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Weight loss independently predicts urinary albumin excretion normalization in morbidly obese type 2 diabetic patients undergoing bariatric surgery

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Abstract

Background

Despite obesity being closely associated with two common risk factors for albuminuria, namely type 2 diabetes mellitus (T2DM) and hypertension, information on the impact of weight loss on albumin excretion rate in morbidly obese (MO) subjects is scarce.

Objective

To evaluate the independent contribution of weight loss following bariatric surgery (BS) to the improvement of the albumin-to-creatinine ratio (ACR) in MO subjects with T2DM.

Subjects and methods

Observational prospective study, including consecutive (n = 255) patients undergoing Roux-en-Y gastric bypass (GBP) or sleeve gastrectomy (SG) of whom 37.6 % (n = 96) presented with T2DM. Stepwise logistic regression analysis was used to assess the contribution of T2DM-related, hypertension-related, and weight loss-related variables, and type of surgery to normalization of ACR (<30 mg/g) at 12 and 24 months follow-up.

Results

In T2DM subjects, baseline ACR was 85.7 ± 171 mg/g with ACR ≥30 mg/g being present in 45.7 % of the cohort. At 12 months, the ACR significantly decreased in T2DM subjects (42.2 ± 142.8 mg/g; p < 0.005) with no further reduction at 24 months after surgery (44.4 ± 227.7; p = 0.862). Among T2DM subjects with ACR ≥30 mg/g at baseline, the ACR became <30 mg/g in 58.5 % and 76.9 % at 12 and 24 months, respectively (p < 0.001 relative to baseline). Body mass index (BMI) change from baseline was the only independent predictor of ACR normalization at 12 months [Exp(B) 1.373, 95 % confidence interval 1.075–1.703; p < 0.05]. None of the evaluated variables appeared as an independent predictor of ACR normalization at 24 months.

Conclusions

Our data suggest that, in MO subjects with T2DM, interventions aiming at slowing the progression of nephropathy should not only focus on optimization of glucose and blood pressure control but also include effective weight loss strategies.

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Acknowledgments

This work was supported by a grant from the Fondo de Investigaciones Sanitarias Instituto Carlos III (PI11/00892), Madrid, Spain.

Disclosures

Authors Antonio Amor, Amanda Jiménez, Violeta Moizé, Lílliam Flores, Ainitze Ibarzabal, and Josep Vidal have no financial relationships to declare with any pharmaceutical or device company specific to the data presented herein. Josep Vidal is the principal investigator of the research project PI11/00892 funded by the Fondo de Investigaciones Sanitarias Instituto Carlos III (Madrid, Spain).

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Authors and Affiliations

  1. Obesity Unit, Endocrinology and Diabetes Department, Hospital Clínic Universitari, Villarroel 170, 08036, Barcelona, Spain

    Antonio Amor, Amanda Jiménez, Violeta Moizé, Ainitze Ibarzabal, Lílliam Flores, Antonio M. Lacy & Josep Vidal

  2. Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain

    Lílliam Flores & Josep Vidal

  3. Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain

    Ainitze Ibarzabal, Lílliam Flores, Antonio M. Lacy & Josep Vidal

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  1. Antonio Amor
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  2. Amanda Jiménez
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  3. Violeta Moizé
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  4. Ainitze Ibarzabal
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  5. Lílliam Flores
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  6. Antonio M. Lacy
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  7. Josep Vidal
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Correspondence to Josep Vidal.

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Amor, A., Jiménez, A., Moizé, V. et al. Weight loss independently predicts urinary albumin excretion normalization in morbidly obese type 2 diabetic patients undergoing bariatric surgery. Surg Endosc 27, 2046–2051 (2013). https://doi.org/10.1007/s00464-012-2708-3

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