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Waist-to-height ratio, body mass index, and cardiovascular risk profile in children with chronic kidney disease

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Abstract

Background

Cardiovascular (CV) risk is high in children with chronic kidney disease (CKD), and further compounded in those who are overweight. Children with CKD have a unique body habitus not accurately assessed by body mass index (BMI). Waist-to-height ratio (WHr), a better predictor of CV risk in populations with short stature, has not been investigated in children with CKD.

Methods

Analysis of 1723 visits of 593 participants enrolled in the Chronic Kidney Disease in Children (CKiD) study was conducted. CKiD participants had BMI and WHr measured and classified as follows: (1) lean (WHr ≤ 0.49, BMI < 85th percentile); (2) WHr-overweight (WHr > 0.49, BMI < 85th percentile); (3) BMI-overweight (WHr ≤ 0.49, BMI ≥ 85th percentile); or (4) overweight by both BMI and WHr. Left ventricular mass index (LVMI), fasting lipids, fibroblast growth factor 23 (FGF23), blood pressure, and glucose were measured as markers of CV risk. Linear mixed-effects regression was used to evaluate differences in CV markers between overweight and lean groups.

Results

Participants were 12.2 years old, 60% male, and 17% African-American. Approximately 15% were overweight by WHr but not by BMI. Overweight status by WHr-only or both WHr and BMI was associated with lower high-density lipoprotein (HDL) and higher LVMI, triglycerides, and non-HDL cholesterol compared to lean. CV markers of participants overweight by BMI-only were similar to those of lean children.

Conclusions

WHr-adiposity is associated with an adverse CV risk profile in children with CKD. A significant proportion of children with central adiposity are missed by BMI. WHr should be utilized as a screening tool for CV risk in this population.

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Acknowledgements

Data in this manuscript were collected by the Chronic Kidney Disease in Children prospective cohort study (CKiD) with the clinical coordinating centers (Principal Investigators) at Children’s Mercy Hospital and the University of Missouri – Kansas City (Bradley Warady, MD) and Children’s Hospital of Philadelphia (Susan Furth, MD, PhD), Central Biochemistry Laboratory (George Schwartz, MD) at the University of Rochester Medical Center, and data coordinating center (Alvaro Muñoz, PhD) at the Johns Hopkins Bloomberg School of Public Health.

Funding

The CKiD Study is supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases, with additional funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Heart, Lung, and Blood Institute (U01-DK-66143, U01-DK-66174, U01DK-082194, U01-DK-66116). The CKiD website is located at http://www.statepi.jhsph.edu/ckid.

Author information

Authors and Affiliations

  1. Department of Nephrology, Children’s National Health System, 111 Michigan Avenue NW, Washington, DC, 20010, USA

    Kristen Sgambat & Asha Moudgil

  2. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Jennifer Roem

  3. Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Mark Mitsnefes

  4. University of California, San Francisco, CA, USA

    Anthony A. Portale

  5. The Children’s Hospital of Philadelphia, Department of Pediatrics, Philadelphia, PA, USA

    Susan Furth

  6. Children’s Mercy Kansas City, Kansas City, MO, USA

    Bradley Warady

Authors
  1. Kristen Sgambat
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  2. Jennifer Roem
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  3. Mark Mitsnefes
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  4. Anthony A. Portale
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  5. Susan Furth
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  6. Bradley Warady
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  7. Asha Moudgil
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Contributions

All authors contributed to the conception or design of the study, analysis, and/or interpretation of data, writing, and/or revising the manuscript. All authors contributed to the intellectual contents of this work.

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Correspondence to Kristen Sgambat.

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Sgambat, K., Roem, J., Mitsnefes, M. et al. Waist-to-height ratio, body mass index, and cardiovascular risk profile in children with chronic kidney disease. Pediatr Nephrol 33, 1577–1583 (2018). https://doi.org/10.1007/s00467-018-3987-2

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  • DOI: https://doi.org/10.1007/s00467-018-3987-2

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