New Delhi: Even as the World Kidney day this year is dedicated to the theme of obesity and chronic kidney disease, data from a large pan-India study led by the George Institute for Global Health, India is only confirming the worst-obesity is highly prevalent amongst Indians with chronic kidney disease, with over-representation of individuals with disproportionately enlarged waistlines, which is likely to take huge toll on their kidney function. Worse still, women are impacted in more numbers than men.
Preliminary data emerging the Indian Chronic Kidney Disease (ICKD) study – a longitudinal study that is recruiting patients with kidney disease early on with the aim of following them up over a long period to identify the risk factors so that appropriate timely prevention measures can be applied – has shown alarmingly high levels of body mass index and waist circumference, thus highlighting the association between measures of obesity and development and progression of CKD.
The study funded by the Department of Biotechnology, Government of India, has been enrolling patients in nine hospitals across the country. A preliminary analysis of data of 1500 patients with kidney disease recruited as part of the study shows the overall prevalence of obesity at 49%, but the figure in women was a whopping 57%. The data on abdominal obesity is even more alarming, with about 63% of women and 48% of men exhibiting waist circumference beyond the cut-offs accepted for the Asian population.
Data for the 1500 patients with Kidney Diseases recruited for the study:
| BMI | Male (%) | Female (%) | Total (%) |
| <15 | 0.69 | 0.99 | 0.78 |
| 15-17.9 | 5.38 | 4.71 | 5.17 |
| 18-21.9 | 25.54 | 16.13 | 22.57 |
| 22-24.9 | 24.32 | 20.55 | 23.45 |
| 25-29.9 | 33.87 | 37.02 | 34.55 |
| >30 | 10.19 | 20.60 | 13.48 |
| Total | 100.00 | 100.00 | 100.00 |
| Waist | Male (%) | Female (%) | Total (%) |
| <70 | 2.68 | 5.84 | 3.72 |
| 71-85 | 33.75 | 29.20 | 32.25 |
| 86-89.9 | 14.11 | 13.50 | 13.91 |
| 90-99.9 | 30.54 | 32.12 | 31.06 |
| >100 | 18.93 | 19.34 | 19.06 |
| Total | 100.00 | 100.00 | 100.00 |
“The data confirms the fact that there is high prevalence of obesity in patients with chronic kidney disease. Of particular concern is the high prevalence of abdominal obesity among women,” says Dr Vivekanand Jha, Executive Director of the George Institute for Global Health, India.
“Obese people are twice as likely to develop kidney disease compared to those with normal weight. Obesity also increases the likelihood of progression of kidney disease and development of complications, such as cardiovascular disease. There are no data on this relationship from India. We hope to follow these patients over a period and review their biomarkers from time to time so that we can understand better the mechanisms underlying the link between CKD and obesity. This will also give us a way to manage and prevent CKD among the obese. In particular, we hope to be explore the link between kidney disease and central or abdominal obesity that is prevalent in Indians and is proven to be particularly harmful.”, said Dr Jha
As per the data from the Global Burden of Disease Study 2013, India is just behind the US and China in terms of the number of obese people. The US is number one with 13 per cent, while China and India account for 15 per cent with 46 million and 30 million obese people respectively.
The exact mechanisms whereby obesity may cause development and worsening of CKD remain unclear. Some of the deleterious renal consequences of obesity may be mediated by comorbid conditions such as diabetes or hypertension but there are also effects of adiposity that impact the kidneys directly resulting in pathological changes,” informs Dr Jha.
The good news is that obesity is largely preventable. “Education and awareness of the risk of obesity and a healthy lifestyle, including proper nutrition and exercise, can dramatically help in preventing obesity and kidney disease,’’ says Dr Jha
