Interaction of general obesity and abdominal obesity with frailty in patients with chronic kidney disease: a nationally representative analysis

Abstract Background General and abdominal obesity are prevalent, with established associations to frailty in the elderly. However, few studies investigated these associations in patients with chronic kidney disease (CKD), yielding inconsistent results. Methods This cross-sectional study analyzed data from the National Health and Nutrition Examination Survey (NHANES 2003–2018). Frailty was evaluated by the 36-item frailty index. General obesity was defined as body mass index (BMI) above 30 kg/m2; abdominal obesity was identified if waist circumference (WC) reached 102 cm in men and 88 cm in women. The association of general and abdominal obesity with frailty were analyzed using weighted multivariate logistic regression and restricted cubic splines. The interaction of general and abdominal obesity with frailty was examined. Results 5 604 adult patients (median age 71 years, 42% men) with CKD were included in this analysis, with a median estimated glomerular filtration rate of 57.3 mL/min/1.73 m2. 21% were frail with general obesity and 32% were frail with abdominal obesity. Neither general nor abdominal obesity alone was associated with frailty. There was the interaction between general and abdominal obesity with frailty. Compared with individuals with normal BMI and WC, those with both general and abdominal obesity, rather than either alone, exhibited significantly increased odds of frailty [odds ratio (OR): 1.53, 95% confidence interval (CI): 1.20–1.95]. General obesity was associated with being frail only when CKD patients had abdominal obesity (OR: 1.59, 95%CI: 1.08–2.36). Conclusions There may be an interaction between general and abdominal obesity with frailty in patients with CKD. Interventions aimed at preventing frailty should consider both aspects.