The Relationship between Generalized and Abdominal Obesity with Diabetic Kidney Disease in Type 2 Diabetes: A Multiethnic Asian Study and Meta-Analysis

Abstract

This study examined the associations of body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR) and waist-height ratio (WHtR) with diabetic kidney disease (DKD) in a clinical sample of Asian patients with type 2 diabetes (T2DM); substantiated with a meta-analysis of the above associations. We recruited 405 patients with T2DM (mean (standard deviation (SD)) age: 58 (7.5) years; 277 (68.4%) male; 203 (50.1%) with DKD) from a tertiary care centre in Singapore. DKD was defined as urinary albumin-creatinine ratio >3.3 mg/mmoL and/or estimated glomerular filtration rate <60 mL/min/1.73 m². All exposures were analysed continuously and categorically (World Health Organization cut-points for BMI and WC; median for WHR and WHtR) with DKD using stepwise logistic regression models adjusted for traditional risk factors. Additionally, we synthesized the pooled odds ratio of 18 studies (N = 19,755) in a meta-analysis of the above relationships in T2DM. We found that overweight and obese persons (categorized using BMI) were more likely to have DKD compared to under/normal weight individuals, while no associations were found for abdominal obesity exposures. In meta-analyses however, all obesity parameters were associated with increased odds of DKD. The discordance in our abdominal obesity findings compared to the pooled analyses warrants further validation via longitudinal cohorts.

Keywords: body mass index; diabetic kidney disease; meta-analysis; obesity; waist circumference; waist-height ratio; waist-hip ratio.

Figure 1

Flowchart showing search terms and article selection for meta-analysis.

Figure 2

Forest plots * of the association of continuous and categorical body mass index (BMI) with diabetic kidney disease. * The size of the box of each study effect corresponds to the relative weight given to that study in the meta-analysis; the diamond refers to the overall pooled estimates with 95% confidence interval.

Figure 3

Forest plots * of the association of continuous and categorical waist circumference with diabetic kidney disease. * The size of the box of each study effect corresponds to the relative weight given to that study in the meta-analysis; the diamond refers to the overall pooled estimates with 95% confidence interval.

Figure 4

Forest plots * of the association of continuous and categorical waist hip/height ratio with diabetic kidney disease. * The size of the box of each study effect corresponds to the relative weight given to that study in the meta-analysis; the diamond refers to the overall pooled estimates with 95% confidence interval.