate marker of early atherosclerosis.2 At the other end of the spectrum is the equally serious effect of underweight, which is associated with increased mortality compared with normal-weight adults;3 a trend that is also seen in children.4 In an observational study based on data from the European Society for Paediatric Nephrology/European Renal Association— Eu rop e an D i a ly s is and Tr anspl ant Association (ESPN/ERA-EDTA) registry,5 Bonthuis et al. report the prevalence of underweight, and overweight or obese patients in the European paediatric population receiving renal replacement therapy (RRT), as well as the evolution of BMI and its associated risk factors, after the start of RRT.5 In this study, the prevalence of underweight patients was 3.5%, whereas 20.8% of patients were overweight and 12.5% were obese. There were differences in prevalence across ages, namely the prevalence of being underweight was remarkably higher in patients aged ≤2 years (15.8%) than in
adolescents, who were more likely to be overweight or obese (40.8%). The authors also highlight differences in the prevalence of increased BMI across participating countries; children from the UK and Spain showed the highest prevalence of overweight and obesity in both the dialysis and the transplant population. An important observation was that in renal transplant recipients and infants undergoing dialysis, those who are short for their age are more likely to become overweight (height standard deviation score for chronological age and increased BMI were inversely correlated), underscoring the potential role of the complex maladaptive metabolic response described in children with end-stage renal disease. On the basis of these observations the investigators concluded that infant-age (
