Metabolically Healthy Obesity and Development of Chronic Kidney Disease

Letters15 November 2016Metabolically Healthy Obesity and Development of Chronic Kidney DiseaseYoosoo Chang, MD, PhD, Seungho Ryu, MD, PhD, Juhee Cho, PhD, Roberto Pastor-Barriuso, PhD, and Eliseo Guallar, MD, DrPHYoosoo Chang, MD, PhDFrom Kangbuk Samsung Hospital and Sungkyunkwan University, Seoul, South Korea; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; and Carlos III Institute of Health and Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain., Seungho Ryu, MD, PhDFrom Kangbuk Samsung Hospital and Sungkyunkwan University, Seoul, South Korea; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; and Carlos III Institute of Health and Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain., Juhee Cho, PhDFrom Kangbuk Samsung Hospital and Sungkyunkwan University, Seoul, South Korea; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; and Carlos III Institute of Health and Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain., Roberto Pastor-Barriuso, PhDFrom Kangbuk Samsung Hospital and Sungkyunkwan University, Seoul, South Korea; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; and Carlos III Institute of Health and Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain., and Eliseo Guallar, MD, DrPHFrom Kangbuk Samsung Hospital and Sungkyunkwan University, Seoul, South Korea; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; and Carlos III Institute of Health and Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L16-0405 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We thank Drs. Stanford and Butsch, Drs. Kahn and Pavkov, and Dr. Little and colleagues for their interest in our study and for raising important points about the interpretation of our results. Several of the arguments address the use of Asian-specific cutoffs for BMI and the obesity paradox. For a given BMI, Asians have a higher percentage of total body fat (1) and a higher risk for cardiometabolic disease (2) than white persons. As a consequence, Asian Pacific–specific BMI criteria have gained widespread acceptance. As for more detailed analyses by degree of obesity, only 211 (0.3%) participants in ...References1. Deurenberg P, Deurenberg-Yap M, Guricci S. Asians are different from Caucasians and from each other in their body mass index/body fat per cent relationship. Obes Rev. 2002;3:141-6. [PMID: 12164465] CrossrefMedlineGoogle Scholar2. Wen CP, David Cheng TY, Tsai SP, Chan HT, Hsu HL, Hsu CC, et al. Are Asians at greater mortality risks for being overweight than Caucasians? Redefining obesity for Asians. Public Health Nutr. 2009;12:497-506. [PMID: 18547457] doi:10.1017/S1368980008002802 CrossrefMedlineGoogle Scholar3. Lainscak M, von Haehling S, Doehner W, Anker SD. The obesity paradox in chronic disease: facts and numbers. J Cachexia Sarcopenia Muscle. 2012;3:1-4. [PMID: 22450395] doi:10.1007/s13539-012-0059-5 CrossrefMedlineGoogle Scholar4. Hainer V, Aldhoon-Hainerová I. Obesity paradox does exist. Diabetes Care. 2013;36 Suppl 2:S276-81. [PMID: 23882059] doi:10.2337/dcS13-2023 CrossrefMedlineGoogle Scholar5. Standl E, Erbach M, Schnell O. Defending the con side: obesity paradox does not exist. Diabetes Care. 2013;36 Suppl 2:S282-6. [PMID: 23882060] doi:10.2337/dcS13-2040 CrossrefMedlineGoogle Scholar6. Banack HR, Kaufman JS. Does selection bias explain the obesity paradox among individuals with cardiovascular disease? Ann Epidemiol. 2015;25:342-9. [PMID: 25867852] doi:10.1016/j.annepidem.2015.02.008 CrossrefMedlineGoogle Scholar7. Lajous M, Banack HR, Kaufman JS, Hernán MA. Should patients with chronic disease be told to gain weight? The obesity paradox and selection bias [Editorial]. Am J Med. 2015;128:334-6. [PMID: 25460531] doi:10.1016/j.amjmed.2014.10.043 CrossrefMedlineGoogle Scholar8. Kramer CK, Zinman B, Retnakaran R. Are metabolically healthy overweight and obesity benign conditions?: a systematic review and meta-analysis. Ann Intern Med. 2013;159:758-69. [PMID: 24297192]. doi:10.7326/0003-4819-159-11-201312030-00008 LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Kangbuk Samsung Hospital and Sungkyunkwan University, Seoul, South Korea; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; and Carlos III Institute of Health and Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-1323. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMetabolically Healthy Obesity and Development of Chronic Kidney Disease Yoosoo Chang , Seungho Ryu , Yuni Choi , Yiyi Zhang , Juhee Cho , Min-Jung Kwon , Young Youl Hyun , Kyu-Beck Lee , Hyang Kim , Hyun-Suk Jung , Kyung Eun Yun , Jiin Ahn , Sanjay Rampal , Di Zhao , Byung-Seong Suh , Eun Cheol Chung , Hocheol Shin , Roberto Pastor-Barriuso , and Eliseo Guallar Metabolically Healthy Obesity and Development of Chronic Kidney Disease Fatima Cody Stanford and W. Scott Butsch Metabolically Healthy Obesity and Development of Chronic Kidney Disease Henry S. Kahn and Meda E. Pavkov Metabolically Healthy Obesity and Development of Chronic Kidney Disease Dustin J. Little , Wondaye T. Deressa , Maura A. Watson , and Christina M. Yuan Metrics Cited byAssociation of chronic kidney disease with exposure to polycyclic aromatic hydrocarbons in the US populationLong-term kidney and systemic effects of calorie restriction in overweight or obese type 2 diabetic patients (C.Re.S.O. 2 randomized controlled trial)Gender-Specific Impact of Metabolic Obesity Phenotypes on the Risk of Hashimoto's Thyroiditis: A Retrospective Data Analysis Using a Health Check-Up DatabaseBidirectional association between blood pressure and depressive symptoms in young and middle-age adults: A cohort studyAssociation of Variability in Body Mass Index and Metabolic Health With Cardiometabolic Disease RiskChildhood Obesity and the Metabolic SyndromeCardiometabolic Risk Factors, Metabolic Syndrome, and Chronic Kidney Disease Progression in ChildrenObesity and chronic kidney diseaseMetabolically-healthy obesity is associated with higher prevalence of colorectal adenoma 15 November 2016Volume 165, Issue 10Page: 744-745KeywordsAdipose tissueBody mass indexFatsKidneysMedical risk factorsMortalityMusclesObesityPopulation statisticsType 2 diabetes ePublished: 15 November 2016 Issue Published: 15 November 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. 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