The Relationship Between Increased Ratio of Visceral-to-Subcutaneous Fat Area and Renal Outcome in Chinese Adults With Type 2 Diabetes and Diabetic Kidney Disease

Abstract

Objective: Abdominal obesity is a risk factor of diabetes and hypertension. The aim of this study was to investigate the association between excessive abdominal fat and renal outcomes in patients with type 2 diabetes and diabetic kidney disease.

Methods: Thirty-five patients with type 2 diabetes and diabetic kidney disease who were followed up on for at least 1 year were enrolled. Visceral fat area and subcutaneous fat area were assessed by computed tomography to evaluate the degree of abdominal fat. Patients were divided into 2 groups. Patients in group 1 had a ratio of visceral fat area to subcutaneous fat area (V/S ratio) <0.70 (n=16), and those in group 2 had a V/S ratio ≥0.70 (n=19) according to the second quartile. Renal outcome was defined as end-stage renal disease and initiation of renal replacement therapy.

Results: At baseline, patients with a high V/S ratio had higher levels of triglycerides (p=0.060) and C-reactive protein (p=0.028), but lower high-density lipoprotein cholesterol levels (p=0.006). Strong correlations between V/S ratio and C-reactive protein (r=0.521, p=0.015) and high-density lipoprotein cholesterol (r=-0.576, p<0.001) were observed. Univariate Cox regression indicated the higher the V/S ratio, the greater the risk for a poor renal outcome (hazard ratio, 3.536; 95% confidence interval, 1.140 to 10.960; p=0.029). However, multivariate Cox analysis demonstrated that a higher V/S ratio was not an independent risk factor for progression to end-stage renal disease (hazard ratio, 2.212; 95% confidence interval, 0.543 to 9.005; p=0.268) when adjustments were made for important clinical variables.

Conclusion: The V/S ratio was positively correlated with C-reactive protein and high-density lipoprotein cholesterol. The higher V/S ratio was associated with a greater risk for progression to end-stage renal disease, although it did not emerge as an independent predictor of diabetic kidney disease progression.

Keywords: abdominal obesity; diabetic kidney disease; diabète de type 2; néphropathie diabétique; obésité abdominale; subcutaneous fat area; surface de graisse sous-cutanée; surface de graisse viscérale; type 2 diabetes; visceral fat area.