Gain in adiposity over 3 years is associated with progressive renal decline in multi-ethnic South-East Asians with type 2 diabetes.

Background This study evaluated the association between gain in adiposity and renal decline in a large prospective multiethnic South-east Asian cohort with type 2 diabetes mellitus (T2DM). Methods Three years after the baseline visit, 2057 T2DM subjects were recalled for reassessment. The final cohort comprised 1014 subjects and was categorized into tertiles based on changes in body weight (Delta Wt), body mass index (Delta BMI), visceral fat area (Delta VFA), and BMI-adjusted VFA (Delta VFA(BMI)). Outcomes included annual and rapid (>= 3 mL/min per 1.73 m(2) per year) decline in estimated glomerular filtration rate (eGFR) and progression of albuminuria. Results Participants (mean [+/- SD] age 57 +/- 11 years, 48.8% women, BMI 27.7 +/- 5.4 kg/m(2)) exhibited a median annual decline in eGFR of 1.0 mL/min per 1.73 m(2). Compared with the lower tertiles, Tertile 3 of Delta Wt, Delta BMI, Delta VFA, and Delta VFA(BMI) had the highest anthropometric increase, albeit of modest magnitude, and this was accompanied by the worst renal outcomes (all P < 0.05). The relationship between annual eGFR decline and Tertile 3 of Delta Wt, Delta BMI, and Delta VFA(BMI) persisted after multivariate adjustment in men but not in women. In addition, Tertile 3 of Delta Wt, Delta BMI, Delta VFA, and Delta VFA(BMI) predicted rapid eGFR decline. Anthropometric gains were also associated with progression of albuminuria. Conclusions Modest longitudinal gain in adiposity was associated with progressive renal decline in T2DM patients, suggesting that increased adiposity over time adversely affects renal outcomes. Therefore, a carefully designed weight-neutral or -loss antidiabetic treatment regimen is important when managing T2DM in the clinic.