title: Obesity and kidney disease in type 1 and 2 diabetes: an analysis of the National Diabetes Audit.
abstract: BACKGROUND
  Obesity is increasingly prevalent in many countries. Obesity is a major risk factor for the development of type 2 diabetes but its relationship with diabetic kidney disease (DKD) remains unclear. Some studies have suggested that the metabolic syndrome (including obesity) may be associated with DKD in type 1 diabetes.
  
  
  OBJECTIVE
  To investigate the association between obesity and DKD.
  
  
  METHODS
  Retrospective cross-sectional study.
  
  
  METHODS
  National Diabetes Audit data were available for the 2007-08 cycle. Type 1 and 2 diabetes patients with both a valid serum creatinine and urinary albumin:creatinine ratio were included. DKD was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2), albuminuria or both. Logistic regression was used to analyse associations of obesity (body mass index ≥30 kg/m(2)) and other variables including year of birth, year of diagnosis, ethnicity and stage of kidney disease.
  
  
  RESULTS
  A total of 58 791 type 1 and 733 769 type 2 diabetes patients were included in the analysis. After adjustment, when compared with type 1 diabetes patients with normal renal function those with DKD were up to twice as likely to be obese. Type 2 DKD patients were also more likely to be obese. For example, type 2 diabetes patients with an eGFR <15 ml/min/1.73 m(2) and normoalbuminuria, microalbuminuria or macroalbuminuria were all more likely to be obese; odds ratios (95% CI) 1.65 (1.3-2.1), 1.56 (1.28-1.92) and 1.27 (1.05-1.54), respectively.
  
  
  CONCLUSIONS
  This study has highlighted a strong association between obesity and kidney disease in type 1 diabetes and confirmed their association in type 2 diabetes.
authors.affiliation: Centre for Public Health, Institute of Clinical Sciences Block B, Queen's University Belfast, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, UK. chill05@qub.ac.uk.
authors.forename: C J
authors.initials: CJ
authors.lastname: Hill
authors.forename: C R
authors.initials: CR
authors.lastname: Cardwell
authors.forename: A P
authors.initials: AP
authors.lastname: Maxwell
authors.forename: R J
authors.initials: RJ
authors.lastname: Young
authors.forename: B
authors.initials: B
authors.lastname: Matthews
authors.forename: D J
authors.initials: DJ
authors.lastname: O'Donoghue
authors.forename: D G
authors.initials: DG
authors.lastname: Fogarty
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005006:Ethnicity; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology