Intra-Abdominal Fat and Elevated Urine Albumin Excretion in Men With Type 1 Diabetes
- Shalamar D. Sibley, MD, MPH1,
- Ian H. de Boer, MD, MS2,
- Michael W. Steffes, MD, PHD1,
- John D. Brunzell, MD2 and
- the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Research Study Group
- 1Department of Endocrinology and Diabetes, University of Minnesota, Minneapolis, Minnesota
- 2School of Medicine, University of Washington, Seattle, Washington
- Address correspondence and reprint requests to Shalamar D. Sibley, Endocrinology and Diabetes, University of Minnesota, Mayo Medical Code 101, 420 Delaware St. SE, Minneapolis, MN 55455. E-mail: sible004{at}umn.edu
- ACR, albumin-to-creatinine ratio
- IAF, intra-abdominal fat
- SQF, abdominal subcutaneous fat
- WHR, waist-to-hip ratio
Earlier studies documented associations between central obesity and elevated albumin excretion rate or other renal injury indicators in nondiabetic subjects (1–11). A retrospective study conducted in a Kaiser Permanente mixed diabetic-nondiabetic cohort suggested that obesity increased risk for progression to end-stage renal disease (12). Studies also identified obesity as a risk factor for renal disease in type 1 diabetes (13,14). We previously examined obesity-related factors and albumin excretion within the total Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) cohort. Conducted between 1982 and 1993, the DCCT included 1,441 subjects with type 1 diabetes randomized to intensive or conventional diabetes treatment and followed for 6.5 years on average. Details of resources utilized for the DCCT/EDIC (observational follow-up) study designs were previously published (15–18). These studies demonstrate the powerful effect of intensive insulin therapy on preventing and slowing progression of micro- and macrovascular complications and established intensive therapy as the current standard of diabetes care for patients with type 1 diabetes. However, type 1 diabetic subjects, like the general population, are becoming heavier and more at risk for obesity-related complications (19). In our cross-sectional analysis 4 years after the end of the DCCT, waist-to-hip ratio (WHR), a visceral fat surrogate, was associated with elevated albumin excretion (20). In our longitudinal analysis, waist circumference was associated with subsequent development of persistent microalbuminuria (21). For this current analysis, we hypothesized that …
