Abstract
Background
Visceral obesity has been implicated in the pathogenesis of diabetic nephropathy. Waist circumference has been used as a surrogate measure of visceral fat mass; however, subcutaneous fat mass is also correlated with waist circumference. We therefore conducted this cross-sectional study to clarify the relationship between directly measured sizes of visceral and subcutaneous fat and microalbuminuria in patients with type 2 diabetes (T2DM).
Methods
We studied a total of 208 adult Japanese individuals with T2DM, 99 women and 109 men, with a mean ± standard deviation (SD) age of 56 ± 13 years. Patients with macroalbuminuria, defined as a urinary albumin-to-creatinine ratio (ACR) ≥300 mg/g creatinine, and those with an estimated glomerular filtration rate <15 ml/min/1.73 m2 were excluded. Visceral and subcutaneous fat areas were measured by abdominal computed tomography.
Results
In the univariate correlational analysis, logarithmically transformed urinary ACR was significantly associated with visceral fat area (r = 0.14, p = 0.047) but not with subcutaneous fat area (r = 0.08, p = 0.237). In the multiple regression analysis with stepwise selection procedure, visceral fat area but not subcutaneous fat area was selected as an independent variable that was statistically associated with urinary ACR.
Conclusion
This cross-sectional study suggests that increased visceral but not subcutaneous fat is independently associated with microalbuminuria in Japanese adult patients with T2DM.
Similar content being viewed by others
References
Dinneen SF, Gerstein HC. The association of microalbuminuria and mortality in non-insulin-dependent diabetes mellitus. A systemic overview of the literature. Arch Intern Med. 1998;157:1413–8.
Kikkawa R, Kojima H. Insulin resistance, hypertension and nephropathy. Hypertens Res. 1996;19:S27–9.
Tanaka M, Babazono T, Takeda M, Iwamoto Y. Pulse pressure and chronic kidney disease in patients with type 2 diabetes. Hypertens Res. 2006;29:345–52.
Parvanova AI, Trevisan R, Iliev IP, et al. Insulin resistance and microalbuminuria: a cross-sectional, case-control study of 158 patients with type 2 diabetes and different degrees of urinary albumin excretion. Diabetes. 2006;55:1456–62.
Rossi MC, Nicolucci A, Pellegrini F, et al. Identifying patients with type 2 diabetes at high risk of microalbuminuria: results of the DEMAND (Developing Education on Microalbuminuria for Awareness of reNal and cardiovascular risk in Diabetes) Study. Nephrol Dial Transplant. 2008;23:1278–84.
Poirier P, Giles TD, Bray GA, et al. Obesity and cardiovascular disease. Pathophysiology, evaluation, and effect of weight loss. Arterioscler Thromb Vasc Biol. 2006;26:968–76.
Kurella M, Lo JC, Chertow GM. Metabolic syndrome and the risk for chronic kidney disease among nondiabetic adults. J Am Soc Nephrol. 2005;16:2134–40.
Bonnet F, Marre M, Halimi JM, et al. Waist circumference and the metabolic syndrome predict the development of elevated albuminuria in non-diabetic subjects: the DESIR Study. J Hypertens. 2006;24:1157–63.
Hanai K, Babazono T, Iwamoto Y. Renal manifestations of metabolic syndrome in type 2 diabetes. Diabetes Res Clin Pract. 2008;79:318–24.
Retnakaran R, Cull CA, Thorne KI, Adler AI, Holman RR, for the UKPDS Study Group. Risk factors for renal dysfunction in type 2 diabetes. Diabetes. 2006;55:1832–9.
de Boer IH, Sibley SD, Kestenbaum B, et al. Central obesity, incident microalbuminuria, and change in creatinine clearance in the epidemiology of diabetes interventions and complications study. J Am Soc Nephrol. 2007;18:235–43.
Chiba Y, Saitoh S, Takagi S, et al. Relationship between visceral fat and cardiovascular disease risk factors: the Tanno and Sobetsu study. Hypertens Res. 2007;30:229–36.
Eguchi M, Tsuchihashi K, Saitoh S, et al. Visceral obesity in Japanese patients with metabolic syndrome: reappraisal of diagnostic criteria by CT scan. Hypertens Res. 2007;30:315–23.
Sibley SD, de Boer IH, Steffes MW, Brunzell JD, the Diabetes Control, Complications Trial/Epidemiology of Diabetes Interventions, Complications (DCCT/EDIC) Research Study Group. Intra-abdominal fat and elevated urine albumin excretion in men with type 1 diabetes. Diabetes Care. 2007;30:1898–900.
Anderson PJ, Chan JCN, Chan YL, et al. Visceral fat and cardiovascular risk factors in Chinese NIDDM patients. Diabetes Care. 1997;20:1854–8.
Asakawa H, Tokunaga K, Kawakami F. Relationship of abdominal fat with metabolic disorder in diabetes mellitus patients. Diabetes Res Clin Pract. 2002;55:139–49.
The Committee of the Japan Diabetes Society on the Diagnostic Criteria of Diabetes Mellitus, Kuzuya T, Nakagawa S, et al. Report of the committee on the classification and diagnostic criteria of diabetes mellitus. Diabetes Res Clin Pract. 2002;55:65–85.
Levey AS, Coresh J, Greene T, et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006;145:247–54.
Imai E, Matsuo S, Makino H, et al. Chronic kidney disease Japan cohort (CKD-JAC) study: design and methods. Hypertens Res. 2008;31:1101–7.
Nakamura T, Tokunaga K, Shimomura I, et al. Contribution of visceral fat accumulation to the development of coronary artery disease in non-obese men. Atherosclerosis. 1994;107:239–46.
Matsuzawa Y, Nakamura T, Shimomura I, Kotani K. Visceral fat accumulation and cardiovascular disease. Obes Res. 1995;3(suppl 5):645S–7S.
Hall JE, Henegar JR, Dwyer TM, et al. Is obesity a major cause of chronic kidney disease? Adv Ren Replace Ther. 2004;11:41–54.
Wahba IM, Mak RH. Obesity and obesity-initiated metabolic syndrome: mechanistic links to chronic kidney disease. Clin J Am Soc Nephrol. 2007;2:550–62.
Wolf G, Hamann A, Han DC, et al. Leptin stimulates proliferation and TGF-beta expression in renal glomerular endothelial cells: potential role in glomerulosclerosis. Kidney Int. 1999;56:860–72.
Alvarez GE, Beske SD, Ballard TP, Davy KP. Sympathetic neural activation in visceral obesity. Circulation. 2002;106:2533–6.
Wiecek A, Kokot F, Chudek J, Adamczak M. The adipose tissue—a novel endocrine organ of interest to the nephrologists. Nephrol Dial Transplant. 2002;17:191–5.
Babazono T, Takahashi C, Iwamoto Y. Definition of microalbuminuria in first-morning and random spot urine in diabetic patients. Diabetes Care. 2004;27:1838–9.
Ishizaka N, Ishizaka Y, Toda E, et al. Association between obesity and chronic kidney disease in Japanese: differences in gender and hypertensive status? Hypertens Res. 2007;30:1059–64.
Conflict of interest statement
We have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Hanai, K., Babazono, T., Nyumura, I. et al. Involvement of visceral fat in the pathogenesis of albuminuria in patients with type 2 diabetes with early stage of nephropathy. Clin Exp Nephrol 14, 132–136 (2010). https://doi.org/10.1007/s10157-009-0245-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10157-009-0245-8