(r = 0.67, p < 0.01 and r = 0.66, p < 0.01, respectively). Seventeen men below this cut-off had an eGFR > 130 while 6 men above this cut-off did, suggesting that lower BMI at this stage of the CART was more predictive of higher eGFR. "Black people need to be included in the research, to have research that is reflective of black people of all ethnicities," says Dr Tosin Sotubo, a GP and advocate for diversity in health and wellness. Next, multivariate logistic regression models were used to assess the risk of hyper filtration (eGFR > 130) associated with BMI and WC. Although BMI is still a widely recommended toolto work out if you're at a healthy weight, some argue that more research needs to be done into other ethnic groups. Am J Transplant 11: 1650-1655. (2011) Ethic and gender related difference in the risk of end-stage renal disease after living kidney donation. Similarly, obese live kidney donors were also more likely to have a decrease in GFR . View Figure 2. In addition, WC-categorized obese men and women had GFR > 130. Am J Transplant 7: 394-401. The CART does not suggest that WC is an important predictor as the logistic regression did; however, it does suggest that SBP is predictive of eGFR, but this finding is not strong given its late appearance in the CART. Thirty-eight males fell above the cut-off of 130 for eGFR at the initial step of the CART while 60 males fell below this cut-off.
For example, Asian-Americans tend to develop health risks, including the risk of diabetes, at lower BMIs than whites.
In the past, transplant surgeons have rejected donors with low creatinine clearances < 80, hypertension, and with morbid obesity but have not considered an eGFR > 130 as a risk factor. To examine relationships between BMI, waist circumference [WC] and GFR as potential risk factors for CKD in relatively healthy Blacks. But if you're from India, your risk of diabetes starts going up with a BMI of about 21 or 22.". Black people are more likely to be overweight than white peopleandblack and Asian groups have a higher risk of diabetes and heart disease, according to research from the Institute for Fiscal Studies. Unadjusted associations among study variables are found in Table 3 (Appendix 1, Appendix 2 and Appendix 3). Results indicate that increased BMI (> 30 kg/m2), increased waist circumference (> 40 inches) and increased GFR (> 130 ml/min) were strongly correlated in Black volunteers. Sex differences in WC cut-offs were utilized to stratify participants as non-obese or obese. J Am Coll Surg 210: 708-717. Figure 1 illustrates the CART for females. This was achieved by examining a community-based sample of potential AA. GFR was stratified into two categories: GFR less than or equal to 130 and GFR greater than 130. Likewise, males with WC at or below 102 cm/40 inches were categorized as non-obese. I didn't know how to get myself to a healthy BMI. This analysis is a useful statistical technique that may help, identify participants most at risk for hyper filtration. "They have very low levels of muscle and bone -- often elderly people, those in poor shape, sometimes those who are sick. Hall JE (2003) The kidney, hypertension, and obesity. (2019) BMI, Waist Size, GFR: In African American Blacks. Your activity level: Someone who is very inactive may have a BMI in the normal range and have lots of body fat, though they may not look out of shape. But the National Institute for Health and Care Excellence, which provides guidance for healthcare in England, has reported that the BMI cut-off points that determine if someone is overweight or obese are from previous studies of European-derived populations and may not be appropriate for other ethnic groups. Sample mean age was 45 years; 48% were males. The purpose of this study was to determine if being overweight and obese were associated with glomerular hyper filtration (as defined by an eGFR > 130) in a non-patient sample of African Americans. ", Gambling addiction: 'A vicious cycle I couldn't get out of', Aspiring chef: 'Small or tall, I'm the same standard as everyone else in the kitchen', Conversations with Friends: 'Endometriosis plot might make someone visit GP', Peacock's Allan 'Seapa' Mustafa: 'People are being more open about body image issues', Every question you ever had about female ejaculation, answered, Five expert-approved break-up texts to send instead of ghosting. Data collection took place at the General Clinical Research Center (GCRC) and included blood and urine collection by a registered nurse employed by the GCRC. While the risk of ESRD among obese individuals has been emphasized in the literature, the dangers of overweight and obesity for live kidney donors have received little attention. "The standard definition of overweight is a BMI of 25 or above. Waist size: For an accurate measurement, the tape measure should go around your waist at the top of your hip bones in your lower back and go around to the belly button. Clin J Am Soc Nephrol 2: 1215-1222. Health United States, 2018. Each categorized measure of obesity was used to predict dichotomous eGFR levels with the addition of several covariates. Among men, BMI overweight status did not increase the odds ratio (OR) of an eGFR > 130. Waist circumference was measured in centimeters/inches at the level of the umbilicus. Diabetes 51: 1572-1579. At his center, measuring BMI is only a starting point. They don't seem to have any health effects associated with their excess weight.". He sees people who are overweight but healthy, and their BMI doesn't truly reflect their health risks. Therefore, an African-American with a BMI of 28, which the standard chart calls overweight, might be as healthy as a white person with a BMI of 25. JAMA 311: 579-586. Our initial findings suggested that both BMI and WC were positively associated with glomerular hyper filtration, as indicated by GFR > 130. The goal of the overall study was to identify biological, psychological, and social factors that are associated with impaired renal function and renal disease. You may want to get out your measuring tape. According to Public Health England, it is known that the health risks of being overweight for some BAME groups occur at a lower BMI than for white populations. For women, age was an important variable as well. Figure 2: Classification and regression tree analysis: Males. I was looking for diet pills online that tell you you can achieve your goal weight quickly. -- Scott Kahan, MD. In Tendai's case, for a long time her BMI prevented her from getting surgery that she "would have gone through anything for," she says. We hypothesized that greater BMI and waist circumference would be associated with glomerular hyper filtration and suggest that even overweight and moderate obesity may provide additional insight into the reason AA live kidney donors develop ESRD after donation. "People who are older probably should have a little more fat on them, [but] they shouldn't have a BMI of 30," Atkinson says. After accounting for key health indicators, BMI overweight status did not increase the chances of an e\GFR >130 but BMI-obesity in men did. Summary Health Statistics: National Health Interview Survey: 2018. A football player who is very muscular could have a high BMI and yet their body fat is actually low. Information on age, sex, ethnicity, education, income, and marital status was based on self-report during the interview portion of the study. "An individual's BMI will factor into whether they are allowed to undergo certain surgical procedures and can even affect the life or health insurance premium they can be offered.". African American women have the highest rates of obesity or being overweight compared to other groups in the United States. (2014) Risk of end stage renal disease following live kidney donation. Inrig JK, Gillespie BS, Patel UD, Briley LP, She L, et al. Three seated blood pressure measurements were taken. Acta Endocrinol Suppl (Copenh) 242: 7-10. Wuerzner G, Pruiim M, Maillard M, Bovet P, Renaud C, et al. The current study investigated the relation between overweight and obesity and glomerular hyper filtration to identify possible risk factors for live kidney donation in a community-based sample of Blacks. According to NHS England, an ideal BMI is in the 18.5-24.9 range, anything between 25-29.9 is in the overweight range and a BMI between 30-39.9 would be classed as obese. A healthy BMI for Asians ranges from 18.5 to 23.9, a full point lower than the standard range. Informed consent was obtained from all patients being included in the study. The study aimed to better understand the disparity between Black's, who disproportionately develop ESRD after donation, and other ethnic populations. Table A-15a. This finding was contrary to what has been suggested in other research. And Asians are considered obese at a BMI of 27 or higher, compared to the standard BMI obesity measure of 30 or higher. To better understand the intricacies of our data, we utilized classification and regression trees (CART). Nephrol Dial Transplant 27: 1708-1714. The location of your fat makes a difference to your health. Previous research [21-25] has suggested that when glomerular hyper filtration is in excess of 130, kidney damage may occur. CART analysis identified a gender difference in these risk factors with males aged < 53 and WC > 105 having a strong association with eGFR > 130 and females aged < 57 and BMI > 34 being strongly associated with eGFR > 130. "BMI wasn't even made for people of colour like me so I was very frustrated.". But now she no longer feels like it's necessary. Their BMI shows up pretty high, and yet their body fat is actually pretty low," Kahan says. The risk for complications among morbidly obese individuals has been emphasized in the literature and may have substantial relevance for AA. People who are overweight are more likely to suffer from high blood pressure, high levels of blood fats, diabetes and LDL cholesterol. "I am trying to lose weight myself so I do talk about weight every now and again but I try to do it in a way that is accessible for everyone and not make anybody feel like they need to be a certain weight or number. Previous findings have identified eGFR greater than 130 as a marker for hyper filtration [16,17].
The final partition in this subset was defined by a BMI > 29. Self-reported data on hypertension and diabetes were provided by subjects based on a physician's previous diagnosis. Table 26. "When the doctors told me that because of my BMI it was too risky, I just remember feeling very hopeless. Younger women were eight times as likely as older women to have an eGFR > 130 (OR = 8.180). Brenner BM, Hostetter TH, Olson JL, Rennke HG, Venkatachalam MA (1981) The role of glomerular hyperfiltration in the initiation and progression of diabetic nehropathy. He points out that late in life, people who are "a little bit overweight" tend to have a better survival rate than leaner people. Journal of Obesity and Weight-loss Medication. https://nhqrnet.ahrq.gov/inhqrdr/data/query, Obesity is a risk factor for several diseases. Among men, BMI and WC were significantly and positively associated with eGFR. Mean BMI and waist circumference were 31 and 38 respectively. 2019. As a result, GFR and renal plasma flow rate increase. Clive O Callender, Department of Surgery, Howard University School of Medicine, USA. Several mechanisms have been put forth in an attempt to explain the obesity-hyper filtration link. Questions to Ask Your Doctor. Explanations for these live donation data are few. The strongest predictor of an eGFR > 130 among females was BMI. Other ways to measure body fat that may be more accurate than using BMI alone include the waist-to-hip circumference, skinfold thickness measurement, and ultrasound. While the risk for developing ESRD after live kidney donation is minimal, when it does occur, Blacks, are disproportionately represented. Not only is weight associated with reduced kidney functioning, but extensive evidence implicates increased body mass index (BMI) as a risk factor for hyper filtration [11-13]. ", Joslin Diabetes Center: "Diabetes in Asians and Asian Americans. Pearson correlations and multiple regressions were utilized to assess initial relations between BMI, waist circumference, eGFR, and other explanatory variables. Transplant Proc 40: 1337-1340. BMI-categorized obese women were nearly 40 times more likely to have an eGFR > 130 than their normal BMI counterparts (OR = 39.493). Eknoyan, G. Nephrology Dialysis Transplantation, published online Sept. 22, 2007. Other research identified older age at the time of donation as a potential risk factor for poorer renal function atrer donation in both Blacks and Caucasians . Black donors with obesity risk factors, when combined with GFR > 130 may be the factors placing overweight or obese AAs at increased risk for CKD after kidney donation. In the beginning, Scola says, "I used BMI very strictly to measure my progress and see how well I was doing and I remember getting so excited when I was getting a lower number on the BMI scale. "I got to a point where it was starting to affect my life at home because I was doing everything I could for me to get to that BMI where I could desperately have this operation. Kahan specializes in helping people manage excess weight that can lead to health problems, including diabetes and heart disease. Ellison MD, McBride MA, Taranto SE, Delmonico FL, Kauffman HM (2002) Living kidney donors in need of kidney transplants: A report from the organ procurement and transplant network.
And yet on every level that we look at, their health is actually quite good," he says. Read about our approach to external linking. Springer, New York. 2005 - 2022 WebMD LLC. Your BMI doesn't reveal anything about the makeup of your body, such as how much muscle vs. fat you have. Within the subset of 23 men who fell below this cut-off, age was the next most important predictor. The Howard University Institutional Review Board approved the study protocol. There has been a sustained effort to encourage live kidney donation among Blacks in the past three decades, and organ donation has consistently risen within this community [1-3]. Classification and Regression trees (CARTs)  were analyzed to confirm logistic regression findings without imposed cut-offs. This manuscript was made possible by Howard University's General Clinical Research Center grant #2MO1-RR010284 from the National Center for Research Resources (NCRR) a component of the National Institutes of Health (NIH) and its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH. Blacks have a greater need for kidney transplants than other American ethnic groups. Above age 37, 7 females had an eGFR > 130 and below 37, 9 females had an eGFR > 130. Reeves-Daniel A, Adams PL, Daniel K, Assimos D, Westcott C, et al. "But health is much more complex and we have to look at a person's background, lifestyle, and muscle mass. Generally, it's the belly fat, or the "apple" shape, that has a higher health risk. BMI was calculated by dividing weight (kilograms) by height (square meters). "Ultimately, they have similar risks as people who carry lots of body fat and have a high BMI.". Wickman, C, Kraver H (2013) Obesity and kidney disease: Potential mechanism. Transplant Proc 48: 2392-2395. Clin J Am Soc Nephrol 10: 1565-1574. Figure 1: Classification and regression tree analysis: Females. "It's always about how you feel in yourself. Findings for females were mainly consistent with the logistic regression findings where BMI and age were the strongest predictors of an eGFR > 130. Transplantation 74: 1349-1351. "I ended up looking at fad diets, thinking maybe if I stopped eating I would lose weight. So what other tools can you use besides BMI? The covariates (BMI, WC, age, systolic blood pressure, self-reported hypertension, and self-reported diabetes) and the response variable (eGFR) were defined as in logistic regression with the response representing whether an individual had an eGFR < 130 or greater than or equal to 130. Recursive partitioning was employed to force the data into homogeneous groups according to an entropy criterion . Gibney EM, King AL, Maluf DG, Garg AX, Parikh CR (2007) Living kidney donors requiring transplantation: Focus on African Americans. Younger women and men were more likely to have GFR > 130. This manuscript poses a question that the Kidney Transplant Black/White disparity has recently raised concerns for the ethicists and transplant surgeons for some time. It may be even more helpful than waist circumference alone, Kahan says.
https://nhqrnet.ahrq.gov/inhqrdr/data/query, Source: National Healthcare Quality and Disparities Reports. Diabetes See Diabetes and African Americans "In order for me to move mentally forward, I felt like I needed to have this operation," she says. "Health is not just a number, healthcare professionals need to understand a patient's culture and background, which can all have an influence. Over half of London's LGBT venues have closed. Data Query: Table 7_2_1_5_1.2b [Accessed 03/03/2020] "We do sometimes base health on certain parameters, such as BMI, so we can get an idea of how we can help our patients if they're at higher risk for certain diseases or health conditions. Physical exams, laboratory and anthropometric data were collected. Search: Source: CDC 2019. Callender CO, Mwendwa DT, Gholson G, Wright RS, Larry KII, et al. Your body type: Are you an apple shape or a pear shape? "Back then, as a 14-year-old trying to learn everything by yourself, I didn't know that chart might not be for me.". At a WC cut-off of 105.41, 23 males fell below this cut-off and 15 males fell above it, suggesting that lower WC was more predictive of an eGFR > 130. Brenner BM, Lawler EV, Mackenzie HS (1996) The hyperfiltration theory: A paradigm shift in nephrology. Another explanation suggests that excessive visceral adiposity physically compresses the kidneys and increases renal-pressure natriuresis . Future prospective studies therefore are necessary to better identify if Blacks are at greater risk for ESRD after live kidney donations. The final partitioning of this subset indicated that a systolic blood pressure of 157 was the cut-off where 26 females with SBP less than or equal to 157 had an eGFR > 130 and one female with SBP > 157 had an eGFR > 130. BMI was categorized based on established cut-offs: 18.5 - 24.9 = normal weight; 25.0 - 29.9 = overweight; and greater than or equal to 30 = obese.
(2009) A study of renal outcomes in African American living kidney donors. View Table 2, Table 3: Unadjusted associations between BMI, WC, eGFR, and explanatory variables. National Heart, Lung, and Blood Institute: "How Are Overweight and Obesity Diagnosed? The GFR was estimated using the Cockcroft Gault equation method. Participants included 214 Black community volunteers from the Washington, DC area.