‘Yo-Yo Dieting’ Could Be Hard on Kidneys in Type 1 Diabetes Patients

Body-weight cycling, sometimes referred to as yo-yo dieting, may be harmful to the kidneys for people with type 1 diabetes, according to retrospective data analysis.

Among 1,432 people with type 1 diabetes, high variability of average body weight was associated with a 25% higher risk of experiencing a 40% decline in estimated glomerular filtration rate (eGFR) over an average 6-year follow-up (HR 1.25, 95% CI 1.09-1.41, P=0.001), reported Marion Camoin, MD, of Bordeaux University Hospital in France, and colleagues in the Journal of Clinical Endocrinology & Metabolism.

Greater weight variability also was associated with significantly higher risks for a few other negative renal outcomes, which were adjusted for several variables including baseline eGFR, HbA1c, and use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs):

• Doubling of baseline serum creatinine: HR 1.34 (95% CI 1.13-1.57, P=0.001)
• Stage 3 chronic kidney disease: HR 1.36 (95% CI 1.12-1.63, P=0.002)
• Rapid decline in eGFR (decline >3 mL/min/m² per year): OR 1.49 (95% CI 1.15-1.93, P=0.003)

There was also a trend towards an increased risk for moderate albuminuria (urinary albumin excretion rate 30-300 mg/24 hours) and severe albuminuria (>300 mg/24 hours), though this didn’t reach significance after adjustment.

Body-weight cycling isn’t uncommon in the general population, with an estimated prevalence up to 35% in men and 55% in women. Drivers behind weight cycling “can be multiple and complex, involving genetic, environmental, and pharmacological factors, along with behavioral, lifestyle, and dietary influences often shaped by body perception,” the researchers said.

Repeatedly gaining and losing weight several times is known to have a “deleterious impact” on risk of cardiovascular events and all-cause mortality, but this is the first study to report associations with the risk of renal events in people with type 1 diabetes.

“In type 1 diabetes, insulin therapy may play a particularly significant role in driving body-weight cycling due to the anabolic effects of the hormone,” Camoin and colleagues pointed out. “Weight loss can result from suboptimal insulin therapy, while weight gain is commonly associated with improved glycemic control. Additionally, the hypoglycemia risk associated with insulin use may lead to defensive snacking and reduced physical activity.”

They advised that “strategies aimed at weight reduction in people with type 1 diabetes should focus on promoting long-term weight maintenance, as weight stability may have a positive impact on health outcomes.”

Data for the analysis came from the Diabetes Control and Complications Trial (DCCT) and the post-trial observational follow-up, the Epidemiology of Diabetes Interventions and Complications (EDIC) study. The randomized DCCT reported benefits of intensive glycemic control (blood glucose goal between 70-120 mg/dL) on microvascular complications. It enrolled 1,441 participants with type 1 diabetes between ages 13 and 39 from 1983 to 1993.

Camoin’s group used four indices of intraindividual variability of body weight using annual body-weight data. Participants in the highest tertile for body-weight variability were more likely to be women (59% vs 35%) and younger (25 vs 29 years) compared to those with the most stable body weight. They also had a lower baseline BMI (23.1 vs 23.5), higher HbA1c (9.1% vs 8.7%), and a higher eGFR (129 vs 124 mL/min/1.73 m²).

Those with the highest body-weight variability were also more likely to have been allocated to the DCCT study intensive treatment group (50% vs 39%). The researchers noted that during the trial, frequent nonsevere episodes of hypoglycemia during intensive glucose control were associated with subsequent weight gain.

During follow-up, 18.8% of participants experienced a 40% decline in eGFR from baseline, 8.6% had a doubling of baseline serum creatinine, and 8.9% progressed to stage 3 chronic kidney disease (eGFR <60 mL/min/1.73 m²). The highest tertile for body-weight variability had an eGFR change of -1.73 mL/min/1.73 m² per year compared with -1.51 mL/min/1.73 m² per year for those with more stable weight.

Camoin’s group didn’t have information of the underlying cause of body-weight variability, limiting the generalizability of the findings. Also, data for the cohort was obtained in 1983 and type 1 diabetes management has greatly evolved since then.

“[I]t would be interesting to confirm these results with more recent data,” they concluded.

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