Is there an obesity-related epidemic of CKD starting already in childhood?

The obesity epidemic is spreading all over the world. In this issue of NDT we learn that children between the ages of 5 and 18 years in a developing country like Turkey show high and increasing levels of overweight of 9.3% and obesity of 8.9%. Very importantly, the authors also show that already at a young age, obesity and hypertension have started to influence the kidney function. A sub-normal, GFR <90 mL/min/1.73 m 2 , was found in 4.9% of the obese children compared with between 2.8 and 3.2% in the other groups of children. The mean estimated GFR values were significantly lower in the obese children, 122.7 mL/ min/1.73 m 2 , compared with 128.2–133.3 mL/min/1.73 m 2 in the other two groups of children. The highest levels of obesity were found in urban areas and in the richer western parts of the country. Previous studies from Turkey have shown that being part of a high-income family is a risk factor for obesity [1]. This is in contrast to studies from some other parts of the world. There seems to be a pattern that in low-income countries obesity is more common in children from wealthier families while the opposite can be seen with more obesity in disadvantaged children and in particular in girls in more developed countries [2, 3].