Obesity, Metabolic Syndrome, and Diabetes and CKD in Men and Women

Previous studies have documented associations between chronic kidney disease (CDK), obesity, and metabolic syndrome. However, there are few data available on how those associations vary across obesity/metabolic phenotypes in males and females.

Chyng-Wen Fwu and colleagues conducted an analysis of data from the 2003-2020 cycles of the National Health and Nutrition Examination Survey for 8586 men and 8420 nonpregnant women ≥20 years of age. Results were reported during a poster session at the American Society of Nephrology Kidney Week 2023 in a poster titled Association of Obesity, Metabolic Syndrome, and Diabetes With CKD in Men and Women: National Health and Nutrition Examination Survey (NHAMES), 2003-2020.

CKD was defined as albuminuria or estimated glomerular filtration rate <60 mL/min/1.73 m²; metabolic syndrome was defined as three of the following: hypertension, prediabetes, hypertriglyceridemia, low high-density lipoprotein cholesterol, and/or central obesity; and obesity was defined as body mass index ≥30 kg/m². CKD, metabolic syndrome, and obesity were defined by physical examination and/or results from fasting laboratory samples.

Diabetes was defined by self-report, prior diagnosis, and/or high fasting glucose or hemoglobin A1c. Participants without diabetes were further categorized based on four obesity/metabolic phenotypes: (1) metabolically healthy nonobese (MHNO); (2) metabolically unhealthy nonobese (MUNO); (3) metabolically healthy obese (MHO): and (4) metabolically unhealthy obese (MUO).

The relationship between CKD and obesity/metabolic phenotypes was examined using multivariable-adjusted logistic regression models.

Among participants with diabetes, the prevalence of CKD was 36.7% for men and 35.9% for women (95% CI, 33.6%-39.8% and 32.2%-39.9%, respectively). In the MUNO group, the prevalence of CKD was 13.2% for men and 21.0% for women (95% CI, 10.6%-16.5% and 18.0%-24.3%, respectively). In the MUO group, the prevalence was 10.9% for men and 14.8% for women (95% CI, 9.1%-13.1% and 12.9%-16.9%, respectively). In the MHNO group, the prevalence was 5.6% for men and 9.6% for women (95% CI, 4.9%-6.5% and 8.5%-10.9%, respectively). In the MHO group, the prevalence was 4.6% for men and 8.4% for women (95% CI, 3.4%-6.2% and 6.6%-10.7%, respectively).

There was an association between CKD and the metabolically unhealthy phenotypes in men (adjusted odds ratio [aOR], MUNO 1.94; 95% CI, 1.41-2.687 and MUO 1.83; 95% CI, 1.40-2.38). In women, there was an association between CKD and the MUNO group only (aOR, 1.50; 95% CI, 1.12-1.99).

In conclusion, the authors said, “These findings suggest different associations between metabolic syndrome and CKD between males and females. Understanding how sex-specific differences such as sex hormones modulate the interaction between obesity/metabolic phenotypes and CKD may provide additional avenues for prevention and treatment.”

Source: Fwu C-W, Barthold J, Kimmel PL, et al. Association of obesity, metabolic syndrome, and diabetes with CKD in men and women: National Health and Nutrition Examination Survey (NHANES), 2003-2020. TH-PO923. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2023; November 2, 2023; Philadelphia, Pennsylvania.