title: Obesity, weight change, and chronic kidney disease in patients with type 2 diabetes mellitus: A longitudinal study in Taiwan.
abstract: BACKGROUND
  The aim of the present study was to investigate relationships between the risk of chronic kidney disease (CKD) and obesity and weight changes in Asian patients with type 2 diabetes.
  
  
  METHODS
  At baseline (2003-05), 1187 diabetic patients aged 30-70 years were recruited to the study, with follow-up surveys completed in 2008, 2009, and 2010. Chronic kidney disease was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min per 1.73 m2; body mass index (BMI) was categorised as normal (18.5-22.9 kg/m2), overweight (23-27.4 kg/m2), or obese (≥27.5 kg/m2); waist circumference (WC) ≥80 cm for women and ≥90 cm for men was taken to indicate abdominal obesity. Changes in weight and WC were calculated from baseline to each follow-up survey. Relative risk (RR) and 95% confidence intervals (CIs) of CKD were estimated. To estimate the risk for incident CKD, associations were examined in patients without CKD at baseline (n = 881).
  
  
  RESULTS
  Over 7 years of follow-up, obesity (RR 1.48; 95% CI 1.08-2.04; P = 0.015) and high WC (RR 1.23; 95% CI 1.00-1.52; P = 0.049) were associated with CKD after adjusting for covariates. Among participants without CKD at baseline, those who gained >10% weight (RR 1.43; 95% CI 1.07-1.90; P = 0.015) and in whom WC increased >15% (RR 1.37; 95% CI 1.01-1.85; P = 0.045) had a higher risk of incident CKD than those who remained stable (±5% changes in weight or WC).
  
  
  CONCLUSIONS
  Diabetic patients who are obese and those with excessive central fat were more likely to have CKD. Large weight gain (>10%) and increases in WC (>15%) independently predicted incident CKD.
authors.affiliation: School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Hsin-Fang
authors.initials: HF
authors.lastname: Chung
authors.affiliation: School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Al Mamun
authors.affiliation: Department of Public Health and Environmental Medicine, Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.|Department of Nutrition and Dietetics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Meng-Chuan
authors.initials: MC
authors.lastname: Huang
authors.affiliation: School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.|Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
authors.forename: Kurt Z
authors.initials: KZ
authors.lastname: Long
authors.affiliation: Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan.
authors.forename: Ya-Fang
authors.initials: YF
authors.lastname: Huang
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University and University Hospital, Kaohsiung, Taiwan.
authors.forename: Shyi-Jang
authors.initials: SJ
authors.lastname: Shin
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University and University Hospital, Kaohsiung, Taiwan.
authors.forename: Shang-Jyh
authors.initials: SJ
authors.lastname: Hwang
authors.affiliation: Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan.|Department of Health Services Administration, China Medical University, Taichung, Taiwan.|Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan.
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Hsu
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000208:ethnology; D005260:Female; D005919:Glomerular Filtration Rate; D006306:Health Surveys / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000208:ethnology; D050177:Overweight / Q000150:complications* / Q000208:ethnology; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000208:ethnology; D012307:Risk Factors; D013624:Taiwan; D055105:Waist Circumference
keywords: 2型糖尿病; Asian; chronic kidney disease; obesity; type 2 diabetes; weight change; 亚洲人; 体重改变; 慢性肾病; 肥胖