Association between body fat variation rate and risk of diabetic nephropathy - a posthoc analysis based on ACCORD database

Abstract

Background: Weight control has consistently been regarded as a significant preventive measure against diabetic nephropathy. however, the potential impact of substantial fluctuations in body fat during this process on the risk of diabetic nephropathy remains uncertain. This study aimed to investigate the association between body fat variation rate and diabetic nephropathy incident in American patients with type 2 diabetes.

Methods: The study used data from the Action to Control Cardiovascular Risk in diabetes (ACCORD) trial to calculate body fat variation rates over two years and divided participants into Low and High groups. The hazard ratio and 95% confidence interval were estimated using a Cox proportional hazards model, and confounding variables were addressed using propensity score matching.

Results: Four thousand six hundred nine participants with type 2 diabetes were studied, with 1,511 cases of diabetic nephropathy observed over 5 years. High body fat variation rate was linked to a higher risk of diabetic nephropathy compared to low body fat variation rate (HR 1.13, 95% CI 1.01-1.26). Statistically significant interaction was observed between body fat variation rate and BMI (P interaction = 0.008), and high level of body fat variation rate was only associated with increased risk of diabetic nephropathy in participants with BMI > 30 (HR 1.34 and 95% CI 1.08-1.66).

Conclusions: Among participants with Type 2 Diabetes Mellitus, body fat variation rate was associated with increased risk of diabetic nephropathy. Furthermore, the association was modified by BMI, and positive association was demonstrated in obese but not non-obese individuals. Consequently, for obese patients with diabetes, a more gradual weight loss strategy is recommended to prevent drastic fluctuations in body fat.

Trial registration: Clinical Trials. gov, no. NCT000000620 (Registration Date 199909).

Trial registration: ClinicalTrials.gov NCT00000620.

Keywords: Body composition; Body fat variation rate; Diabetic nephropathy; Obesity; Type 2 Diabetes.

Fig. 1

Kaplan-Meier survival curve of the total population. Association of different levels of body fat variability with the cumulative probability of diabetic nephropathy (1a, 1b). The highest curve is the population with lower body fat variation rate, and the second curve is the population with higher body fat varition rate. The results were analyzed again after matching and adjusting confounding factors for the population in the second picture

Fig. 2

Restricted cubic spline of body fat variability in different populations. Multivariate adjusted model risk ratio of body fat variability and diabetes nephropathy events in the overall population (1a, 1b), obese (2a, 2b) and non obese people (3a, 3b). The curve represents the risk ratio of diabetes nephropathy adjusted based on the restricted cubic spline. The model was adjusted for participants' age, race, sex, BMI, glycated hemoglobin, blood glucose, blood pressure and lipids, duration of diabetes, alcohol consumption, smoking, history of hypertension, history of ACEI/ARB medication, history of cardiovascular disease, waist circumference, and early renal function decline during the second year. The solid red line represents the risk ratio, and the black line represents the 95% confidence interval for the association between the rate of variation in body fat and the overall outcome diabetic nephropathy. We also used propensity score matching to adjust all covariates for confounding in the above analysis