Obesity without metabolic abnormality and incident CKD: a population-based British cohort study

Research output: Contribution to journalArticlepeer-review

External organisations

  • Queen Elizabeth Hospital Birmingham
  • University of Warwick


Rationale & Objective: Metabolically healthy obesity (obesity without any metabolic abnormality) is not considered to be associated with increased risk of morbidity and mortality. We examined and quantified the association between metabolically healthy overweight/obesity and the risk of incident chronic kidney disease (CKD) in a British primary care population. Study Design: Retrospective population-based cohort study. Setting & Participants: 4,447,955 of the 5,182,908 adults in The Health Improvement Network (THIN) database (United Kingdom, 1995-2015) with a recorded body mass index (BMI) at the time of registration date who were free of CKD and cardiovascular disease. Exposure: 11 body size phenotypes were created, defined by BMI categories (underweight, normal weight, overweight, and obesity) and 3 metabolic abnormalities (diabetes, hypertension, and dyslipidemia). Outcome: Incident CKD defined as a recorded code for kidney replacement therapy, a recorded diagnosis of CKD, or by an estimated glomerular filtration rate of <60 mL/min/1.73 m 2 for ≥90 days, or a urinary albumin-creatinine ratio >3 mg/mmol for ≥90 days. Results: Of the 4.5 million individuals, 1,040,921 (23.4%) and 588,909 (13.2%) had metabolically healthy overweight and metabolically healthy obesity, respectively. During a mean follow-up interval of 5.4 ± 4.3 (SD) years, compared with individuals with a metabolically healthy normal weight (n = 1,656,231), there was a higher risk of incident CKD among those who had metabolically healthy overweight (adjusted HR, 1.30 [95% CI, 1.28-1.33]) and metabolically healthy obesity (adjusted HR, 1.66 [95% CI, 1.62-1.70]). The association was stronger in those younger than 65 years of age. In all BMI categories, there was greater risk of incident CKD with a greater number of metabolic abnormalities in a graded manner. Limitations: Potential misclassification of metabolic status due to delayed diagnosis and residual confounding due to unmeasured factors. Conclusions: Overweight and obesity without metabolic abnormality are associated with a higher risk of incident CKD compared with those with normal body weight and no metabolic abnormality.

Bibliographic note

Funding Information: Jingya Wang, PhD, Krishnarajah Niratharakumar, MD, Krishna Gokhale, MSc, Abd A. Tahrani, PhD, Tom Taverner, PhD, G. Neil Thomas, PhD, and Indranil Dasgupta, DM. Conceived the research question: ID, KN, GNT; wrote the protocol: ID; contributed to the protocol: KN, GNT, JW; extracted the data: KG; performed the data analysis: JW; contributed to data interpretation: JW, ID, KN, AAT, GNT; checked the analysis externally: TT. Each author contributed important intellectual content during manuscript drafting or revision and agrees to be personally accountable for the individual's own contributions and to ensure that questions pertaining to the accuracy or integrity of any portion of the work, even one in which the author was not directly involved, are appropriately investigated and resolved, including with documentation in the literature if appropriate. None. The authors declare that they have no relevant financial interests. Received November 30, 2020. Evaluated by 2 external peer reviewers, with direct editorial input from a Statistics/Methods Editor, an Associate Editor, and the Editor-in-Chief. Accepted in revised form May 27, 2021. Publisher Copyright: © 2021 National Kidney Foundation, Inc.


Original languageEnglish
JournalAmerican Journal of Kidney Diseases
Early online date16 Jun 2021
Publication statusE-pub ahead of print - 16 Jun 2021


  • GFR, albuminuria, chronic kidney disease, metabolically healthy, obesity, overweight

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