Viewpoint On
Bamba R, Okamura T, Hashimoto Y, Hamaguchi M, Obora A, Kojima T, Fukui M: The Visceral Adiposity Index Is a Predictor of Incident Chronic Kidney Disease: A Population-Based Longitudinal Study. Kidney and Blood Pressure Research DOI 10.1159/000506461
Obesity and its association with CKD is well described but prediction of the incident CKD from a description of obesity is understudied. As a modifiable risk factor such an analysis would be very important from a public health perspective. In addition, the different effects of visceral compared to subcutaneous adiposity on the complications of obesity, such as diabetes or the metabolic syndrome, are well known.
Using a novel visceral adiposity index (VAI; which includes the variables of waist circumference, body mass index, serum triglyceride, and HDL-cholesterol levels) in men and women, Bamba and coworkers conducted a population-level, historical cohort study to examine the utility of VAI for prediction of incident CKD in Japanese subjects. The follow-up was relatively short, at about 3.3 years. The average age of the cohort was about 42 years. None of the included subjects were taking any medications at baseline.
Over 4,000 days of observation, incident CKD (defined by eGFR and/or dipstick proteinuria) was 3.7% in men and 3.9% in women. Men had a higher VAI than women at baseline. The difference in risk of incident CKD between the lowest and highest quartile of VAI was significant (hazard rate of 1.51 in men and 1.65 in women). However, the AUC for predicting incident CKD was low in both men (0.595) and women (0.597).
While this novel index of obesity takes into account visceral obesity and its metabolic consequences, it is not clear whether it will have utility in the identification of subjects for interventional trials to determine whether reduction in the VAI will have an important effect on incident CKD in the population as a whole. Furthermore, confirmatory studies in non-Japanese populations are needed.
