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

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) >or=300 mg/g creatinine, and those with an estimated glomerular filtration rate <15 ml/min/1.73 m(2) 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.