Childhood Obesity and the Metabolic Syndrome

https://doi.org/10.1016/j.pcl.2018.08.004Get rights and content

Section snippets

Key points

  • Obesity and the metabolic syndrome are significant risk factors for the development of chronic kidney disease.

  • The pathophysiology of obesity-related kidney disease is multifactorial and includes hemodynamic factors (hypertension and hyperfiltration), inflammation, and renal lipotoxicity.

  • Children with severe obesity have an increased prevalence of early kidney abnormalities, although the natural history and clinical spectrum of obesity-related kidney disease in children are not known.

  • Treatment

Childhood Obesity

Childhood adiposity is commonly measured using body mass index (BMI), defined as the weight in kilograms divided by the square of the height in meters. Because the distribution of BMI changes with age, BMI levels must be interpreted relative to age- and gender-specific normative distributions. Therefore, expert recommendations to identify elevated BMI in children are based on percentile cutoffs rather than absolute values. In 2005, a committee composed of representatives from the American

The epidemic of obesity, the metabolic syndrome, and chronic kidney disease

There has been increasing interest in the association of obesity with CKD, in part generated by a parallel increase in obesity and kidney disease over recent decades. Concurrent with the increase in obesity from 1980 to 2000, the incidence of ESRD nearly quadrupled.19 Epidemiologic studies have confirmed obesity is a strong, independent risk factor for developing CKD and ESRD.20, 21, 22 Vivante and colleagues7 investigated the incidence of ESRD in 1.2 million adolescents followed for a mean of

Mechanisms of kidney disease in obesity and the metabolic syndrome

Despite the burgeoning evidence linking obesity with CKD, the mechanism of obesity-related kidney disease has remained largely elusive. Proposed pathways of kidney injury in obesity and the metabolic syndrome include hemodynamic factors, inflammatory/metabolic effects, and lipotoxicity (Fig. 1).

Presentation and Disease Course

Obesity-related kidney disease often presents as isolated proteinuria with or without renal insufficiency. Proteinuria may be discovered incidentally or as part of an evaluation for other obesity-related comorbidities. Because kidney disease is often asymptomatic and may be present for years before detection, targeted screening for microalbuminuria in obese children at higher risk for kidney disease is a reasonable approach. This screening should include those with insulin resistance, diabetes,

Summary

Obesity and the obesity-related metabolic syndrome are now recognized as significant causes of CKD. The injurious renal effects of severe obesity are present in childhood, although the natural history and clinical spectrum of obesity-related kidney disease in children are not known. Treatment options include weight loss and angiotensin-converting enzyme inhibitors, although kidney disease may progress despite these measures. Future research efforts aimed at early identification and novel

First page preview

First page preview
Click to open first page preview

References (82)

  • M. Tomaszewski et al.

    Glomerular hyperfiltration: a new marker of metabolic risk

    Kidney Int

    (2007)
  • B.M. Brenner et al.

    The hyperfiltration theory: a paradigm shift in nephrology

    Kidney Int

    (1996)
  • M. Navarro-Diaz et al.

    Obesity, inflammation, and kidney disease

    Kidney Int Suppl

    (2008)
  • A. Shankar et al.

    Markers of inflammation predict the long-term risk of developing chronic kidney disease: a population-based cohort study

    Kidney Int

    (2011)
  • G. Wolf et al.

    Leptin stimulates proliferation and TGF-beta expression in renal glomerular endothelial cells: potential role in glomerulosclerosis [see comments]

    Kidney Int

    (1999)
  • S.E. Simonds et al.

    Leptin mediates the increase in blood pressure associated with obesity

    Cell

    (2014)
  • T. Jiang et al.

    Diet-induced obesity in C57BL/6J mice causes increased renal lipid accumulation and glomerulosclerosis via a sterol regulatory element-binding protein-1c-dependent pathway

    J Biol Chem

    (2005)
  • Y. Nishida et al.

    Effect of lipoproteins on cultured human mesangial cells

    Am J Kidney Dis

    (1997)
  • H.H. Szeto et al.

    Protection of mitochondria prevents high-fat diet-induced glomerulopathy and proximal tubular injury

    Kidney Int

    (2016)
  • L. Sun et al.

    Role of sterol regulatory element-binding protein 1 in regulation of renal lipid metabolism and glomerulosclerosis in diabetes mellitus

    J Biol Chem

    (2002)
  • J.M. Weinberg

    Lipotoxicity

    Kidney Int

    (2006)
  • A. Kamijo et al.

    Urinary free fatty acids bound to albumin aggravate tubulointerstitial damage

    Kidney Int

    (2002)
  • E. Morales et al.

    Beneficial effects of weight loss in overweight patients with chronic proteinuric nephropathies

    Am J Kidney Dis

    (2003)
  • C. Wanner et al.

    KDIGO Clinical Practice Guideline for Lipid Management in CKD: summary of recommendation statements and clinical approach to the patient

    Kidney Int

    (2014)
  • C. Boza et al.

    Laparoscopic sleeve gastrectomy in obese adolescents: results in 51 patients

    Surg Obes Relat Dis

    (2012)
  • E.P. Nadler et al.

    Laparoscopic adjustable gastric banding for morbidly obese adolescents affects android fat loss, resolution of comorbidities, and improved metabolic status

    J Am Coll Surg

    (2009)
  • A.R. Chang et al.

    Bariatric surgery is associated with improvement in kidney outcomes

    Kidney Int

    (2016)
  • T.H. Imam et al.

    Estimated GFR before and after bariatric surgery in CKD

    Am J Kidney Dis

    (2017)
  • E.J. Nehus et al.

    Kidney outcomes three years after bariatric surgery in severely obese adolescents

    Kidney Int

    (2017)
  • Y. Wang et al.

    Worldwide trends in childhood overweight and obesity

    Int J Pediatr Obes

    (2006)
  • C.L. Ogden et al.

    Prevalence of childhood and adult obesity in the United States, 2011-2012

    JAMA

    (2014)
  • A.M. Lee et al.

    Trends in metabolic syndrome severity and lifestyle factors among adolescents

    Pediatrics

    (2016)
  • A.S. Singh et al.

    Tracking of childhood overweight into adulthood: a systematic review of the literature

    Obes Rev

    (2008)
  • M. Juonala et al.

    Childhood adiposity, adult adiposity, and cardiovascular risk factors

    N Engl J Med

    (2011)
  • A. Vivante et al.

    Body mass index in 1.2 million adolescents and risk for end-stage renal disease

    Arch Intern Med

    (2012)
  • S.E. Barlow et al.

    Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report

    Pediatrics

    (2007)
  • R.C. Whitaker et al.

    Predicting obesity in young adulthood from childhood and parental obesity

    N Engl J Med

    (1997)
  • D.S. Freedman et al.

    The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study

    Pediatrics

    (1999)
  • D.S. Freedman et al.

    Relationship of childhood obesity to coronary heart disease risk factors in adulthood: the Bogalusa Heart Study

    Pediatrics

    (2001)
  • V. Calcaterra et al.

    Prevalence of metabolic syndrome (MS) in children and adolescents with varying degrees of obesity

    Clin Endocrinol

    (2008)
  • D.S. Freedman et al.

    Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study

    J Pediatr

    (2007)
  • Cited by (65)

    • Mastication in overweight and obese children: A comparative cross-sectional study

      2023, Jornal de Pediatria
      Citation Excerpt :

      Childhood obesity is an important concern in terms of public health because of its association with cardiovascular disease risk factors, such as; type 2 diabetes mellitus, dyslipidemia, and hypertension.7 Many of the associated cardiovascular disease risk factors present a strong tendency to persist into adolescence and adult life.8 Worldwide, about 43 million children under 5 years of age are overweight.9

    • Adolescent obesity

      2023, Encyclopedia of Child and Adolescent Health, First Edition
    View all citing articles on Scopus

    Financial Disclosure: There are no conflicts of interest to disclose.

    View full text