As more Malaysians be­come over­weight or obese, the num­ber of kid­ney pa­tients will rise. Med­i­cal ex­perts warn about the link be­tween obe­sity and kid­ney dis­ease, es­pe­cially among chil­dren, writes AU­DREY VIJAINDREN

New Straits Times - - News -

TWENTY years ago, only 4.4 per cent of Malaysians were obese. A decade later, the fig­ure rose to 14 per cent.

In 2015, the Na­tional Health and Mor­bid­ity Sur­vey (NHMS) found that more than five mil­lion peo­ple (17.7 per cent of the coun­try) were obese and a fur­ther 30 per cent were over­weight.

In other words, nearly half the pop­u­la­tion of Malaysia were ei­ther over­weight or obese.

The sur­vey un­der the Health Min­istry also found that 11.9 per cent of chil­dren aged 18 years and be­low were obese, with seven per cent of them un­der the age of 5.

Pro­fes­sor Dr Goh Bak Leong, se­nior con­sul­tant nephrol­o­gist and Nephrol­ogy Depart­ment head in Hospi­tal Ser­dang, said obe­sity had in­de­pen­dent ef­fects on blood flow in the kid­ney (re­nal haemo­dy­nam­ics).

“In­di­vid­u­als with a low num­ber of nephrons (the part of the kid­ney re­spon­si­ble for fil­ter­ing waste from blood) are the most sus­cep­ti­ble to these changes.

“Mul­ti­ple mech­a­nisms have been pos­tu­lated, where obe­sity di­rectly im­pacts kid­ney dis­ease, in­clud­ing hy­per­fil­tra­tion (ex­tra work­load to fil­ter blood), in­creased glomeru­lar cap­il­lary wall ten­sion, and podocyte stress (stress to the sup­port­ing cells of the kid­ney),” said Dr Goh, who is also president of the Malaysian So­ci­ety of Nephrol­ogy.

He warned that obe­sity could ham­per a child’s de­vel­op­ment and qual­ity of life, lead­ing to sec­ondary com­pli­ca­tions, such as di­a­betes, car­dio­vas­cu­lar dis­eases and sleeping disor­ders.

“It will also com­pro­mise their cog­ni­tive abil­ity and ed­u­ca­tional at­tain­ment, in­crease their vul­ner­a­bil­ity to ill­nesses and lead to in­creased health costs and loss of hu­man cap­i­tal and pro­duc­tiv­ity.”

Dr Arini Nu­ran Idris, pae­di­atric en­docri­nol­o­gist at the Pae­di­atric In­sti­tute of Hospi­tal Kuala Lumpur (HKL), said par­ents could help chil­dren make healthy choices.

“Fam­i­lies should serve rea­son­ably-sized por­tions of food, limit con­sump­tion of sug­ary bev­er­ages and high-calo­rie snacks, en­cour­age chil­dren to eat five or more serv­ings of fruits and veg­eta­bles a day, eat meals to­gether as a fam­ily as of­ten as pos­si­ble, and limit eat­ing out, es­pe­cially at fast­food restau­rants.

The Amer­i­can Academy of Pae­di­atrics, she said, had sug­gested prac­ti­cal steps fam­i­lies could take to help chil­dren main­tain a healthy weight.

“These in­clude adopt­ing healthy habits into daily life. They con­sist of a well-bal­anced diet, in­creased num­ber of phys­i­cal ac­tiv­i­ties and re­duced seden­tary be­hav­iour.

“Par­ents and fam­i­lies are strongly en­cour­aged to be a role model for healthy be­hav­iour in chil­dren,” she said.

The study showed that Pu­tra­jaya had the high­est per­cent­age of over­weight and obese peo­ple in the coun­try.

The ad­min­is­tra­tive cap­i­tal’s pop­u­la­tion had a 37 per cent chance of be­ing over­weight, while the obe­sity rate was at 43 per cent.

NHMS 2015 also showed that 40.3 per cent of gov­ern­ment and semi-gov­ern­ment em­ploy­ees were obese.

A change from seden­tary be­hav­iour to an ac­tive life­style is an­other im­por­tant strat­egy in main­tain­ing a healthy weight.

“Ad­e­quate sleep is cru­cial to pre­vent weight is­sues. Chil­dren who sleep less than nine hours a night are more likely to be over­weight or obese,” she said, adding that par­ents should ob­serve strict bed­time for their chil­dren. “Fam­i­lies can help kids stay ac­tive by en­joy­ing fun, mod­er­ate in­ten­sity phys­i­cal ac­tiv­i­ties to­gether to meet the rec­om­mended 60 minutes of ac­tiv­ity most days of the week, or ev­ery day if pos­si­ble.

“This can in­clude par­tic­i­pat­ing in team sports, go­ing to a park, play­ground or walk­ing/bi­cy­cle trails, swim­ming, bowl­ing, skip­ping, dancing, dog-walk­ing, climb­ing stairs or walk­ing to a desti­na­tion in­stead of driv­ing.

“Par­ents and other fam­ily mem­bers are strongly en­cour­aged to adopt the same fit­ness and life­style changes as the child. Doc­tors can ed­u­cate fam­i­lies, pro­vide sup­port and mo­ti­vate them to make the changes.”

She also urged par­ents to en­sure that their chil­dren got their health check­ups once a year.

“Dur­ing this visit, the doc­tor mea­sures your child’s height and weight, and cal­cu­lates his or her Body Mass In­dex (BMI).

“De­pend­ing on the sever­ity and com­plex­ity of the weight prob­lem, he or she may be re­ferred to a fam­ily medicine spe­cial­ist or a pae­di­a­tri­cian, or a pae­di­atric en­docri­nol­o­gist for fur­ther man­age­ment,” she said.

Kid­ney dis­eases can be pre­vented by adopt­ing healthy habits in daily life, such as eat­ing a bal­anced diet, in­creas­ing phys­i­cal ac­tiv­ity and re­duc­ing seden­tary be­hav­iour.

Glob­ally, 2.6 mil­lion pa­tients with end-stage re­nal dis­ease re­ceived dial­y­sis in 2010 and this num­ber will almost double to 5.4 mil­lion by 2030.

Dr Goh Bak Leong

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