Metabolically healthy obesity and development of chronic kidney disease: A cohort study

Yoosoo Chang, Seungho Ryu, Yuni Choi, Yiyi Zhang, Juhee Cho, Min Jung Kwon, Young Youl Hyun, Kyu Beck Lee, Hyang Kim, Hyun Suk Jung, Kyung Eun Yun, Jiin Ahn, Sanjay Rampal, Di Zhao, Byung Seong Suh, Eun Cheol Chung, Hocheol Shin, Roberto Pastor-Barriuso, Eliseo Guallar

Research output: Contribution to journalArticlepeer-review

148 Scopus citations


Background: The risk for chronic kidney disease (CKD) among obese persons without obesity-related metabolic abnormalities, called metabolically healthy obesity, is largely unexplored. Objective: To investigate the risk for incident CKD across categories of body mass index in a large cohort of metabolically healthy men and women. Design: Prospective cohort study. Setting: Kangbuk Samsung Health Study, Kangbuk Samsung Hospital, Seoul, South Korea. Participants: 62 249 metabolically healthy, young and middleaged men and women without CKD or proteinuria at baseline. Measurements: Metabolic health was defined as a homeostasis model assessment of insulin resistance less than 2.5 and absence of any component of the metabolic syndrome. Underweight, normal weight, overweight, and obesity were defined as a body mass index less than 18.5 kg/m2, 18.5 to 22.9 kg/m2, 23 to 24.9 kg/m2, and 25 kg/m2 or greater, respectively. The outcome was incident CKD, defined as an estimated glomerular filtration rate less than 60 mL/min/1.73 m2. Results: During 369 088 person-years of follow-up, 906 incident CKD cases were identified. The multivariable-adjusted differences in 5-year cumulative incidence of CKD in underweight, overweight, and obese participants compared with normalweight participants were-4.0 (95% CI,-7.8 to-0.3), 3.5 (CI, 0.9 to 6.1), and 6.7 (CI, 3.0 to 10.4) cases per 1000 persons, respectively. These associations were consistently seen in all clinically relevant subgroups. Limitation: Chronic kidney disease was identified by a single measurement at each visit. Conclusion: Overweight and obesity are associated with an increased incidence of CKD in metabolically healthy young and middle-aged participants. These findings show that metabolically healthy obesity is not a harmless condition and that the obese phenotype, regardless of metabolic abnormalities, can adversely affect renal function.

Original languageEnglish (US)
Pages (from-to)305-312
Number of pages8
JournalAnnals of internal medicine
Issue number5
StatePublished - Mar 1 2016

ASJC Scopus subject areas

  • Internal Medicine


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