Open Access在多民族的东南亚2型糖尿病患者中超过3年的肥胖可导致肾功能逐渐下降
Author(s) -
Moh Mei Chung,
Sum Chee Fang,
Tavintharan Subramaniam,
Ang Keven,
Kwan Pek Yee,
Lee Simon Biing Ming,
Tang Wern Ee,
Lim Su Chi
Publication year - 2019
Publication title -
journal of diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.949
H-Index - 43
eISSN - 1753-0407
pISSN - 1753-0393
DOI - 10.1111/1753-0407.12848
Subject(s) - medicine , body mass index , albuminuria , anthropometry , renal function , type 2 diabetes , diabetes mellitus , prospective cohort study , cohort , endocrinology , weight gain , body weight
Background This study evaluated the association between gain in adiposity and renal decline in a large prospective multiethnic South‐east Asian cohort with type 2 diabetes mellitus (T2DM). Methods Three years after the baseline visit, 2057 T2DM subjects were recalled for reassessment. The final cohort comprised 1014 subjects and was categorized into tertiles based on changes in body weight (ΔWt), body mass index (ΔBMI), visceral fat area (ΔVFA), and BMI‐adjusted VFA (ΔVFA BMI ). Outcomes included annual and rapid (≥3 mL/min per 1.73 m 2 per year) decline in estimated glomerular filtration rate (eGFR) and progression of albuminuria. Results Participants (mean [±SD] age 57 ± 11 years, 48.8% women, BMI 27.7 ± 5.4 kg/m 2 ) exhibited a median annual decline in eGFR of 1.0 mL/min per 1.73 m 2 . Compared with the lower tertiles, Tertile 3 of ΔWt, ΔBMI, ΔVFA, and ΔVFA BMI had the highest anthropometric increase, albeit of modest magnitude, and this was accompanied by the worst renal outcomes (all P < 0.05). The relationship between annual eGFR decline and Tertile 3 of ΔWt, ΔBMI, and ΔVFA BMI persisted after multivariate adjustment in men but not in women. In addition, Tertile 3 of ΔWt, ΔBMI, ΔVFA, and ΔVFA BMI predicted rapid eGFR decline. Anthropometric gains were also associated with progression of albuminuria. Conclusions Modest longitudinal gain in adiposity was associated with progressive renal decline in T2DM patients, suggesting that increased adiposity over time adversely affects renal outcomes. Therefore, a carefully designed weight‐neutral or ‐loss antidiabetic treatment regimen is important when managing T2DM in the clinic.