That is, for every risk factor examined, the presence of obesity increased the risk. In the Australian population,23 more than 75% of obese males and 65% of obese females had at least one comorbidity (hypertension, dyslipidaemia or diabetes) and 7–10% had all three. The AusDiab 2005 report demonstrated that compared with those with a normal BMI at baseline, the overweight and obese have a 2- to 4-fold increase in the annual incidence of diabetes and hypertension

(see Table 1). For example, the annual incidence of hypertension in obese patients was 5% and for diabetes EGFR inhibitor it was 1.6%. These data are derived from a 5-year follow-up study24 and further information is required to determine the relationship between baseline BMI and the incidence of hypertension and diabetes over time. However, this is of particular relevance to living kidney donors in whom the average age at nephrectomy is 48 years25 and who have a life expectancy of many more decades. The impact of obesity on risk of diabetes and hypertension is even more pronounced in Aboriginal Australians. Compared with the AusDiab population, the OR (95% CI) for diabetes among normal, overweight and obese (by waist circumference) remote Selumetinib living aboriginal women were 2.6 (06–11.5), 13.1 (6.7–25.7) and 6.1 (4.6–8.0), respectively.8 The risk for diabetes in aboriginal men was 6-fold higher in each of the weight categories. Similar

increased prevalence of obesity, diabetes, hypertension and cardiovascular risk were also described in a cohort of urban indigenous Metalloexopeptidase people

from Perth.26 The adjusted relative risk for the incidence of newly diagnosed diabetes in an 8-year follow-up study was 3- to 4 fold higher for BMI > 25 kg/m2 compared with those with a lean BMI.11 In summary, indigenous Australians have a significantly increased risk of diabetes, hypertension, cardiovascular and kidney disease, which is further magnified even at low levels of adiposity. In New Zealand, the prevalence of obesity is increased in Maori and Pacific Islander peoples compared with the Caucasian population (BMI ≥ 31 kg/m2 63%, 69% and 26%, respectively).27 Similarly, the prevalence of diabetes is a least 3-fold higher in the Maori and Pacific Islanders and occurs at a younger age (typically between 5 and 10 years younger than Caucasians).28 The relationship between fasting insulin and BMI was independent of ethnicity, suggesting that the high prevalence of diabetes was related to obesity. Hypertension is also increased in the Maori and Pacific Islander population29 and in a large church-based survey, BMI was positively associated with blood pressure (BP), with a 14 mmHg difference in systolic BP between the lowest and highest quartile of BMI in men and 9 mmHg in women.30 At any given level of obesity, the absolute risk of diabetes is consistently higher in Asians, for both men and women.