Visceral fat is strongly associated with post-transplant diabetes mellitus and glucose metabolism 1 year after kidney transplantation

Abstract

Body composition after kidney transplantation is linked to glucose metabolism, and impaired glucose metabolism is associated with increased risk of cardiovascular events and death. One year after transplantation we examined 150 patients for new-onset diabetes performing OGTTs and body composition measurements including visceral adipose tissue (VAT) content from dual-energy X-ray absorptiometry scans. We found that glucose metabolism was generally improved and that the levels of VAT and percentage VAT of total body fat mass (VAT<small>%totBFM</small>) were lowest in those with normal glucose tolerance and highest in those with post transplant diabetes mellitus. In a multivariable linear regression analysis 87.4% of the variability in fasting glucose concentration was explained by insulin resistance (p<0.001,HOMA-IR index), beta cell function (p<0.001,HOMA-beta), VAT<small>%totBFM</small> (p=0.007) and BMI (p=0.015) (total model p<0.001), while insulin resistance (p<0.001) and beta cell function (p<0.001) explained 31.9% of the variability in 2-hour glucose concentration in a multivariable model (total model p<0.001). VAT was associated with glucose metabolism to a larger degree than BMI. In conclusion, VAT is associated with hyperglycemia one year after kidney transplantation, and insulin resistance and beta cell function estimates are the most robust markers of glucose metabolism.