Abstract
BackgroundThe prevalence of diabetes is on the rise globally coupled with its associated complications, such as diabetic nephropathy (DN). Obesity has been identified as a risk factor for the development of DN but it is still unclear which obesity index is the best predictor of incident DN.MethodsData from the participants with type 2 diabetes mellitus (T2DM) in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study were used to examine the sex-specific association between waist circumference (WC), waist-to-height ratio (WHtR), and body mass index (BMI) with incident DN risk.ResultsAmong the 8,887 participants with T2DM (5,489 men and 3,398 women), 5,296 participants (3,345 men and 1,951 women) developed the DN composite outcome during a follow-up period of 24302 person-years. Among men, null associations were observed between all anthropometric measures with incident DN in the multivariate analysis although the 3rd quartile of WHtR showed marginally significant results (P = 0.052). However, among women, both central and general obesity measures were associated with increased risks of incident DN. Compared with participants in the WC <88 cm category, the fully adjusted HR and 95% CI for those in the ≥88 cm of WC was 1.35 (95% CI 1.15-1.57). Compared with the lowest quartile, the fully adjusted HRs and 95% CIs for the 2nd to the 4th quartile of WHtR were 1.09 (95% CI 0.96-1.25), 1.12 (95% CI 0.98-1.28), and 1.14 (95% CI 1.00-1.30) respectively; also, compared with the normal BMI category, the fully adjusted HRs and 95% CIs for class I – class III obese were 1.36 (95% CI 1.10 – 1.67), 1.43 (95% CI 1.16 – 1.78) and 1.32 (95% CI 1.05 – 1.66) respectively.ConclusionsAmong participants with T2DM, higher levels of both central and general obesity indexes were associated with DN risk among women but not in men. Women with T2DM should maintain a healthy weight targeted at reducing both central and general obesity to enhance nephroprotection. Trial registration: ClinicalTrials.gov., no. NCT00000620.
Highlights
Diabetes mellitus, a chronic metabolic disorder, has been recognized as a major global public health burden [1]
Null associations were observed between all anthropometric measures with incident diabetic nephropathy (DN) in the multivariate analysis the 3rd quartile of waist-to-height ratio (WHtR) showed marginally significant results (P = 0.052)
Among women, both central and general obesity measures were associated with increased risks of incident DN
Summary
A chronic metabolic disorder, has been recognized as a major global public health burden [1]. A number of studies have reported a positive relationship between renal disease and being overweight among individuals with or without diabetes [9,10,11,12,13]. In one prospective observational study, the authors found higher levels of body mass index (BMI), a measure of obesity, to be protective against renal function decline in patients with type 2 diabetes mellitus [14]. Other studies have reported U-shaped relationship between obesity measures and microvascular diabetic complications, suggesting that both low and high levels of obesity indexes may act as potential risk factors for renal dysfunction [15, 16]. The prevalence of diabetes is on the rise globally coupled with its associated complications, such as diabetic nephropathy (DN).
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