Transpl Int. 2015 Oct;28(10):1162-71. doi: 10.1111/tri.12606.
Visceral fat is better related to impaired glucose metabolism than body mass index after kidney transplantation.
- 1Department of Transplantation Medicine, Section of Nephrology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
- 2Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
- 3Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway.
- 4Department of Endocrinology, Section of Specialized Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
- 5Norwegian Renal Registry, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
- 6School of Pharmacy, University of Oslo, Oslo, Norway.
The role of visceral adipose tissue (VAT) in post-transplant hyperglycaemia is not known. We evaluated 167 patients without diabetes 8-10 weeks after kidney transplantation, performing oral glucose tolerance tests and measuring VAT content from dual-energy X-ray absorptiometry scans. Median VAT weight in normal glucose tolerance patients was 0.9 kg, impaired fasting glucose patients 1.0 kg, impaired glucose tolerance patients 1.3 kg and patients with post-transplant diabetes (PTDM) 2.1 kg (P = 0.004, indicating a difference between groups). Percentage VAT of total body fat was associated with fasting (R(2) = 0.094, P < 0.001) and 2-h glucose concentration (R(2) = 0.062, P = 0.001), while BMI was only associated with 2-h glucose concentration (R(2) = 0.029, P = 0.028). An association between BMI and 2-h glucose concentration was lost in adjusted models, as opposed to the associations between VAT as percentage of total body fat and glucose concentrations (R(2) = 0.132, P < 0.001 and R(2) = 0.097, P = 0.001, respectively for fasting and 2-h glucose concentration). In conclusion, VAT is more closely related to impaired glucose metabolism than BMI after kidney transplantation. The association with central obesity should encourage additional studies on lifestyle interventions to prevent PTDM.
KEYWORDS: HOMA-IR index; insulin resistance; kidney transplantation; new-onset diabetes mellitus; post-transplant diabetes mellitus; visceral fat
- Our aim was to elucidate the association between visceral fat (VAT) and blood glucose levels in kidney transplant patients.
- Visceral fat is the fat located in the abdomen around the abdominal organs, in the so-called “android area” (figure 1). Visceral fat is closely related to insulin resistance and linked to the adverse effects of obesity.
- Post transplant diabetes mellitus (PTDM) and type 2 diabetes have several similarities and share traditional risk factors. We hypothesised that we would find higher amount of visceral fat in the patients that presented with PTDM at 10 weeks after transplantation based on oral glucose tolerance tests than those with normal glucose tolerance at the same time.
- We found a significant difference in visceral fat among glucose tolerance groups (figure 2), and visceral fat was adversely associated with glucose metabolism. The association between VAT and glucose metabolism was stronger than between BMI and glucose metabolism.
- Whether reduction of excess body fat including visceral fat mass may prevent development of PTDM needs further studies, underpinning the call for exercise and appropriate diet in kidney transplant patients.