AbstractObjectiveTo evaluate the associations between adiposity measures (body mass index,
waist circumference, and waist-to-height ratio) with decline in glomerular
filtration rate (GFR) and with all cause mortality.DesignIndividual participant data meta-analysis.SettingCohorts from 40 countries with data collected between 1970 and 2017.ParticipantsAdults in 39 general population cohorts (n=5 459 014), of which 21
(n=594 496) had data on waist circumference; six cohorts with high
cardiovascular risk (n=84 417); and 18 cohorts with chronic kidney disease
(n=91 607).Main outcome measuresGFR decline (estimated GFR decline ≥40%, initiation of kidney replacement
therapy or estimated GFR <10 mL/min/1.73 m2) and all cause
mortality.ResultsOver a mean follow-up of eight years, 246 607 (5.6%) individuals in the
general population cohorts had GFR decline (18 118 (0.4%) end stage kidney
disease events) and 782 329 (14.7%) died. Adjusting for age, sex, race, and
current smoking, the hazard ratios for GFR decline comparing body mass
indices 30, 35, and 40 with body mass index 25 were 1.18 (95% confidence
interval 1.09 to 1.27), 1.69 (1.51 to 1.89), and 2.02 (1.80 to 2.27),
respectively. Results were similar in all subgroups of estimated GFR.
Associations weakened after adjustment for additional comorbidities, with
respective hazard ratios of 1.03 (0.95 to 1.11), 1.28 (1.14 to 1.44), and
1.46 (1.28 to 1.67). The association between body mass index and death was J
shaped, with the lowest risk at body mass index of 25. In the cohorts with
high cardiovascular risk and chronic kidney disease (mean follow-up of six
and four years, respectively), risk associations between higher body mass
index and GFR decline were weaker than in the general population, and the
association between body mass index and death was also J shaped, with the
lowest risk between body mass index 25 and 30. In all cohort types,
associations between higher waist circumference and higher waist-to-height
ratio with GFR decline were similar to that of body mass index; however,
increased risk of death was not associated with lower waist circumference or
waist-to-height ratio, as was seen with body mass index.ConclusionsElevated body mass index, waist circumference, and waist-to-height ratio are
independent risk factors for GFR decline and death in individuals who have
normal or reduced levels of estimated GFR.
Urinary triclosan concentrations are inversely associated with body mass index and waist circumference in the US general population: Experience in NHANES 2003–2010