Epidemic of Childhood Obesity: Implications for Kidney Disease

  • Youfa Wang
    Address correspondence to Youfa Wang, MD, PhD, Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205.
    Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

    Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
    Search for articles by this author
  • Xiaoli Chen
    Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
    Search for articles by this author
  • Michael J. Klag
    Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
    Search for articles by this author
  • Benjamin Caballero
    Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
    Search for articles by this author
      Childhood obesity has become a global epidemic. Childhood obesity has many long-term adverse effects on morbidity and mortality. The prevalence of end-stage renal disease (ESRD) has risen dramatically in the past decade in parallel with the increase in obesity. Our current understanding of the consequences of childhood obesity on kidney function and disease is very limited. The present study presents the worldwide trends in childhood obesity and reviews published studies that have examined the association between obesity and kidney disease in the pediatric and adult populations. A large number of studies have been conducted to examine the association between obesity and kidney disease in general adult populations; however, few have been conducted to examine the impact of childhood obesity on the risk of kidney disease. Findings from large cohort studies in adult general populations show that obesity increases the risk of kidney diseases. Six follow-up studies in pediatric patients were identified, and they indicate that childhood obesity is associated with an increased risk of kidney disease and the progression and mortality of kidney disease. Future studies in the pediatric populations are needed.

      Index Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Advances in Chronic Kidney Disease
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Lobstein T.
        • Baur L.
        • Uauy R.
        Obesity in children and young people: A crisis in public health.
        Obes Rev. 2004; 5: S4-S104
        • Wang Y.
        • Monteiro C.
        • Popkin B.M.
        Trends of obesity and underweight in older children and adolescents in the United States, Brazil, China and Russia.
        Am J Clin Nutr. 2002; 75: 971-977
        • Wang Y.
        • Lobstein T.
        Worldwide trends in childhood obesity.
        Int J Pediatr Obes. 2006; 1: 11-25
        • World Health Organization
        Obesity: Preventing and managing the global epidemic. World Health Organization, Geneva, Switzerland2000 (WHO Technical Report Series 894)
        • Marion A.W.
        • Baker A.J.
        • Dhawan A.
        Fatty liver disease in children.
        Arch Dis Child. 2004; 89: 648-652
        • Reilly J.J.
        • Methven E.
        • McDowell Z.C.
        • et al.
        Health consequences of obesity.
        Arch Dis Child. 2003; 88: 748-752
        • Must A.
        Morbidity and mortality associated with elevated body weight in children and adolescents.
        Am J Clin Nutr. 1996; 63: 445S-447S
        • Hall J.E.
        • Crook E.D.
        • Jones D.W.
        • et al.
        Mechanisms of obesity associated cardiovascular and renal disease.
        Am J Med Sci. 2002; 324: 127-137
        • Bray G.A.
        • Bouchard C.
        • James W.P.T.
        Handbook of Obesity. Marcel Dekker, New York, NY1998
        • Finkelstein E.A.
        • Fiebelkorn I.C.
        • Wang G.
        National medical spending attributable to overweight and obesity: How much, and who’s paying?.
        Health Aff (Millwood) Suppl Web Exclusives. 2003; (W3-219-26)
        • USDHHS
        The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity. Office of the Surgeon General, Rockville, MD2001
        • Sweeting H.
        • Wright C.
        • Minnis H.
        Psychosocial correlates of adolescent obesity, ‘slimming down’ and ‘becoming obese’.
        J Adolesc Health. 2005; 37: 409
        • Tremblay L.
        • Frigon J.Y.
        The interaction role of obesity and pubertal timing on the psychosocial adjustment of adolescent girls: Longitudinal data.
        Int J Obes. 2005; 29: 1204-1211
        • Serdula M.K.
        • Ivery D.
        • Coates R.J.
        • et al.
        Do obese children become obese adults? A review of the literature.
        Prev Med. 1993; 22: 167-177
        • Must A.
        • Strauss R.S.
        Risks and consequences of childhood and adolescent obesity.
        Int J Obes Relat Metab Disord. 1999; 23: S2-S11
      1. The United States Renal Data System.
        Am J Kidney Dis. 2003; 42: 1-230
        • Xue J.L.
        • Ma J.Z.
        • Louis T.A.
        • et al.
        Forecast of the number of patients with end-stage renal disease in the United States to the year 2010.
        J Am Soc Nephrol. 2001; 12: 2753-2758
        • US Renal Data System
        USRDS 1999 annual data report: Patient mortality and survival in ESRD.
        Am J Kidney Dis. 1999; 34: S102-S113
        • Wong C.S.
        • Gipson D.S.
        • Gillen D.L.
        • et al.
        Anthropometric measures and risk of death in children with end-stage renal disease.
        Am J Kidney Dis. 2000; 36: 811-819
        • Zandi-Nejad K.
        • Brenner B.M.
        Strategies to retard the progression of chronic kidney disease.
        Med Clin North Am. 2005; 89: 489-509
        • Srivastava T.
        Nondiabetic consequences of obesity on kidney.
        Pediatr Nephrol. 2006; 21: 463-470
        • Fox C.S.
        • Larson M.G.
        • Leip E.P.
        • et al.
        Predictors of new-onset kidney disease in a community-based population.
        JAMA. 2004; 291: 844-850
        • Iseki K.
        • Ikemiya Y.
        • Fukiyama K.
        Predictors of end-stage renal disease and body mass index in a screened cohort.
        Kidney Int. 1997; 63: S169-S170
        • Iseki K.
        • Ikemiya Y.
        • Kinjo K.
        • et al.
        Body mass index and the risk of development of end-stage renal disease in a screened cohort.
        Kidney Int. 2004; 65: 1870-1876
        • Hallan S.
        • de Mutsert R.
        • Carlsen S.
        • et al.
        Obesity, smoking, and physical inactivity as risk factors for CKD: Are men more vulnerable?.
        Am J Kidney Dis. 2006; 47: 396-405
        • Serdula M.K.
        • Ivery D.
        • Coates R.J.
        • et al.
        Do obese children become obese adults? A review of the literature.
        Prev Med. 1993; 22: 167-177
        • Power C.
        • Lake J.K.
        • Cole T.J.
        Measurement and long-term health risks of child and adolescent fatness.
        Int J Obes Relat Metab Disord. 1997; 21: 507-526
        • Praga M.
        • Hernandez E.
        • Morales E.
        • et al.
        Clinical features and long-term outcome of obesity-associated focal segmental glomerulosclerosis.
        Nephrol Dial Transplant. 2001; 16: 1790-1798
        • Praga M.
        • Hernandez E.
        • Herrero J.C.
        • et al.
        Influence of obesity on the appearance of proteinuria and renal insufficiency after unilateral nephrectomy.
        Kidney Int. 2000; 58: 2111-2118
        • Guillaume M.
        Defining obesity in childhood: current practice.
        Am J Clin Nutr. 1999; 70: 126S-130S
        • Wang Y.
        • Wang J.Q.
        A comparison of different international references for the assessment of child and adolescent overweight and obesity in different populations.
        Eur J Clin Nutr. 2002; 56: 973-982
        • Zimmermann M.B.
        • Hess S.Y.
        • Hurrell R.F.
        A national study of the prevalence of overweight and obesity in 6-12 y-old Swiss children: Body mass index, body-weight perceptions and goals.
        Eur J Clin Nutr. 2000; 54: 568-572
        • Reilly J.J.
        Assessment of childhood obesity: National reference data or international approach?.
        Obes Res. 2002; 10: 838-840
        • Dietz W.H.
        • Robinson T.N.
        Use of the body mass index (BMI) as a measure of overweight in children and adolescents.
        J Pediatr. 1998; 132: 191-193
        • Kuczmarski R.J.
        • Ogden C.L.
        • Grummer-Strawn L.M.
        • et al.
        CDC Growth Charts: United States. 2000 (No. 314)
        • Cole T.J.
        • Freeman J.V.
        • Preece M.A.
        Body mass index reference curves for the UK, 1990.
        Arch Dis Child. 1995; 73: 25-29
        • Ji C.Y.
        Body mass index reference norm for screening overweight and obesity in Chinese children and adolescents.
        Chin J Epidemiol. 2004; 25: 97-102
        • Rolland-Cachera M.F.
        • Cole T.J.
        • Sempe M.
        • et al.
        Body mass index variations: Centiles from birth to 87 years.
        Eur J Clin Nutr. 1991; 45: 13-21
        • World Health Organization
        Physical status, the use and interpretation of anthropometry. WHO, Geneva1995 (WHO Technical Report Series No. 854)
        • Cole T.J.
        • Bellizzi M.C.
        • Flegal K.M.
        • et al.
        Establishing a standard definition for child overweight and obesity worldwide: International survey.
        Br Med J. 2000; 320: 1240-1243
        • Shrier R.W.
        • Gottschalk C.W.
        Diseases of the Kidney. (ed 5). Little, Brown, New York, NY1993
        • Massry S.G.
        • Glassock R.T.
        Textbook of Nephrology. (ed 3). Williams & Wilkins, Baltimore, MD1995
      2. World Health Organization: International classification of diseases (ICD). 10th Revision, Version for 2003. Available at: Assessed March 30, 2006

        • Hanevold C.D.
        • Ho P.L.
        • Talley L.
        • et al.
        Obesity and renal transplant outcome: A Report of the North American Pediatric Renal Transplant Cooperative Study.
        Pediatrics. 2005; 115: 352-356
        • Filler G.
        • Payne R.P.
        • Orrbine E.
        • et al.
        Changing trends in the referral patterns of pediatric nephrology patients.
        Pediatr Nephrol. 2005; 20: 603-608
        • Levey A.S.
        • Coresh J.
        • Balk E.
        • et al.
        National Kidney Foundation practice guidelines for chronic kidney disease: Evaluation, classification, and stratification.
        Ann Intern Med. 2003; 139: 137-147
        • Willms J.D.
        • Tremblay M.S.
        • Katzmarzyk P.T.
        Geographic and demographic variation in the prevalence of overweight Canadian children.
        Obes Res. 2003; 11: 668-673
        • Kautiainen S.
        • Rimpëla A.
        • Vikat A.
        • et al.
        Secular trends in overweight and obesity among Finnish adolescents in 1977-1999.
        Int J Obes. 2002; 26: 544-552
        • Kalies H.
        • Lenz J.
        • von Kries R.
        Prevalence of overweight and obesity and trends in body mass index in German pre-school children, 1982-1997.
        Int J Obes Relat Metab Disord. 2002; 26: 1211-1217
        • Moreno L.A.
        • Sarría A.
        • Fleta J.
        • et al.
        Sociodemographic factors and trends on overweight prevalence in children and adolescents in Aragón (Spain) from 1985 to 1995.
        J Clin Epidemiol. 2001; 54: 921-927
        • Petersen S.
        • Brulin C.
        • Bergstrom E.
        Increasing prevalence of overweight in young schoolchildren in Umea, Sweden, from 1986 to 2001.
        Acta Paediatr. 2003; 92: 848-853
        • Chinn S.
        • Rona R.J.
        Prevalence and trends in overweight and obesity in three cross sectional studies of British children, 1974-94.
        Br Med J. 2001; 322: 24-26
        • Bundred P.
        • Kitchiner D.
        • Buchan I.
        Prevalence of overweight and obese children between 1989 and 1998: Population based series of cross sectional studies.
        Br Med J. 2001; 322: 326-328
        • Matsushita Y.
        • Yoshiike N.
        • Kaneda F.
        • et al.
        Trends in childhood obesity in Japan over the last 25 years from the national nutrition survey.
        Obes Res. 2004; 12: 205-214
        • Magarey A.M.
        • Daniels L.A.
        • Boulton T.J.
        Prevalence of overweight and obesity in Australian children and adolescents: Reassessment of 1985 and 1995 data against new standard international definitions.
        Med J Aust. 2001; 174: 561-564
        • Turnbull A.
        • Barry D.
        • Wickens K.
        • et al.
        Changes in body mass index in 11-12-year-old children in Hawkes Bay, New Zealand (1989-2000).
        J Paediatr Child Health. 2004; 40: 33-37
        • Ogden C.L.
        • Flegal K.M.
        • Carroll M.D.
        • et al.
        Prevalence and trends in overweight among US children and adolescents, 1999-2000.
        JAMA. 2002; 288: 1728-1732
        • Hedley A.A.
        • Ogden C.L.
        • Johnson C.L.
        • et al.
        Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002.
        JAMA. 2004; 291: 2847-2850
        • Ji C.Y.
        • Sun J.
        • Chen T.
        Dynamic analysis on the prevalence of obesity and overweight school-age children and adolescents in recent 15 years in China.
        Chin J Epidemiol. 2004; 25: 103-108
        • Wang Y.
        • Mi J.
        • Shan X.
        • et al.
        Is China facing an obesity epidemic and the consequences?.
        Int J Obes (Lond). 2006; (in press)
        • Kano K.
        • Kyo K.
        • Ito S.
        • et al.
        Spinal epidural lipomatosis in children with renal diseases receiving steroid therapy.
        Pediatr Nephrol. 2005; 20: 184-189
        • Mitsnefes M.
        • Khoury P.
        • McEnery P.T.
        Body mass index and allograft function in pediatric renal transplantation.
        Pediatr Nephrol. 2002; 7: 535-539
        • Omoloja A.
        • Stolfi A.
        • Mitsnefes M.
        Pediatric obesity at renal transplantation: A single center experience.
        Pediatr Transplant. 2005; 9: 770-772
        • Rosner B.
        • Prineas R.
        • Loggie J.
        • et al.
        Percentiles for body mass index in U.S. children 5 to 17 years of age.
        J Pediatr. 1998; 132: 211-222
        • Hsu C.Y.
        • McCulloch C.E.
        • Iribarren C.
        • et al.
        Body mass index and risk for end-stage renal disease.
        Ann Intern Med. 2006; 144: 21-28
        • Gelber R.P.
        • Kurth T.
        • Kausz A.T.
        • et al.
        Association between body mass index and CKD in apparently healthy men.
        Am J Kidney Dis. 2005; 46: 871-880
        • Kramer H.
        • Luke A.
        • Bidani A.
        • et al.
        Obesity and prevalent and incident CKD: The hypertension detection and follow-up program.
        Am J Kidney Dis. 2005; 46: 587-594
        • Stengel B.
        • Tarrer-Carr M.E.
        • Powe N.R.
        • et al.
        Lifestyle factors, obesity and the risk of chronic kidney disease.
        Epidemiology. 2003; 14: 479-487
        • Meier-Kriesche H.U.
        • Arndorfer J.A.
        • Kaplan B.
        The impact of body mass index on renal transplant outcomes: A significant independent risk factor for graft failure and patient death.
        Transplantation. 2002; 73: 70-74
        • Gretz N.
        • Zeier M.
        • Gerberth S.
        • et al.
        Is gender a determinant for evolution of renal disease? A study in autosomal dominant polycystic kidney disease.
        Am J Kidney Dis. 1989; 14: 178-183
        • Taylor E.N.
        • Stampfer M.J.
        • Curhan G.C.
        Obesity, weight gain, and the risk of kidney stones.
        JAMA. 2005; 293: 455-462
        • Sakemi T.
        • Toyoshima H.
        • Morito F.
        Testosterone eliminates the attenuating effect of castration on the progressive glomerular injury in hypercholesterolemic male Imai rats.
        Nephron. 1994; 67: 469-476
        • Cofan F.
        • Vela E.
        • Cleries M.
        Obesity in renal transplantation: Analysis of 2691 patients.
        Transplant Proc. 2005; 37: 3695-3697
        • Mogensen C.E.
        Prediction of clinical diabetic nephropathy in IDDM patients: Alternatives to microalbuminuria.
        Diabetes. 1990; 39: 761-767
        • de Jong P.E.
        • Verhave J.C.
        • Pinto-Sietsma S.J.
        • et al.
        Obesity and target organ damage: the kidney.
        Int J Obesity. 2002; 26: S21-S24
        • Chagnac A.
        • Weinstein T.
        • Korzets A.
        • et al.
        Glomerular hmodynamics in severe obesity.
        Am J Physiol Renal Physiol. 2000; 278: F817-F822