Abstract
BackgroundLean body mass (LBM) and fat mass (FM) have been shown to have different associations with several chronic diseases but little is known about the sex-specific association of LBM and FM with diabetic nephropathy (DN) risk among participants with diabetes.MethodsParticipants from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study was used in a post hoc analysis to examine the association of predicted LBM index (LBMI) and FM index (FMI) with incident DN risk (defined as a composite outcome of three types of predefined DN). Because of sex differences in body composition, analyses were conducted separately using sex-specific quartiles of predicted LBMI and FMI.ResultsOf the 9,022 participants with type 2 diabetes (5,575 men and 3,447 women) included in this study, 5,374 individuals developed DN (3,396 in men and 1,978 in women). Higher quartiles of LBMI were associated with a reduced risk of DN while higher quartiles of FMI were associated with an increased higher risk of DN among men but not women. Compared with the lowest quartile, the fully adjusted hazard ratios (HRs) and 95% confidence intervals (CIs)for the highest quartile of predicted LBMI and FMI were respectively 0.83 (95% CI 1.71 – 0.96) and 1.23 (95% CI 1.06-1.43) among men; and 0.92 (95% CI 0.63 – 1.33) and 1.14 (95% CI 0.79 – 1.63) among women.ConclusionsAmong participants with diabetes, predicted LBMI was inversely associated with risk of DN while predicted FMI was positively associated with an increased risk of incident DN among men but not women. Trial registration: ClinicalTrials.gov., no. NCT00000620.
Highlights
The incidence and prevalence of diabetes mellitus have been on the increase and have since been recognized as one of the rapidly growing global health emergencies of the 21st century [1, 2]
In a study of patients with diabetes managed in a care setting, Yu et al found diabetic kidney disease to be more prevalent among men compared with women women were more likely to be overweight than men [14]; which is similar to the findings of Shankar et al who found higher body mass index (BMI) to be associated with an increased risk of renal disease in men but not in women [15]
There were no significant interactions between various subgroups. In this post hoc study of 9,022 participants with type 2 diabetes mellitus (T2DM), we found a sex-specific association of predicted LBM index (LBMI) and predicted FM index (FMI) with incident diabetic nephropathy (DN)
Summary
The incidence and prevalence of diabetes mellitus have been on the increase and have since been recognized as one of the rapidly growing global health emergencies of the 21st century [1, 2]. A number of studies have reported a positive relationship between renal disease and being overweight among both men and women with or without diabetes [8,9,10,11,12]. Other studies found a sex-specific association between obesity and renal disease risk [13]. In a study of patients with diabetes managed in a care setting, Yu et al found diabetic kidney disease to be more prevalent among men compared with women women were more likely to be overweight than men [14]; which is similar to the findings of Shankar et al who found higher body mass index (BMI) to be associated with an increased risk of renal disease in men but not in women [15]. Lean body mass (LBM) and fat mass (FM) have been shown to have different associations with several chronic diseases but little is known about the sexspecific association of LBM and FM with diabetic nephropathy (DN) risk among participants with diabetes
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