One in seven American adults estimated to have chronic kidney disease

The number of Americans affected by chronic kidney disease (CKD) is higher than previously estimated and affects 15% of the U.S. adult population, this according to new data analyzed by the Centers for Disease Control and Prevention (CDC). One in seven American adults, or 30 million people, are estimated to have CKD. However, 96% of those with early kidney disease (stages 1 and 2) don't even know they have CKD. And of those with severely reduced kidney function, (stage 4) but not on dialysis, 48%, are not aware of having the disease.

"30 million Americans are affected by chronic kidney disease and most do not even know they have it. Let these new statistics from CDC serve as a warning bell that a major public health challenge is right in front of our eyes and more must be done to address it," said Kevin Longino, CEO, National Kidney Foundation and a kidney transplant patient. "Additional federal resources must be allocated towards increasing public awareness about the disease and advancing programs targeted towards prevention and early detection. Leaders in the healthcare industry also need to prioritize CKD for the costly, impactful disease that it is - the earlier we can diagnose someone with kidney disease the better their long-term outcomes."

Some other important findings are that women are more likely than men to be affected by CKD, (16% vs. 13%), but men are 64% more likely than women to progress to end stage renal disease (ESRD), the stage when kidneys stop working and dialysis or a transplant is needed just to stay alive. An estimated 15% of Hispanics have CKD and Hispanics are 35% more likely than non-Hispanics to progress to ESRD. In addition, CKD is estimated to be more common in non-Hispanic blacks (18%) than in non-Hispanic whites (13%).

The study, which analyzed adults aged 18 years or older with CKD stages 1-5, used data from the 2011-2014 National Health and Nutrition Examination Survey and the CKD Epidemiology Collaboration (CKD-EPI) equation. The higher estimate in the number of Americans affected by chronic kidney disease, versus statistics previously reported, is due to several factors including differences in study time frames, methodologies and populations, as well as an aging population and increased prevalence of risk factors such as diabetes and hypertension.

Kidney Disease Facts:

30 million American adults are estimated to have chronic kidney disease - and most aren't aware of it. 1 in 3 American adults are at risk for kidney disease. Risk factors for kidney disease include diabetes, high blood pressure, heart disease, obesity and family history. People of African American, Hispanic, Native American, Asian or Pacific Islander descent are at increased risk for developing the disease. African Americans are 3 times more likely than Whites, and Hispanics are nearly 1.5 times more likely than non-Hispanics to develop end stage renal disease (kidney failure).

Weight Loss

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Two interventions help improve weight management in children with overweight or obesity

Two interventions that link clinical care with community resources helped improve key health measures in children with overweight or obesity at the outset of the study. As reported in JAMA Pediatrics, both programs - developed by investigators at MassGeneral Hospital for Children (MGHfC) and Harvard Vanguard Medical Associates, a practice of Atrius Health - not only improved body mass index (BMI) in participants but also increased parents' sense that they had the information and resources to address their child's weight problem.

"More and more we recognize that, if we don't assist families in tackling the social and environmental conditions that impede their ability to make changes to their obesity-related behaviors, we will not be successful in pediatric weight management," says Elsie Taveras, MD, MPH, chief of General Pediatrics at MassGeneral Hospital for Children, who led the study. "To help us create our interventions we looked to families with children who had managed to improve their BMI, often under challenging environmental and social settings. These "positive outlier" families provided guidance on the content of health coaching, available resources in the community, language to use in motivating other families to change and the importance of building parents' confidence in taking on the challenge of reducing their child's excess weight."

The Connect 4 Health trial was conducted from June 2014 through March 2016 at six Harvard Vanguard pediatric practices in the Boston area and enrolled 721 children, ages 2 through 12, with a BMI in the overweight or obese range. Participants were randomly assigned to one of two interventions - enhanced primary care or enhanced primary care plus coaching.

Parents of those in both groups received educational materials focusing on key goals - decreasing screen time and consumption of sugar-sweetened beverages, improving diet quality, increasing moderate or vigorous physical activity, improving the quality and duration of sleep, and promoting social and emotional wellness. The enhanced primary care intervention - incorporating practices introduced at Harvard Vanguard in recent years - included monthly text message to parents with links to publicly available resources to support behavioral change and a Neighborhood Resource Guide listing supportive facilities in their communities.

Parents of children in the enhanced primary care plus coaching group were contacted every other month - either over the phone, via videoconference or in person - by specially trained health coaches who provided individualized support through motivational interviewing, discussion of strategies for addressing and managing obesity risk factors, and identification of supportive resources in families' communities. Parents in the coaching groups also received additional educational materials after each coaching session and twice-weekly text messages or emails. Families were offered a free, one-month family membership in local YMCAs and invited to attend a program on healthy grocery shopping.

"Combatting obesity is an enormous challenge in pediatrics and identifying tools that are proven to make a difference in the health and well-being of our patients is essential," says co-author Daniel H. Slater, MD, chairman of Pediatrics at Atrius Health. "Our collaboration with Dr. Taveras' team and Connect 4 Health has been extremely rewarding and builds on the work that we have done together for more than a decade. Improvements - which include the electronic health record flagging of children with an unhealthy BMI, clinical decision support tools to help clinicians provide high quality care, and educational materials for parents to support self-guided behavior change - have all laid the groundwork for the two interventions tested in this study. It is gratifying to see that we can make a difference and improve our patients' health as well as their quality of life."

Along with comparing participants' BMI z scores - an age-specific measure used for children - at the beginning and end of the one-year study period, the investigators surveyed parents regarding their child's health-related quality of life and their own sense of empowerment in managing their child's weight. At the end of the study parents were also asked whether they had received and were satisfied with study messages and materials and how their participation in the program affected their satisfaction with their child's health services.

In general, participants in both groups had improved BMI z scores at the end of the study period, with slightly greater improvement among those in the enhanced primary care plus coaching group. Comparisons with measurements taken a year before the outset of the study indicated that these reductions did not reflect previous trends towards a lower BMI; in fact, both groups had showed trends toward increasing BMI in the year before the study.

Parents of children in the enhanced primary care plus coaching group reported significant improvements in the child's health-related quality of life and parents in both groups reported an increased sense of empowerment. Most parents reported receiving and being satisfied with text messages and the Neighborhood Resource Guide, and satisfaction with the additional services provided to the coaching group was also high. Overall, 63 percent of parents in the enhanced primary care plus coaching group and 48 percent of those in the enhance care group felt their participation in the program increased their satisfaction with their child's health care services.

Study co-author Earlene Avalon, PhD, MPH, who chaired the Youth and Parental Advisory Board that helped create the two programs, says. "This is such a relevant and important study because it takes a multi-pronged approach - not only looking at what the experts in the field are saying, but also asking people who walk the walk and deal with this daily to be architects of interventions and programs to tackle obesity. It is essential to consult people who have been successful and help them feel empowered to contribute and share best practices. To promote the diversity of opinions we seek, we have to go above and beyond solely consulting the literature for true creativity and innovation to occur." Avalon is on the staff of Boston Children's Hospital and is an assistant professor of Health Management and Health Science at Northeastern University.

Taveras, a professor of Pediatrics at Harvard Medical School, says, "Our findings are pretty conclusive that there are three aspects of interventions for childhood obesity that work: improving clinical practices for obesity management; engaging and supporting families in behavior change; and linking families to community resources for further support. We're now testing a family-based intervention that starts working with mothers in pregnancy and their children ages 2 and under to support prevention and developing more aggressive weight management approaches for children with the most severe obesity, for whom the interventions in this study were not successful."

Article: Comparative Effectiveness of Clinical-Community Childhood Obesity Interventions A Randomized Clinical Trial, Elsie M. Taveras, MD, MPH et al., JAMA Pediatrics, doi: 10.1001/jamapediatrics.2017.1325, published online 5 June 2017.

Weight Loss

Later meal times can promote weight gain and upset metabolism

For the first time, researchers offer experimental evidence that, compared with eating earlier in the day, a pattern of later meal times can promote weight gain and has an unfavorable impact on energy metabolism and hormonal markers that are linked to health problems such as diabetes and heart disease.

A new study has shown that regularly eating later in the day can have negative health consequences.

A report on the findings - led by researchers from the University of Pennsylvania's Perelman School of Medicine in Philadelphia - were presented at this year's joint meeting of the American Academy of Sleep Medicine and the Sleep Research Society.

The study finds that compared with eating earlier in the day, eating later can have a negative impact on weight control, fat metabolism, and energy usage.

The researchers also found that a prolonged pattern of later eating results in higher levels of glucose and insulin (which is linked to higher risk for diabetes), and also of cholesterol and triglycerides (which are linked to cardiovascular problems).

Lead author Namni Goel, a research associate professor of psychology in psychiatry at the Perelman School of Medicine, explains that previous research has already shown that sleep loss can have a bad effect on weight and metabolism, and that this is partly attributed to eating later at night.

However, the new findings suggest that timing of meal times on its own, independent of sleep, can affect weight and metabolism.

Daytime and delayed meal time patterns compared

Prof. Goel says that the preliminary findings of their study - which is still ongoing - "give a more comprehensive picture of the benefits of eating earlier in the day."

For the randomized crossover trial, nine healthy-weight adults (five men and four women) aged between 23 and 29 underwent two different daily meal time patterns: a daytime pattern, and a delayed eating pattern - both of which lasted for 8 weeks.

The 8-week patterns were separated by a 2-week "washout" period to ensure that the first pattern did not carry over into the second.

The daytime pattern consisted of three meals and two snacks eaten between 8 a.m. and 7 p.m. The delayed pattern also consisted of three meals and two snacks, except that these were consumed between 12 p.m. and 11 p.m.

The sleep period was the same in both patterns, occurring between 11 p.m. and 9 a.m. This was confirmed by use of wearable activity monitors. Calories and exercise were also held constant between the two patterns.

The researchers measured the participants' metabolism, energy usage, blood markers, and weight at four points during the study: before the first 8-week meal time pattern, after the first 8-week meal time pattern, after the 2-week washout period, and then after the second 8-week meal time pattern.

Less healthy metabolic profile in delayed meal time pattern

A preliminary analysis of the results found that compared with daytime eating, a delayed meal time pattern led to weight gain.

It also found that "respiratory quotient" went up when meal times were later. Respiratory quotient is a ratio of the amount of carbon dioxide that the body produces compared with the amount of oxygen it consumes. It is used as an indicator of which nutrients the body is metabolizing. If the quotient goes up, then it means that the body is processing more carbohydrates and fewer lipids, or fats.

The results also showed evidence of a less healthy metabolic profile during the delayed meal time pattern. This was reflected in changes in fasting glucose, insulin, cholesterol, and triglycerides.

Hormonal differences were also marked. For example, in the 8 weeks of daytime eating, levels of ghrelin (a hormone that stimulates appetite) peaked earlier in the day, and levels of leptin (a hormone that produces the sensation of fulness) peaked later.

Such a combination could suggest that participants on the daytime eating pattern were more likely to receive eating cues earlier in the day, and by eating earlier, they also stayed satiated for longer.

The findings confirm those of similar, but much shorter, studies. However, the new study is the first long-term comparison of early and late meal time patterns that rules out possible influencing factors, such as the sleep-wake cycle, physical activity, and diet.

While acknowledging that "lifestyle change is never easy," senior author Kelly Allison, an associate professor of psychology in psychiatry and director of the Center for Weight and Eating Disorders at the Perelman School of Medicine, says that their findings suggest that "eating earlier in the day may be worth the effort to help prevent these detrimental chronic health effects." She concludes:

"We have an extensive knowledge of how overeating affects health and body weight, but now we have a better understanding of how our body processes foods at different times of day over a long period of time."

Learn how poor sleep habits may promote weight gain in adults with genetic obesity risk.

Weight Loss

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3 More Tips to Break Through a Weight Loss Plateau

Almost everyone who has ever committed to a weight loss routine long term has run into the dreaded problem of the plateau. You’ve At one point or another, you’ve been chugging along, following your meal plan and hitting the gym while seeing success every week and then, all of a sudden the scale starts refusing to cooperate. I’ve shared tips for breaking through plateaus before, but I was thinking more about this topic recently and realized I had a few had more ideas to share.

The most important thing to note is that weight loss isn’t linear. When you lose for a long time, you will notice that sometimes weight loss will slow down and then suddenly you’ll be losing a pound a day for a few days. You aren’t in a plateau until you have gone 3+ weeks with no weight loss while carefully tracking what you eat. Oftentimes plateaus are just the result of people underestimating the calories they’re consuming or overestimating how much they’re burning through exercise.

Regardless, plateaus do occasionally happen and they can be incredibly frustrating. If you are positive you are doing everything right, the best advice is probably just to stay the course. You will lose the weight eventually. But if you feel like you need to do something to get the scale moving for some added motivation, here are a few things that might work:

Drink more water
Hydration is important for all bodily functions, it will help your workouts and it will help you flush excess sodium which should get the scale moving if you have been a bit dehydrated.

Get more sleep
So far this reads like a boring list of general health tips but truthfully it is the best way to approach the problem. Simple solutions are usually the best. If you aren’t getting enough sleep your body isn’t going to be functioning at its best. Not getting enough sleep will slow down your workouts, make you hungrier, and it can have adverse effects on your metabolism.

Eat a little more
This one is counterintuitive but it is one of the top anecdotal tips you will hear on the subject. Sometimes if you are restricting too much for too long your hormones can get out of whack. Assuming you don’t have a serious problem that would require a doctor, eating more and focusing on better complete nutrition could get your body functioning better. Increase your intake by 10-20% and get the additional calories from foods rich in micronutrients.

There are countless more tips out there. But the best advice is to not worry about it too much. We get so obsessed with a number on the scale when really that is just a tiny piece of the overall puzzle. Just try to be as healthy as you can and the results will come.

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