Early-Life Overweight Trajectory and CKD in the 1946 British Birth Cohort Study

Background: Few studies have examined the impact of childhood obesity on later kidney disease, and consequently, our understanding is very limited. Study Design: Longitudinal population-based cohort. Setting & Participants: The Medical Research Council National Survey of Health and Development, a socially stratified sample of 5,362 singletons born in 1 week in March 1946 in England, Scotland, and Wales, of which 4,340 were analyzed. Predictor: Early-life overweight latent classes (never, prepubertal only, pubertal onset, or always), derived from repeated measurements of body mass index between ages 2 and 20 years. Outcomes & Measurements: The primary outcome was chronic kidney disease (CKD), defined as creatinine- or cystatin C-based estimated glomerular filtration rate (eGFR(cr) and eGFR(cys), respectively) <60 mL/min/1.73 m(2) or urine albumin-creatinine ratio (UACR) >3.5 mg/mmol measured at age 60-64 years. Associations were explored through regression analysis, with adjustment for socioeconomic position, smoking, physical activity level, diabetes, hypertension, and overweight at ages 36 and 53 years. Results: 2.3% of study participants had eGFR(cr) <60 mL/min/1.73 m(2), 1.7% had eGFR(cys) <60 mL/min/1.73 m(2), and 2.9% had UACR >= 3.5 mg/mmol. Relative to being in the never-overweight latent class, being in the pubertal-onset- or always-overweight latent classes was associated with eGFR(cys)-defined CKD (OR, 2.04; 95% CI, 1.09-3.82). Associations with CKD defined by eGFR(cr) (OR, 1.27; 95% CI, 0.71-2.29) and UACR (OR, 1.33; 95% CI, 0.70-2.54) were less marked, but in the same direction. Adjustment for lifestyle and health factors had little impact on effect estimates. Limitations: A low prevalence of CKD resulted in low statistical power. No documentation of chronicity for outcomes. All-white study population restricts generalizability. Conclusions: Being overweight in early life was found to be associated with eGFR(cys)-defined CKD in later life. The associations with CKD defined by eGFR(cr) and UACR were less marked, but in the same direction. Reducing or preventing overweight in the early years of life may significantly reduce the burden of CKD in the population. (c) 2013 by the National Kidney Foundation, Inc.