Body Mass Index and Kidney Disease-Related Mortality in Midlife: A Nationwide Cohort of 2.3 Million Adolescents

Obesity (Silver Spring). 2018 Apr;26(4):776-781. doi: 10.1002/oby.22144. Epub 2018 Mar 2.


Objective: This study aimed to evaluate the association of body mass index (BMI) in adolescence with mortality attributed to kidney disease.

Methods: In this study, 2,294,139 Jewish Israeli adolescents with measured weight and height at 17 years old during the military fitness assessment were analyzed with a follow-up extending up to 45 years. All kidney-related outcomes, coded by the Central Bureau of Statistics from death notifications as the underlying cause of death, were obtained by linkage. Cox hazards models were applied.

Results: During 42,297,007 person-years of follow-up (median 18.4 years), 226 deaths related to kidney disease were recorded. There was an increased risk for kidney-related death among adolescents with overweight and obesity with adjusted hazard ratios of 2.7 (95% CI: 1.8-3.9) and 8.4 (5.1-13.8), respectively, with BMI between 18.5 and 22.0 kg/m2 as the reference. A 15% increased risk for kidney-related mortality (1.11-1.19) per unit increment in BMI was observed. Furthermore, a multivariable spline model indicated a minimum risk for kidney-related mortality starting at BMI of 18.6 kg/m2 with significantly increased risk seen above values of 22.8 kg/m2 . The results withstood extensive sensitivity analyses, including stratification of kidney-related death attributed to acute, chronic, and total kidney disease.

Conclusions: Adolescent overweight and obesity are risk markers for kidney-related mortality over 4 decades.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Body Mass Index*
  • Cohort Studies
  • Female
  • Humans
  • Kidney Diseases / epidemiology
  • Kidney Diseases / etiology*
  • Male
  • Obesity / complications*
  • Overweight / complications*
  • Young Adult