Overweight Prediabetics – More Sudden Death with Both Kidneys

An analysis of 15,156 people 45 to 64 years of age showed that having high belly-fat appears to increase the risk of sudden death from heart failure.*  This is one of those studies that confirms what most people already know intuitively – That excess body weight, especially around the midsection, make many prediabetics “a heart attack waiting to happen.”

tape measure for prediabetic waist to hip ratioThe researchers found a correlation between death from the heart suddenly stopping and an increased waist-to-hip ratio. In other words, if the girth of your waistline is substantially higher than that of your hips, you have a higher chance of dying from your heart suddenly stopping on you.

People in the bottom 20% with the worst waist-to-hip ratio (0.97 and higher for women and 1.01 and higher for men) had a risk of sudden heart death that was 40% higher when compared to people in the best 20% (less than 0.82 for women and less than 0.92 for men).

What do these numbers mean?

If you have a hip circumference of:

  • 34 inches your waistline should not exceed 32-33 inches
  • 36 inches your waistline should not exceed 34 inches
  • 38 inches your waistline should not exceed 36 inches

Generally speaking, these ratios work out that your waist measurement should not be about 2 inches more than your hips.

Most people are aware of body mass index (BMI) as a gauge of being overweight or obese.  Waist-to-hip ratio is not typically measured in your doctor’s office, but it is something you need to pay attention to.  This waist to hip measurement is important because it can provide information about the possible degree of inflammation and prediabetes metabolic dysfunction that you can be vulnerable to.

As the smart readers of Nutrientology know, belly fat is not simply an inactive storage clump. It is an active part of your body’s system and is putting out damaging inflammatory chemicals that are disruptive to health.  These proinflammatory compounds from body fat promote the insulin resistance found in prediabetes and type 2 diabetes.  This then effects the development of cardiovascular disease not only effecting the heart, but throughout the body, especially the kidneys, brain, eyes and feet.

pre diabetes puts you at risk for kidney cardiovascular diseaseAs a matter of fact, it appears that these inflammation-producing chemicals from abdominal fat can be so harmful, the pool of potential kidney donors is shrinking as America’s waistlines continue to grow.

One study showed that about one out of four people who wanted to donate a kidney did not meet the criteria for a good transplant outcome because they were too fat.**  And only a small percentage of those patients were ultimately able to lose enough weight to donate a kidney, despite their initial motivation to want to make a kidney donation.

There are no official national guidelines, but most kidney donation centers state that the donor cannot have “major weight problems.”   Reading through the various kidney donation sites, I have seen upper limit BMI values from 34 to 40.

Evaluation of the outcomes of transplants from donors with a higher BMI shows poorer results for both the kidney donor and the person receiving the kidney.

Analysis of 104 potential living kidney donors showed that:

Only 18% had a BMI considered to be within the normal range (25 or below)

The majority fell into the overweight-to-obese category:

  • 37% had a BMI between 25 and 30
  • 45% had a BMI of 30 or above
  • 22% of potential donors were excluded from donating their kidneys because they had a BMI of 35 or above

This is despite the fact that patients were referred to a diet counselor who created an individual diet and lifestyle modification plan, and followed up with them on a monthly basis!

Only three donors (13%) were able to lose enough weight to donate!!

It seems to me that this is a sad commentary on the medical profession’s ability to guide people toward a healthy weight reduction. A group of people that is willing to donate one of their organs are a relatively highly motivated and committed bunch. Granted this study only involved 104 people, but if the best we can do is 13% with a presumably motivated group, I believe that says more about our methods of weight loss, and dietary approaches to weight loss, than it does about the patient’s desire to lose weight.

In other words, I do not believe one can justifiably say that these people did not really want to lose the weight, or were simply too lazy. There’s more to this story.  We need to figure this out or the prediabetes, diabetes and obesity (“diabesity”) epidemics will continue to grow.

In addition, this study did not look at the impact of the rising number of diabetics on kidney donation.  Most of you know that diabetes causes kidney damage.  So, not only is the pool of eligible donors shrinking because of obesity, but it’s reasonable to assume diabetes and prediabetes are having an impact as well.

*Adabag S, et al “Risk of sudden cardiac death in obese individuals: The Atherosclerosis Risk in Communities (ARIC) study” Heart Rhythm Society, 2012; Abstract PO1-67.
**Sachdeva M, et al “Obesity as a barrier to living kidney donation – A center-based analysis” National Kidney Foundation, 2012.


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About Robert Creighton

Dr. Creighton is a podiatrist and foot surgeon with over 26 years in podiatric practice treating thousands of patients afflicted with the physiological, physical, and psychological side effects and complications of diabetes and pre-diabetes metabolic syndrome. He believes these disorders present a pressing public health concern that need to be more actively addressed in a multidisciplinary way. Dr. Creighton graduated from what is now the Temple University School of Podiatric Medicine after receiving his undergraduate degree in Biology. He is certified by the American Board of Foot and Ankle Surgery, a member of the American Public Health Association, an American College of Sports Medicine certified personal trainer and a Member of the American Nutrition Association.

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