Central Obesity Is an Independent Risk Factor for Albuminuria in Nondiabetic South Asian Subjects

• Published in: Diabetes care Vol. 30; no. 7; pp. 1840 - 1844
• Main Authors: Chandie Shaw, Prataap K, Berger, Stefan P, Mallat, Marko, Frölich, Marijke, Dekker, Friedo W, Rabelink, Ton J
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.07.2007
• Subjects: Abdominal Fat; Adiposity; Adult; Albuminuria; Albuminuria - etiology; Asian Continental Ancestry Group; Asian people; Biological and medical sciences; Blood pressure; Complications and side effects; Diabetes; Diabetes Mellitus, Type 2 - complications; Early intervention; Endocrinopathies; Families & family life; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Health aspects; Humans; Hyperglycemia; Kidney Diseases - etiology; Kidney failure; Male; Medical ethics; Medical sciences; Middle Aged; Minority & ethnic groups; Nonfiction; Obesity; Obesity - complications; Population; Risk Factors; Rodents; South Asians; Studies; Variables; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Waist-Hip Ratio; Asia; South Asia; United States; Human; Obesity; Urinary system disease; Nutrition; Statistical model; Nutrition disorder; Risk factor; Independence; Metabolic diseases; Endocrinology; Nutritional status; Proteinuria
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc07-0028

Central Obesity Is an Independent Risk Factor for Albuminuria in Nondiabetic South Asian Subjects Prataap K. Chandie Shaw , MD 1 , Stefan P. Berger , MD, PHD 2 , Marko Mallat , MD 2 , Marijke Frölich , PHD 3 , Friedo W. Dekker , MD, PHD 4 and Ton J. Rabelink , MD, PHD 2 1 Department of Nephrology, Medical Center Haaglanden, The Hague, the Netherlands 2 Department of Nephrology, Leiden University Medical Center, Leiden, the Netherlands 3 Clinical Chemistry Laboratory, Leiden University Medical Center, Leiden, the Netherlands 4 Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands Address correspondence and reprint requests to Prataap K. Chandie Shaw, MD, Medical Center Haaglanden, Lijnbaan 32, P.O. Box 432, The Hague 2501 CK, Netherlands, E-mail: p.chandie{at}mchaaglanden.nl Abstract OBJECTIVE — South Asians have a high prevalence of central obesity. When the diagnosis of diabetes is made, they have a very high risk of developing renal failure. In the current study, we explored the hypothesis that central obesity is associated with the development of renal injury, before the manifestation of diabetes. RESEARCH DESIGN AND METHODS — We invited first-degree nondiabetic relatives of South Asian type 2 diabetic patients for investigation of microalbuminuria and diabetes. Subjects who used antihypertensive or antidiabetic medication were excluded. We performed a glucose tolerance test according to the classic World Health Organization criteria. A total of 205 subjects were normoglycemic; we excluded 25 subjects because of impaired glucose tolerance, and 30 subjects were excluded because of de novo diabetes. Central obesity was measured by waist-to-hip ratio (WHR). Albuminuria was measured as albumin-to-creatinine ratio (ACR) in the early-morning urine. RESULTS — Central obesity was independently related with albuminuria in the 205 normoglycemic subjects. We found no relation of fasting blood glucose or systolic blood pressure with albuminuria. Multivariate analysis for the presence of increased albuminuria (median ACR >0.31 mg/mmol) showed a relative risk of 4.1 for the highest versus the lowest tertile of WHR ( P = 0.002). CONCLUSIONS — Central obesity is an early and independent risk factor for increased albuminuria in normoglycemic South Asian subjects. This could explain the high incidence of diabetic renal disease in South Asians, probably by the mechanism of insulin resistance and endothelial dysfunction in the pre-diabetic state. ACR, albumin-to-creatinine ratio CRP, C-reactive protein GTT, glucose tolerance test WHR, waist-to-hip ratio Footnotes Published ahead of print at http://care.diabetesjournals.org on 24 April 2007. DOI: 10.2337/dc07-0028. A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances. The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact. Accepted March 15, 2007. Received January 7, 2007. DIABETES CARE