Assessment of obesity and visceral fat in diabetic nephropathy patients

Kumar Prafull Chandra, Balaji D. More, Anju B. More


Background: Diabetic nephropathy is one of the most common diabetic microvascular complication that typically develops after 10 years of diabetes diagnosis. The primary aim of this study was to evaluate the prevalence of obesity and visceral fat in Type 2 Diabetes (T2D) cases with nephropathy and without-nephropathy complication.

Methods: In this cross-sectional study, diabetic nephropathy was diagnosed on the basis of biochemical tests of urine albumin, serum creatinine, eGFR, BP, and clinical assessment in patients with T2D. The prevalence of diabetic nephropathy estimated and the association between adiposity and diabetic nephropathy in patients T2D was evaluated. Measures of adiposity included body weight, Body Mass Index (BMI), Waist Circumference (WC), body fat percentage, muscle mass percentage and visceral fat percentage. Analysis of variance indicate difference in the various fat analysis parameters in presence and absence of nephropathy. PROC GLM procedure in the SAS Software was used for statistical calculations.

Results: A total of 247 patients with type 2 diabetes (mean age 53.46±11.62 years; 39.5% females) were enrolled in this study. The participants were grouped as with Diabetic Nephropathy (DN) 41.60% (N=99) and without Diabetic Nephropathy (NDN) 58.40% (N=139). The comparison of DN and Non-DN groups showed no significant difference in the BMI, body and visceral fat, muscle mass percentage. 

Conclusions: Irrespective of the nephropathy status the body fat and visceral fat percentage is increased, and the muscle mass percentage is decreased in diabetes patients. As both obesity and diabetes contribute to the development and progression of renal disease, measures should to taken to reduce the body fat.


Adiposity, Diabetes, Fat, Nephropathy, Obesity, Visceral

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Yanovski SZ, Yanovski JA. Obesity prevalence in the United States-up, down, or sideways?. New Engl J Med. 2011;364(11):987-9.

Wang SL, Head J, Stevens C, Fuller JH, World Health Organization, Multinational Study Group. Excess Mortality and Its Relation to Hypertension and Proteinuria in Diabetic Patients. Diab Care. 1996;19(4):305-12.

Kopelman P. Health risks associated with overweight and obesity. Obes Rev. 2007;8(1):13-7.

Hall JE, Crook ED, Jones DW, Wofford MR, Dubbert PM. Mechanisms of obesity-associated cardiovascular and renal disease. Am J Med Sci. 2002;324(3):127-37.

Foster MC, Hwang SJ, Larson MG, Lichtman JH, Parikh NI, Vasan RS, et al. Overweight, obesity, and the development of stage 3 CKD: the Framingham Heart Study. Am J Kidney Dis. 2008;52(1):39-48.

Hsu CY, McCulloch CE, Iribarren C, Darbinian J, Go AS. Body mass index and risk for end-stage renal disease. Annal Int Med. 2006;144(1):21-8.

Wang Y, Chen X, Song Y, Caballero B, Cheskin LJ. Association between obesity and kidney disease: a systematic review and meta-analysis. Kidney Int. 2008;73(1):19-33.

Ogden CL, Yanovski SZ. Ca rroll, MD; Flegal, KM The epidemiology of obesity. Gastroenterol. 2007;132:2087-102.

Kramer H, Luke A, Bidani A, Cao G, Cooper R, McGee D. Obesity and prevalent and incident CKD: the hypertension detection and follow-up program. Am J Kidney Dis. 2005;46(4):587-94.

Vivante A, Golan E, Tzur D, Leiba A, Tirosh A, Skorecki K, et al. Body mass index in 1.2 million adolescents and risk for end-stage renal disease. Arch Int Med. 2012;172(21):1644-50.

Elsayed EF, Sarnak MJ, Tighiouart H, Griffith JL, Kurth T, Salem DN, et al. Waist-to-hip ratio, body mass index, and subsequent kidney disease and death. Am J Kidney Dis. 2008;52(1):29-38.

Elsayed EF, Tighiouart H, Weiner DE, Griffith J, Salem D, Levey AS, et al. Waist-to-hip ratio and body mass index as risk factors for cardiovascular events in CKD. Am J Kidney Dis. 2008;52(1):49-57.

Srikanthan P, Seeman TE, Karlamangla AS. Waist-hip-ratio as a predictor of all-cause mortality in high-functioning older adults. Annal Epidemiol. 2009;19(10):724-31.

Oh H, Quan SA, Jeong JY, Jang SN, Lee JE, Kim DH. Waist circumference, not body mass index, is associated with renal function decline in korean population: hallym aging study. PLOS One. 2013;8(3):59071.

Wajchenberg BL. Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocrine Rev. 2000;21(6):697-738.

Goodpaster BH, Krishnaswami S, Harris TB, Katsiaras A, Kritchevsky SB, Simonsick EM, et al. Obesity, regional body fat distribution, and the metabolic syndrome in older men and women. Arch Int med. 2005;165(7):777-83.

Vega GL, Adams-Huet B, Peshock R, Willett D, Shah B, Grundy SM. Influence of body fat content and distribution on variation in metabolic risk. J Clin Endocrinol Metab. 2006;91(11):4459-66.

de Boer IH, Rue TC, Hall YN, Heagerty PJ, Weiss NS, Himmelfarb J. Temporal trends in the prevalence of diabetic kidney disease in the United States. Jama. 2011;305(24):2532-9.

Rossing P, De Zeeuw D. Need for better diabetes treatment for improved renal outcome. Kidney Int. 2011;79:S28-32.

Malone M, Alger-Mayer SA, Anderson DA. Medication associated with weight gain may influence outcome in a weight management program. Annal Pharmacotherapy. 2005;39(7-8):1204-8.

Afshinnia F, Wilt TJ, Duval S, Esmaeili A, Ibrahim HN. Weight loss and proteinuria: systematic review of clinical trials and comparative cohorts. Nephrol Dialy Transplant. 2009;25(4):1173-83.

Slinin Y, Ishani A, Rector T, Fitzgerald P, MacDonald R, Tacklind J, et al. Management of hyperglycemia, dyslipidemia, and albuminuria in patients with diabetes and CKD: a systematic review for a KDOQI clinical practice guideline. Am J Kidney Dis. 2012;60(5):747-69.

World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191-4.

Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42(6):1206-52.

Magee C, Grieve DJ, Watson CJ, Brazil DP. Diabetic nephropathy: a tangled web to unweave. Cardio Drugs Therapy. 2017;31(5-6):579-92.

Hall JE, Kuo JJ, da Silva AA, de Paula RB, Liu J, Tallam L. Obesity-associated hypertension and kidney disease. Curr Opinion Nephrol Hypertension. 2003;12(2):195-200.

Bagby SP. Obesity-initiated metabolic syndrome and the kidney: a recipe for chronic kidney disease?. J Am Soci Nephrol. 2004;15(11):2775-91.

Friedman AN, Chambers M, Kamendulis LM, Temmerman J. Short-term changes after a weight reduction intervention in advanced diabetic nephropathy. Clin J Am Soc Nephrol. 2013;8(11):1892-8.

Celiker M, Selcuk MY, Olt S. Sarcopenia in diabetic nephropathy: a cross-sectional study. Rom J Int Med. 2018;56(2):102-8.

Mak RH, Ikizler AT, Kovesdy CP, Raj DS, Stenvinkel P, Kalantar-Zadeh K. Wasting in chronic kidney disease. J Cachexia, Sarcopenia Muscle. 2011;2(1):9.

Madero M, Katz R, Murphy R, Newman A, Patel K, Ix J, et al. Comparison between different measures of body fat with kidney function decline and incident CKD. Clin J Am Soc Nephrol. 2017;12(6):893-903.

Franceschini N, Gouskova NA, Reiner AP, Bostom A, Howard BV, Pettinger M, et al. Adiposity patterns and the risk for ESRD in postmenopausal women. Clin J Am Soc Nephrol. 2015;10(2):241-50.

Brown RN, Mohsen A, Green D, Hoefield RA, Summers LK, Middleton RJ, et al. Body mass index has no effect on rate of progression of chronic kidney disease in non-diabetic subjects. Nephrol Dialysis Transplant. 2012;27(7):2776-80.