title: Gender and elevated albumin excretion in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) cohort: role of central obesity.
abstract: BACKGROUND
  Microalbuminuria (MA), a predictor of cardiovascular disease in subjects without diabetes and with type 2 diabetes, is more common in men than women in some studies. MA has been linked to central obesity-related traits, including increased waist-hip ratio (WHR), suggesting visceral adiposity might contribute to elevated albumin excretion rate (AER). These relationships have been examined less thoroughly in patients with type 1 diabetes.
  
  
  METHODS
  We examined the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications database obtained 4 years after the end of the DCCT to determine whether sex was related to AER in patients with type 1 diabetes and how WHR, a surrogate for visceral adiposity, affected the sex-MA relationship. We fitted models with ln(AER) as the response, adjusted for age, hemoglobin A1c level, smoking status, diabetes duration, and blood pressure, plus WHR, body mass index (BMI), or sex, alone or in combination.
  
  
  RESULTS
  Men had greater AERs. WHR was associated with AER, whereas neither sex nor BMI alone was associated with AER when adjusted for WHR. For women, but not men, AER was associated with waist circumference.
  
  
  CONCLUSIONS
  Sex is associated with AER in patients with type 1 diabetes, a relationship accounted for by WHR, consistent with a role for visceral adiposity in this process. Whether this observation is caused by a direct effect of sex hormones on the kidney and WHR or the effect of sex hormones on body fat distribution leading to differences in AER remains to be determined.
authors.affiliation: Department of Biostatistics, University of Minnesota School of Medicine, Minneapolis, MN 55455, USA. sible004@umn.edu
authors.forename: Shalamar D
authors.initials: SD
authors.lastname: Sibley
authors.forename: William
authors.initials: W
authors.lastname: Thomas
authors.forename: Ian
authors.initials: I
authors.lastname: de Boer
authors.forename: John D
authors.initials: JD
authors.lastname: Brunzell
authors.forename: Michael W
authors.initials: MW
authors.lastname: Steffes
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000453:epidemiology*; D002986:Clinical Trials as Topic; D048909:Diabetes Complications / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications*; D017678:Sex Distribution; D012737:Sex Factors; D049629:Waist-Hip Ratio