Abstract

Objective South Asians have a high prevalence of central obesity. When the diagnosis 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, prior to the manifestation of diabetes mellitus.

Research Design and Methods We invited first-degree non-diabetic relatives of South Asian type 2 diabetic patients for investigation of microalbuminuria and diabetes. Subjects who used anti-hypertensive or anti-diabetic medication were excluded. We performed a glucose tolerance test according to the classic WHO-criteria; 205 subjects were normoglycemic; we excluded 25 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/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.