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J Diabetes. 2017 Nov;9(11):983-993. doi: 10.1111/1753-0407.12514. Epub 2017 Feb 5.

Obesity, weight change, and chronic kidney disease in patients with type 2 diabetes mellitus: A longitudinal study in Taiwan.

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School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.
Department of Public Health and Environmental Medicine, Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Nutrition and Dietetics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University and University Hospital, Kaohsiung, Taiwan.
Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University and University Hospital, Kaohsiung, Taiwan.
Department of Health Services Administration, China Medical University, Taichung, Taiwan.
Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan.



The aim of the present study was to investigate relationships between the risk of chronic kidney disease (CKD) and obesity and weight changes in Asian patients with type 2 diabetes.


At baseline (2003-05), 1187 diabetic patients aged 30-70 years were recruited to the study, with follow-up surveys completed in 2008, 2009, and 2010. Chronic kidney disease was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min per 1.73 m2 ; body mass index (BMI) was categorised as normal (18.5-22.9 kg/m2 ), overweight (23-27.4 kg/m2 ), or obese (≥27.5 kg/m2 ); waist circumference (WC) ≥80 cm for women and ≥90 cm for men was taken to indicate abdominal obesity. Changes in weight and WC were calculated from baseline to each follow-up survey. Relative risk (RR) and 95% confidence intervals (CIs) of CKD were estimated. To estimate the risk for incident CKD, associations were examined in patients without CKD at baseline (n = 881).


Over 7 years of follow-up, obesity (RR 1.48; 95% CI 1.08-2.04; P = 0.015) and high WC (RR 1.23; 95% CI 1.00-1.52; P = 0.049) were associated with CKD after adjusting for covariates. Among participants without CKD at baseline, those who gained >10% weight (RR 1.43; 95% CI 1.07-1.90; P = 0.015) and in whom WC increased >15% (RR 1.37; 95% CI 1.01-1.85; P = 0.045) had a higher risk of incident CKD than those who remained stable (±5% changes in weight or WC).


Diabetic patients who are obese and those with excessive central fat were more likely to have CKD. Large weight gain (>10%) and increases in WC (>15%) independently predicted incident CKD.


2型糖尿病; Asian; chronic kidney disease; obesity; type 2 diabetes; weight change; 亚洲人; 体重改变; 慢性肾病; 肥胖

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