Cross-sectional associations between central and general adiposity with albuminuria: observations from 400,000 people in UK Biobank

Abstract

Background Whether measures of central adiposity are more or less strongly associated with risk of albuminuria than body mass index (BMI), and by how much diabetes/levels of glycosylated haemoglobin (HbA1c) explain or modify these associations, is uncertain. Methods Ordinal logistic regression was used to estimate associations between values of central adiposity (waist-to-hip ratio) and, separately, general adiposity (BMI) with categories of urinary albumin-to-creatinine ratio (uACR) in 408,527 UK Biobank participants. Separate central and general adiposity-based models were initially adjusted for potential confounders and measurement error, then sequentially, models were mutually adjusted (e.g. waist-to-hip ratio adjusted for BMI, and vice versa), and finally they were adjusted for potential mediators. Results Levels of albuminuria were generally low: 20,425 (5%) had a uACR ≥3 mg/mmol. After adjustment for confounders and measurement error, each 0.06 higher waist-to-hip ratio was associated with a 55% (95%CI 53–57%) increase in the odds of being in a higher uACR category. After adjustment for baseline BMI, this association was reduced to 32% (30–34%). Each 5 kg/m2 higher BMI was associated with a 47% (46–49%) increase in the odds of being in a higher uACR category. Adjustment for baseline waist-to-hip ratio reduced this association to 35% (33–37%). Those with higher HbA1c were at progressively higher odds of albuminuria, but positive associations between both waist-to-hip ratio and BMI were apparent irrespective of HbA1c. Altogether, about 40% of central adiposity associations appeared to be mediated by diabetes, vascular disease and blood pressure. Conclusions Conventional epidemiological approaches suggest that higher waist-to-hip ratio and BMI are independently positively associated with albuminuria. Adiposity–albuminuria associations appear strong among people with normal HbA1c, as well as people with pre-diabetes or diabetes.

Sex difference in the association between pathological albuminuria and subclinical atherosclerosis: insights from the I-Lan longitudinal aging study

“…In contrast, two cross-sectional studies in Chinese and Korea revealed that women with central obesity tended to develop albuminuria but insignificant relationship between albuminuria and obesity in men [ 25 , 26 ]. Our data support that in men, microalbuminuria is the clusters with the components of MetS, especially central obesity more propensity than women, consistent with a finding in 408,527 UK Biobank participants that each 0.06 increase of waist-to-hip ratio was associated with 75% (71–79%) and 40% (38–43%) increases in odds of higher UACR in men and women, respectively [ 27 ]. This suggests that the long-term sequelae of obesity, fat metabolism, and fat deposition may differ between men and women.…”

Lipid Accumulation Product is Associated with Urinary Albumin-creatinine Ratio in Chinese Prediabitic Population: A Report from the REACTION Study

“… 19 In the current study, LAP was proven to be more closely associated with uACR in prediabetes, than WHR and WHtR, and independent of measurement of general adiposity is consistent with previous data. 5 …”

“…19 In the current study, LAP was proven to be more closely associated with uACR in prediabetes, than WHR and WHtR, and independent of measurement of general adiposity is consistent with previous data. 5 Prediabetes was described as a precursor of chronic kidney disease, and vice versa, microvascular dysfunction preceded and contributed to hyperglycemia through impairment of insulin-mediated glucose disposal and insulin secretion. [20][21][22] Meanwhile, visceral obesity was also associated with microvascular abnormality, including insulin-induced microvascular dilation and recruitment, impairments in functional capillary density, and endothelium-dependent vasodilation in the absence of general obesity, [23][24][25] supporting the notion that visceral adiposity was an important driver of DKD.…”

“…Adjusted hazard ratios for declined estimated glomerular filtration rate (eGFR) were 2.02 (95%CI: 1.80–2.27) with body mass indices (BMI) 40 kg/m 2 comparing to BMI of 25 kg/m 2 , 4 A recent UK Biobank study that enrolled 0.4 million people proved that each 5 kg/m 2 ascending in BMI was associated with a 47% (46–49%) increase in the odds of higher urinary albumin-to-creatinine ratio (uACR) category. 5 …”

“…Adjusted hazard ratios for declined estimated glomerular filtration rate (eGFR) were 2.02 (95%CI: 1.80-2.27) with body mass indices (BMI) 40 kg/m 2 comparing to BMI of 25 kg/m 2 , 4 A recent UK Biobank study that enrolled 0.4 million people proved that each 5 kg/m 2 ascending in BMI was associated with a 47% (46-49%) increase in the odds of higher urinary albumin-to-creatinine ratio (uACR) category. 5 To further evaluate obesity-associated risks, an alternative continuous index of lipid over accumulation, the lipid accumulation product (LAP), was calculated from waist circumference (WC, cm) and fasting triglycerides (TGs) (mmol/L): (WC: 65)⨰TG (men) and (WC: 58) ⨰TG (women), initially for better identifying visceral obesity and insulin resistance, elevated glucose, and diabetes than BMI did. 6 Recent studies found that LAP also acquitted itself well in predicting cardiovascular risks 7,8 and identifying CKD 9,10 in the healthy population.…”