Obesity and synergistic risk factors for chronic kidney disease in African American adults: The Jackson Heart Study

Robert E. Olivo, Clemontina A. Davenport, Clarissa Diamantidis, Nrupen A. Bhavsar, Crystal C. Tyson, Rasheeda Hall, Aurelian Bidulescu, Bessie Young, Stanford E. Mwasongwe, Jane Pendergast, Leigh Boulware, Julia J. Scialla

Research output: Contribution to journalArticle

Abstract

Background African Americans are at high risk for chronic kidney disease (CKD). Obesity may increase the risk for CKD by exacerbating features of the metabolic syndrome and promoting glomerular hyperfiltration. Whether other factors also affecting these pathways may amplify or mitigate obesity-CKD associations has not been investigated. Methods We studied interactions between obesity and these candidate factors in 2043 African Americans without baseline kidney disease enrolled in the Jackson Heart Study. We quantified obesity as body mass index (BMI), sex-normalized waist circumference and visceral adipose volume measured by abdominal computed tomography at an interim study visit. Interactions were hypothesized with (i) metabolic risk factors (dietary quality and physical activity, both quantified by concordance with American Heart Association guidelines) and (ii) factors exacerbating or mitigating hyperfiltration (dietary protein intake, APOL1 risk status and use of renin-angiotensin system blocking medications). Using multivariable regression, we evaluated associations between obesity measures and incident CKD over the follow-up period, as well as interactions with metabolic and hyperfiltration factors. Results Assessed after a median of 8 years (range 6-11 years), baseline BMI and waist circumference were not associated with incident CKD. Higher visceral adipose volume was independently associated with incident CKD (P = 0.008) in a nonlinear fashion, but this effect was limited to those with lower dietary quality (P = 0.001; P-interaction = 0.04). In additional interaction models, higher waist circumference was associated with greater risk of incident CKD among those with the low-risk APOL1 genotype (P = 0.04) but not those with a high-risk genotype (P-interaction = 0.02). Other proposed factors did not modify obesity-CKD associations. Conclusions. Higher risks associated with metabolically active visceral adipose volume and interactions with dietary quality suggest that metabolic factors may be key determinants of obesity-associated CKD risk. Interactions between obesity and APOL1 genotype should be considered in studies of African Americans.

Original languageEnglish (US)
Pages (from-to)992-1001
Number of pages10
JournalNephrology Dialysis Transplantation
Volume33
Issue number6
DOIs
StatePublished - Jun 1 2018
Externally publishedYes

Fingerprint

Chronic Renal Insufficiency
African Americans
Obesity
Waist Circumference
Genotype
Body Mass Index
Dietary Proteins
Kidney Diseases
Renin-Angiotensin System
Tomography
Guidelines
Exercise

Keywords

  • albuminuria
  • APOL1
  • CKD
  • metabolic syndrome
  • nutrition
  • obesity

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Cite this

Obesity and synergistic risk factors for chronic kidney disease in African American adults : The Jackson Heart Study. / Olivo, Robert E.; Davenport, Clemontina A.; Diamantidis, Clarissa; Bhavsar, Nrupen A.; Tyson, Crystal C.; Hall, Rasheeda; Bidulescu, Aurelian; Young, Bessie; Mwasongwe, Stanford E.; Pendergast, Jane; Boulware, Leigh; Scialla, Julia J.

In: Nephrology Dialysis Transplantation, Vol. 33, No. 6, 01.06.2018, p. 992-1001.

Research output: Contribution to journalArticle

Olivo, RE, Davenport, CA, Diamantidis, C, Bhavsar, NA, Tyson, CC, Hall, R, Bidulescu, A, Young, B, Mwasongwe, SE, Pendergast, J, Boulware, L & Scialla, JJ 2018, 'Obesity and synergistic risk factors for chronic kidney disease in African American adults: The Jackson Heart Study', Nephrology Dialysis Transplantation, vol. 33, no. 6, pp. 992-1001. https://doi.org/10.1093/ndt/gfx230
Olivo, Robert E. ; Davenport, Clemontina A. ; Diamantidis, Clarissa ; Bhavsar, Nrupen A. ; Tyson, Crystal C. ; Hall, Rasheeda ; Bidulescu, Aurelian ; Young, Bessie ; Mwasongwe, Stanford E. ; Pendergast, Jane ; Boulware, Leigh ; Scialla, Julia J. / Obesity and synergistic risk factors for chronic kidney disease in African American adults : The Jackson Heart Study. In: Nephrology Dialysis Transplantation. 2018 ; Vol. 33, No. 6. pp. 992-1001.
@article{022fb2bcf8e84d4fb2fa57fdd2670fda,
title = "Obesity and synergistic risk factors for chronic kidney disease in African American adults: The Jackson Heart Study",
abstract = "Background African Americans are at high risk for chronic kidney disease (CKD). Obesity may increase the risk for CKD by exacerbating features of the metabolic syndrome and promoting glomerular hyperfiltration. Whether other factors also affecting these pathways may amplify or mitigate obesity-CKD associations has not been investigated. Methods We studied interactions between obesity and these candidate factors in 2043 African Americans without baseline kidney disease enrolled in the Jackson Heart Study. We quantified obesity as body mass index (BMI), sex-normalized waist circumference and visceral adipose volume measured by abdominal computed tomography at an interim study visit. Interactions were hypothesized with (i) metabolic risk factors (dietary quality and physical activity, both quantified by concordance with American Heart Association guidelines) and (ii) factors exacerbating or mitigating hyperfiltration (dietary protein intake, APOL1 risk status and use of renin-angiotensin system blocking medications). Using multivariable regression, we evaluated associations between obesity measures and incident CKD over the follow-up period, as well as interactions with metabolic and hyperfiltration factors. Results Assessed after a median of 8 years (range 6-11 years), baseline BMI and waist circumference were not associated with incident CKD. Higher visceral adipose volume was independently associated with incident CKD (P = 0.008) in a nonlinear fashion, but this effect was limited to those with lower dietary quality (P = 0.001; P-interaction = 0.04). In additional interaction models, higher waist circumference was associated with greater risk of incident CKD among those with the low-risk APOL1 genotype (P = 0.04) but not those with a high-risk genotype (P-interaction = 0.02). Other proposed factors did not modify obesity-CKD associations. Conclusions. Higher risks associated with metabolically active visceral adipose volume and interactions with dietary quality suggest that metabolic factors may be key determinants of obesity-associated CKD risk. Interactions between obesity and APOL1 genotype should be considered in studies of African Americans.",
keywords = "albuminuria, APOL1, CKD, metabolic syndrome, nutrition, obesity",
author = "Olivo, {Robert E.} and Davenport, {Clemontina A.} and Clarissa Diamantidis and Bhavsar, {Nrupen A.} and Tyson, {Crystal C.} and Rasheeda Hall and Aurelian Bidulescu and Bessie Young and Mwasongwe, {Stanford E.} and Jane Pendergast and Leigh Boulware and Scialla, {Julia J.}",
year = "2018",
month = "6",
day = "1",
doi = "10.1093/ndt/gfx230",
language = "English (US)",
volume = "33",
pages = "992--1001",
journal = "Nephrology Dialysis Transplantation",
issn = "0931-0509",
publisher = "Oxford University Press",
number = "6",

}

TY - JOUR

T1 - Obesity and synergistic risk factors for chronic kidney disease in African American adults

T2 - The Jackson Heart Study

AU - Olivo, Robert E.

AU - Davenport, Clemontina A.

AU - Diamantidis, Clarissa

AU - Bhavsar, Nrupen A.

AU - Tyson, Crystal C.

AU - Hall, Rasheeda

AU - Bidulescu, Aurelian

AU - Young, Bessie

AU - Mwasongwe, Stanford E.

AU - Pendergast, Jane

AU - Boulware, Leigh

AU - Scialla, Julia J.

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Background African Americans are at high risk for chronic kidney disease (CKD). Obesity may increase the risk for CKD by exacerbating features of the metabolic syndrome and promoting glomerular hyperfiltration. Whether other factors also affecting these pathways may amplify or mitigate obesity-CKD associations has not been investigated. Methods We studied interactions between obesity and these candidate factors in 2043 African Americans without baseline kidney disease enrolled in the Jackson Heart Study. We quantified obesity as body mass index (BMI), sex-normalized waist circumference and visceral adipose volume measured by abdominal computed tomography at an interim study visit. Interactions were hypothesized with (i) metabolic risk factors (dietary quality and physical activity, both quantified by concordance with American Heart Association guidelines) and (ii) factors exacerbating or mitigating hyperfiltration (dietary protein intake, APOL1 risk status and use of renin-angiotensin system blocking medications). Using multivariable regression, we evaluated associations between obesity measures and incident CKD over the follow-up period, as well as interactions with metabolic and hyperfiltration factors. Results Assessed after a median of 8 years (range 6-11 years), baseline BMI and waist circumference were not associated with incident CKD. Higher visceral adipose volume was independently associated with incident CKD (P = 0.008) in a nonlinear fashion, but this effect was limited to those with lower dietary quality (P = 0.001; P-interaction = 0.04). In additional interaction models, higher waist circumference was associated with greater risk of incident CKD among those with the low-risk APOL1 genotype (P = 0.04) but not those with a high-risk genotype (P-interaction = 0.02). Other proposed factors did not modify obesity-CKD associations. Conclusions. Higher risks associated with metabolically active visceral adipose volume and interactions with dietary quality suggest that metabolic factors may be key determinants of obesity-associated CKD risk. Interactions between obesity and APOL1 genotype should be considered in studies of African Americans.

AB - Background African Americans are at high risk for chronic kidney disease (CKD). Obesity may increase the risk for CKD by exacerbating features of the metabolic syndrome and promoting glomerular hyperfiltration. Whether other factors also affecting these pathways may amplify or mitigate obesity-CKD associations has not been investigated. Methods We studied interactions between obesity and these candidate factors in 2043 African Americans without baseline kidney disease enrolled in the Jackson Heart Study. We quantified obesity as body mass index (BMI), sex-normalized waist circumference and visceral adipose volume measured by abdominal computed tomography at an interim study visit. Interactions were hypothesized with (i) metabolic risk factors (dietary quality and physical activity, both quantified by concordance with American Heart Association guidelines) and (ii) factors exacerbating or mitigating hyperfiltration (dietary protein intake, APOL1 risk status and use of renin-angiotensin system blocking medications). Using multivariable regression, we evaluated associations between obesity measures and incident CKD over the follow-up period, as well as interactions with metabolic and hyperfiltration factors. Results Assessed after a median of 8 years (range 6-11 years), baseline BMI and waist circumference were not associated with incident CKD. Higher visceral adipose volume was independently associated with incident CKD (P = 0.008) in a nonlinear fashion, but this effect was limited to those with lower dietary quality (P = 0.001; P-interaction = 0.04). In additional interaction models, higher waist circumference was associated with greater risk of incident CKD among those with the low-risk APOL1 genotype (P = 0.04) but not those with a high-risk genotype (P-interaction = 0.02). Other proposed factors did not modify obesity-CKD associations. Conclusions. Higher risks associated with metabolically active visceral adipose volume and interactions with dietary quality suggest that metabolic factors may be key determinants of obesity-associated CKD risk. Interactions between obesity and APOL1 genotype should be considered in studies of African Americans.

KW - albuminuria

KW - APOL1

KW - CKD

KW - metabolic syndrome

KW - nutrition

KW - obesity

UR - http://www.scopus.com/inward/record.url?scp=85048626881&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85048626881&partnerID=8YFLogxK

U2 - 10.1093/ndt/gfx230

DO - 10.1093/ndt/gfx230

M3 - Article

C2 - 28992354

AN - SCOPUS:85048626881

VL - 33

SP - 992

EP - 1001

JO - Nephrology Dialysis Transplantation

JF - Nephrology Dialysis Transplantation

SN - 0931-0509

IS - 6

ER -