Gain in adiposity over 3 years is associated with progressive renal decline in multi-ethnic South-East Asians with type 2 diabetes

ABSTRACT
in English, Chinese
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 (ΔVFABMI ). Outcomes included annual and rapid (≥3 mL/min per 1.73 m2 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/m2 ) exhibited a median annual decline in eGFR of 1.0 mL/min per 1.73 m2 . Compared with the lower tertiles, Tertile 3 of ΔWt, ΔBMI, ΔVFA, and ΔVFABMI 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 ΔVFABMI persisted after multivariate adjustment in men but not in women. In addition, Tertile 3 of ΔWt, ΔBMI, ΔVFA, and ΔVFABMI 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. 摘要: 背景 这项研究在一个大型的多民族东南亚2型糖尿病患者队列中前瞻性地评估了肥胖与肾功能下降之间的关系。 方法 基线访视3年后, 再次召集原先的2057名2型糖尿病受试者进行重新评估。最终队列包括1014名受试者, 并且根据体重(ΔWt)、体重指数(ΔBMI)、内脏脂肪面积(ΔVFA)、以及校正BMI后的VFA(ΔVFABMI )的变化将患者进行三分位数分组。根据估算的肾小球滤过率(eGFR)每年与快速(每1.73m2 每年≥ 3mL/min)下降情况, 以及蛋白尿进展评估肾功能结果。 结果 受试者(平均[± SD]年龄为57 ± 11岁,48.8%为女性,BMI为27.7 ± 5.4 kg/m2 )的eGFR下降速度中位数为每1.73m2 每年1.0 mL/min。与较低的三分位数组相比较, ΔWt、ΔBMI、ΔVFA以及ΔVFABMI 处于第3个三分位数组的患者人体测量学结果增幅最高, 尽管幅度不大, 但是伴随着最坏的肾脏功能结果(所有的P < 0.05)。经过多变量校正后发现, 只有在男性中每年eGFR的下降与第3个三分位数组的ΔWt、ΔBMI、ΔVFA以及ΔVFABMI之间仍然存在相关性, 但是在女性中却无相关性。另外, 第3个三分位数组的ΔWt、ΔBMI、ΔVFA以及ΔVFABMI 可以预测eGFR的快速下降。人体测量学结果的增加也与蛋白尿进展相关。 结论 2型糖尿病患者随着时间的推移, 肥胖程度轻度增加与肾功能渐进性下降相关, 这意味着随着时间推移而加重的肥胖会对肾功能结果产生不良影响。因此, 临床上设计2型糖尿病治疗方案时非常重要的一点就是要精心选择不影响体重或可以减轻体重的降糖治疗方案。. Keywords: 2型糖尿病; body mass index; body weight; diabetic kidney disease; type 2 diabetes mellitus; visceral fat; 体重; 体重指数; 内脏脂肪; 糖尿病肾病.