title: Central obesity, incident microalbuminuria, and change in creatinine clearance in the epidemiology of diabetes interventions and complications study.
abstract: Weight gain and central obesity are associated with insulin resistance, hypertension, and dyslipidemia in type 1 diabetes. These metabolic abnormalities are risk factors for kidney disease in the general population, but data addressing the relationship of central obesity with kidney disease in type 1 diabetes are limited. Whether waist circumference is associated with incident microalbuminuria and change in creatinine clearance was examined among 1279 participants who had type 1 diabetes and were enrolled in the Epidemiology of Diabetes Interventions and Complications Study, the observational extension of the Diabetes Control and Complications Trial (DCCT). Ninety-three of 1105 participants with normal albumin excretion rate (AER) at DCCT closeout developed incident microalbuminuria over 5.8 yr of follow-up. The hazard ratio for incident microalbuminuria that was associated with each 10-cm greater waist circumference at DCCT closeout was 1.34 (95% confidence interval 1.07 to 1.68), after adjustment for DCCT closeout age, gender, duration of diabetes, treatment group, smoking status, glycosylated hemoglobin, and AER. This increased risk was modestly attenuated when additional adjustment was made for levels of BP and serum lipids. Creatinine clearance declined by an average of 0.34 ml/min per 1.73 m2 each yr over 8 yr of follow-up. Greater rate of decline in creatinine clearance was associated with greater age, conventional insulin therapy during the DCCT, smoking, and greater glycosylated hemoglobin and AER at DCCT closeout but not with waist circumference. In conclusion, waist circumference predicts the subsequent development of microalbuminuria in type 1 diabetes. In contrast, no association of waist circumference with decline in creatinine clearance was observed.
authors.affiliation: Division of Nephrology, University of Washington, Seattle, Washington 98195, USA. deboer@u.washington.edu
authors.forename: Ian H
authors.initials: IH
authors.lastname: de Boer
authors.forename: Shalamar D
authors.initials: SD
authors.lastname: Sibley
authors.forename: Bryan
authors.initials: B
authors.lastname: Kestenbaum
authors.forename: Joshua N
authors.initials: JN
authors.lastname: Sampson
authors.forename: Bessie
authors.initials: B
authors.lastname: Young
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Cleary
authors.forename: Michael W
authors.initials: MW
authors.lastname: Steffes
authors.forename: Noel S
authors.initials: NS
authors.lastname: Weiss
authors.forename: John D
authors.initials: JD
authors.lastname: Brunzell
mesh_terms: D050153:Abdominal Fat / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000419:Albuminuria / Q000150:complications*; D003404:Creatinine / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000453:epidemiology / Q000378:metabolism; D003928:Diabetic Nephropathies / Q000209:etiology / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications* / Q000473:pathology; D012307:Risk Factors
chemical_list: D003404:Creatinine