Abstract
This study examined the associations of body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR) and waist-height ratio (WHtR) with diabetic kidney disease (DKD) in a clinical sample of Asian patients with type 2 diabetes (T2DM); substantiated with a meta-analysis of the above associations. We recruited 405 patients with T2DM (mean (standard deviation (SD)) age: 58 (7.5) years; 277 (68.4%) male; 203 (50.1%) with DKD) from a tertiary care centre in Singapore. DKD was defined as urinary albumin-creatinine ratio >3.3 mg/mmoL and/or estimated glomerular filtration rate <60 mL/min/1.73 m2. All exposures were analysed continuously and categorically (World Health Organization cut-points for BMI and WC; median for WHR and WHtR) with DKD using stepwise logistic regression models adjusted for traditional risk factors. Additionally, we synthesized the pooled odds ratio of 18 studies (N = 19,755) in a meta-analysis of the above relationships in T2DM. We found that overweight and obese persons (categorized using BMI) were more likely to have DKD compared to under/normal weight individuals, while no associations were found for abdominal obesity exposures. In meta-analyses however, all obesity parameters were associated with increased odds of DKD. The discordance in our abdominal obesity findings compared to the pooled analyses warrants further validation via longitudinal cohorts.
Highlights
Diabetic kidney disease (DKD), a serious microvascular complication of diabetes, is defined as decreased renal function (glomerular filtration rate (GFR)) with persistent clinically detectable proteinuria [1]; and occurs in approximately 25–40% of patients with diabetes [2]
We found that every 5 kg/m2 increase in body mass index (BMI) was on average associated with a 43% increase in the odds of diabetic kidney disease (DKD) (OR: 1.40, 95% CI: 1.27, 1.61, I-squared: 0%), while obesity was was associated associated with withaa65%
Our results suggest that both generalized and abdominal obesity may play a role in the pathophysiology of DKD in T2DM, independent of their established roles as major risk factors of hypertension and diabetes, both of which in turn have been demonstrated to be associated with DKD [9]
Summary
Diabetic kidney disease (DKD), a serious microvascular complication of diabetes, is defined as decreased renal function (glomerular filtration rate (GFR)) with persistent clinically detectable proteinuria (albuminuria) [1]; and occurs in approximately 25–40% of patients with diabetes [2]. Given the dual problems of a significant risk of progression from DKD to end-stage renal disease (ESRD) [3], increased concomitant cardiovascular disease [4], and mortality [5], it is important to identify patients. Nutrients 2018, 10, 1685 at risk of DKD, understand the underlying pathogenic pathways, and initiate renal and cardiovascular therapies based on the knowledge of these causal mechanisms. Obesity is an established risk factor for diabetes and hypertension [7,8], both linked with the development of DKD [9]. While there is emerging evidence suggesting that both forms [11,12,13,14,15,16,17] contribute to the risk of DKD, independent of diabetes and/or hypertension, it is still unclear which one contributes more to the risk of DKD due to their close inter-relationship [18,19,20]
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