Nephrol Dial Transplant (2002) 17: 2273
© 2002 European Renal Association-European Dialysis and Transplant Association
Letter and Reply
Overweight and obesity as a nutritional issue in the dialysis population
Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Vitamin Metabolism and Aging, Boston, MA, USA. Email: afriedman{at}hnrc.tufts.edu
Sir,
The European nutritional consensus paper [1] was in general a cogent summary of the major issues currently facing the dialysis population. However, as with other nutritional guidelines [2], it neglects to address the growing threat of overweight and obesity, a problem associated with increased risk of sudden death, coronary artery disease, hypertension, diabetes and dyslipidaemia.
The major nutritional illness facing dialysis patients has historically been protein-energy malnutrition. However, in parallel with the burgeoning prevalence of overweight and obesity in the West, there is now clear evidence that overweight and obesity is making inroads in the dialysis population. National data reveal the mean body mass index (BMI) for incident dialysis patients [3], as well as dialysis patients at the time of kidney transplantation [4], to be in the overweight range (BMI 25–29.9), with the trend increasing annually. This should not be surprising as the demographic groups at greatest risk for progression of renal disease and renal failure (i.e. ethnic minorities, the elderly and diabetic patients) are also those most susceptible to overweight and obesity.
Concern over this issue may have been mitigated by studies suggesting that a higher BMI in dialysis patients is relatively protective with regards to mortality [5]. However, these reports are vulnerable to confounding by comorbid conditions, by failing to eliminate early mortality from the analyses, and by inappropriately controlling for intermediate risk factors through which overweight and obesity exert their pernicious effects. In contrast, data from the general as well as incident kidney transplant population find that a higher BMI is associated with worse outcomes [4].
It is now time for the nephrology community to approach the issue of overweight and obesity in the dialysis population in a more serious and public manner.
References
- Locatelli F, Fouque D, Heimburger O et al. Nutritional status in dialysis patients: a European consensus. Nephrol Dial Transplant2002; 17:563–572
[Abstract/Free Full Text] - Clinical practice guidelines for nutrition in chronic renal failure. K/DOQI, National Kidney Foundation. Am J Kidney Dis2000; 35 (6 Suppl 2):S1–140
- US Renal Data System, USRDS 2001 Annual Data Report: Atlas of End-Stage Renal Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD,2001
- Meier-Kriesche H-U, Arndorfer JA, Kaplan B. The impact of body mass index on renal transplant outcomes: a significant independent risk factor for graft failure and patient death. Transplantation2002; 73:70–74[Web of Science][Medline]
- Leavey SF, McCullough K, Hecking E, Goodkin D, Port FK, Young EW. Body mass index and mortality in ‘healthier’ as compared with sicker haemodialysis patients: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant2001; 16:2386–2394
[Abstract/Free Full Text]
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