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Body mass index and implications for pediatric kidney health: a cross-sectional study with urinary biomarkers

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Abstract

Background

Extremes of unhealthy body weight, particularly obesity, are known to increase the risk of chronic kidney diseases. However, the current knowledge of kidney health outcomes associated with unhealthy body weight remains incomprehensive, especially in pediatrics. Therefore, the present study aimed to evaluate body mass index (BMI) and its potential associations with kidney health in a selected subset of school students in Sri Lanka.

Methods

This cross-sectional study was conducted among students of both sexes in the range of 11–18 years of age (N = 1078) in education zones with no reported cases of chronic kidney disease of uncertain etiology. Based on sex- and age-specific BMI percentiles (LMS method), the participants were classified into five BMI groups (severely thin, thin, healthy, overweight, and obese) for measurement of urinary biomarkers of kidney injury: kidney injury molecule (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), and albumin creatinine ratio (ACR).

Results

The median urinary levels of NGAL, ACR, and particularly KIM-1, which is a more sensitive indicator of kidney injury, showed no significant differences across the BMI strata. Importantly, moderate correlations of BMI with KIM-1 and NGAL were identified in severely thin girls.

Conclusions

According to the present study, these findings do not produce plausibly strong evidence to establish a potential association of BMI with altered kidney function in the studied pediatric communities. Particularly, a likelihood of abnormal kidney health outcomes associated with undernutrition is apparent in severely thin girls. However, in-depth studies are warranted to develop a comprehensive understanding of the associations of nutritional status with pediatric kidney health in Sri Lanka.

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Data availability

The datasets generated and analyzed during the current study are not publicly available due to restrictions under the approval of the ethics review board. However, they are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors would like to thank all the students who participated in the study, academic and non-academic staff members of the schools, government authorities, and parents for their valuable support.

Funding

This work was supported by the Accelerating Higher Education Expansion and Development (AHEAD) Operation of the Ministry of Higher Education funded by the World Bank (grant number: AHEAD DOR 02/40) and the Duke Global Health Pilot Grant.

Author information

Authors and Affiliations

  1. Department of Zoology, Faculty of Science, University of Ruhuna, Matara, 81000, Sri Lanka

    T. D. K. S. C. Gunasekara & P. Mangala C. S. De Silva

  2. Department of Biosystems Technology, Faculty of Technology, University of Ruhuna, Matara, 81000, Sri Lanka

    E. P. S. Chandana

  3. Department of Pharmacology, Faculty of Medicine, University of Ruhuna, Galle, 80000, Sri Lanka

    Sudheera Jayasinghe

  4. Department of Nephrology, Sri Jayewardenepura General Hospital, Colombo, 10100, Sri Lanka

    Chula Herath

  5. Department of Medicine, Faculty of Medical & Allied Sciences, Rajarata University, Saliyapura, 50008, Sri Lanka

    Sisira Siribaddana

  6. Nicholas School of the Environment, Duke University, Durham, NC, 27708, USA

    Nishad Jayasundara

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  1. T. D. K. S. C. Gunasekara
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Contributions

Conceptualization: PMCSDS, NJ. Data curation: PMCSDS, TDKSCG. Formal analysis: PMCSDS, TDKSCG. Funding acquisition: PMCSDS, NJ. Investigation: PMCSDS, NJ, TDKSCG. Methodology: PMCSDS, NJ, TDKSCG. Project administration: PMCSDS, NJ. Resources: PMCSDS, NJ, SS, EPSC, CH, SSJ. Software: TDKSCG, PMCSDS. Supervision: PMCSDS, EPSC, NJ, SS, CH, SSJ. Validation: PMCSDS, NJ, SS, CH, SSJ, EPSC. Visualization: TDKSCG, PMCSDS. Writing—original draft: TDKSCG. Writing—review and editing: PMCSDS, NJ, SS, CH, SSJ, and EPSC.

Corresponding author

Correspondence to P. Mangala C. S. De Silva.

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Ethical approval

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethics Review Committee of the Faculty of Medicine, University of Ruhuna, Sri Lanka (reference no: 2020.P.124; Date: 29.01.2021).

Competing interests

The authors declare no competing interests.

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Gunasekara, T.D.K.S.C., De Silva, P.M.C.S., Chandana, E.P.S. et al. Body mass index and implications for pediatric kidney health: a cross-sectional study with urinary biomarkers. Pediatr Nephrol 39, 167–175 (2024). https://doi.org/10.1007/s00467-023-06071-0

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