title: Overweight, obesity and intentional weight loss in chronic kidney disease: NHANES 1999-2006.
abstract: OBJECTIVE
  Obesity and chronic kidney disease (CKD) have emerged as major public health problems. We aimed to examine: (a) lifestyle and behavioral factors, (b) factors related to pursuing weight loss and (c) weight loss modalities pursued by CKD and non-CKD individuals who are overweight and obese.
  
  
  METHODS
  Cross-sectional analysis of 10,971 overweight and obese adult participants in the National Health and Nutrition Examination Surveys conducted between 1999 and 2006. We examined the differences in lifestyle and behavioral factors between CKD and non-CKD participants and factors associated with pursuing weight loss using survey regression models.
  
  
  RESULTS
  The total daily energy intake of the CKD population was lower than the non-CKD group (1987 kcal per day versus 2063 kcal per day, P=0.02) even after adjusting for relevant covariates. However, the percentage of energy derived from protein was similar between the groups. Sixty six percent of the CKD population did not meet the minimum recommended leisure time physical activity goals compared with 57% among non-CKD (P<0.001). Fifty percent of CKD participants pursued weight loss (vs fifty-five percent of non-CKD individuals, P=0.01), but the presence of CKD was not independently associated with the pursuit of weight loss in the multivariate model. Among participants pursuing weight loss, modalities including dietary interventions utilized by CKD and non-CKD participants were similar. Eight percent of CKD participants used medications to promote weight loss.
  
  
  CONCLUSIONS
  Among the overweight and obese population, lifestyle and behavioral factors related to obesity and weight loss are similar between CKD and non-CKD participants. Insufficient data exist on the beneficial effects of intentional weight loss in CKD and these data show that a significant proportion of the CKD population use diets that may have high-protein content and medications to promote weight loss that may be harmful. Future clinical trials evaluating the efficacy and optimal modalities to treat obesity in the CKD population are warranted.
authors.affiliation: Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA. navanes@ccf.org
authors.forename: S D
authors.initials: SD
authors.lastname: Navaneethan
authors.forename: J P
authors.initials: JP
authors.lastname: Kirwan
authors.forename: S
authors.initials: S
authors.lastname: Arrigain
authors.forename: M J
authors.initials: MJ
authors.lastname: Schreiber
authors.forename: A R
authors.initials: AR
authors.lastname: Sehgal
authors.forename: J D
authors.initials: JD
authors.lastname: Schold
mesh_terms: D015992:Body Mass Index; D031204:Caloric Restriction; D003430:Cross-Sectional Studies; D002149:Energy Intake; D015444:Exercise; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D033182:Intention; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D009765:Obesity / Q000453:epidemiology / Q000517:prevention & control; D050177:Overweight / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control*; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D015431:Weight Loss