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Erschienen in: Clinical and Experimental Nephrology 2/2010

01.04.2010 | Original Article

Involvement of visceral fat in the pathogenesis of albuminuria in patients with type 2 diabetes with early stage of nephropathy

verfasst von: Ko Hanai, Tetsuya Babazono, Izumi Nyumura, Kiwako Toya, Mari Ohta, Ryotaro Bouchi, Kumi Suzuki, Aiko Inoue, Yasuhiko Iwamoto

Erschienen in: Clinical and Experimental Nephrology | Ausgabe 2/2010

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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.
Literatur
1.
Zurück zum Zitat 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.CrossRef 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.CrossRef
2.
Zurück zum Zitat Kikkawa R, Kojima H. Insulin resistance, hypertension and nephropathy. Hypertens Res. 1996;19:S27–9.CrossRefPubMed Kikkawa R, Kojima H. Insulin resistance, hypertension and nephropathy. Hypertens Res. 1996;19:S27–9.CrossRefPubMed
3.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
4.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
5.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
6.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
7.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
8.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
9.
Zurück zum Zitat Hanai K, Babazono T, Iwamoto Y. Renal manifestations of metabolic syndrome in type 2 diabetes. Diabetes Res Clin Pract. 2008;79:318–24.CrossRefPubMed Hanai K, Babazono T, Iwamoto Y. Renal manifestations of metabolic syndrome in type 2 diabetes. Diabetes Res Clin Pract. 2008;79:318–24.CrossRefPubMed
10.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
11.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
12.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
13.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
14.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
15.
Zurück zum Zitat Anderson PJ, Chan JCN, Chan YL, et al. Visceral fat and cardiovascular risk factors in Chinese NIDDM patients. Diabetes Care. 1997;20:1854–8.CrossRefPubMed Anderson PJ, Chan JCN, Chan YL, et al. Visceral fat and cardiovascular risk factors in Chinese NIDDM patients. Diabetes Care. 1997;20:1854–8.CrossRefPubMed
16.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
17.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
18.
Zurück zum Zitat 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.PubMed 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.PubMed
19.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
20.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
21.
Zurück zum Zitat Matsuzawa Y, Nakamura T, Shimomura I, Kotani K. Visceral fat accumulation and cardiovascular disease. Obes Res. 1995;3(suppl 5):645S–7S.PubMed Matsuzawa Y, Nakamura T, Shimomura I, Kotani K. Visceral fat accumulation and cardiovascular disease. Obes Res. 1995;3(suppl 5):645S–7S.PubMed
22.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
23.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
24.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
25.
Zurück zum Zitat Alvarez GE, Beske SD, Ballard TP, Davy KP. Sympathetic neural activation in visceral obesity. Circulation. 2002;106:2533–6.CrossRefPubMed Alvarez GE, Beske SD, Ballard TP, Davy KP. Sympathetic neural activation in visceral obesity. Circulation. 2002;106:2533–6.CrossRefPubMed
26.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
27.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
28.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
Metadaten
Titel
Involvement of visceral fat in the pathogenesis of albuminuria in patients with type 2 diabetes with early stage of nephropathy
verfasst von
Ko Hanai
Tetsuya Babazono
Izumi Nyumura
Kiwako Toya
Mari Ohta
Ryotaro Bouchi
Kumi Suzuki
Aiko Inoue
Yasuhiko Iwamoto
Publikationsdatum
01.04.2010
Verlag
Springer Japan
Erschienen in
Clinical and Experimental Nephrology / Ausgabe 2/2010
Print ISSN: 1342-1751
Elektronische ISSN: 1437-7799
DOI
https://doi.org/10.1007/s10157-009-0245-8

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