Maintaining stable body weight has long been recommended as a preventive measure against diabetic nephropathy. However, the relationship between significant changes in body fat and the risk of developing diabetic nephropathy remains unclear. A new study seeks to explore the potential association between body fat variation rates and the occurrence of diabetic nephropathy in American patients with type 2 diabetes.
Study Design and Methods
This post-hoc analysis draws on data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Researchers calculated body fat variation rates over a two-year period, dividing participants into two categories: those with low and those with high body fat variation rates. To evaluate the risk of diabetic nephropathy, hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox proportional hazards model. Confounding factors were accounted for through propensity score matching, ensuring more accurate comparisons between the two groups.
Key Findings
The study included 4,609 participants, all diagnosed with type 2 diabetes. Over a five-year follow-up period, 1,511 cases of diabetic nephropathy were recorded. Findings revealed that a higher body fat variation rate was associated with an increased risk of diabetic nephropathy. Specifically, participants in the high variation group faced a 13% greater risk of developing the condition compared to those in the low variation group (HR 1.13, 95% CI 1.01–1.26).
A notable interaction between body fat variation rate and body mass index (BMI) was detected (P interaction = 0.008). Importantly, the increased risk of diabetic nephropathy was only significant among participants with a BMI greater than 30, or those classified as obese. In this subgroup, the hazard ratio jumped to 1.34 (95% CI 1.08–1.66), further highlighting the impact of body fat variation on individuals with higher BMI levels.
Conclusions and Recommendations
The study concludes that in individuals with type 2 diabetes, greater fluctuations in body fat are linked to an elevated risk of diabetic nephropathy, particularly among those who are obese. This suggests that for obese diabetic patients, a more gradual approach to weight loss might be beneficial in preventing rapid shifts in body fat, thereby lowering the risk of kidney complications. The findings underscore the importance of managing both weight and body fat variation in the treatment and prevention of diabetic nephropathy, particularly in the obese population.
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