Diabesity and microvascular disease: the impact of weight loss
DOI:
https://doi.org/10.15277/bjd.2024.438Keywords:
microvascular, diabetes, obesityAbstract
There is increasing evidence that obesity is an independent risk factor for the development of microvascular disease. Addressing modifiable risk factors such as obesity may help prevent and even reverse microvascular complications, including neuropathy, nephropathy and retinopathy.
In this review article, we examine the evidence for the impact of obesity on microvascular disease, as well as the effects of weight loss in individuals with and without type 2 diabetes mellitus (T2DM). Numerous studies have shown obesity to be an independent risk factor for neuropathy and nephropathy in patients with and without T2DM but the association between obesity and retinopathy is less clear. Addressing obesity through weight loss strategies can have beneficial outcomes. Although evidence for medical weight management is limited due to the lack of longitudinal data, there is growing recognition of the positive impact of surgical weight management. Recent studies have shown bariatric surgery to be protective against diabetic neuropathy despite previous concerns from older studies. Similarly, several studies have demonstrated improvements in renal measures after bariatric surgery. Improvements in retinopathy, however, have been less encouraging, with further research required to fully understand the impact of obesity. Overall, managing obesity and implementing weight loss through bariatric surgery has positive outcomes for reducing the burden of microvascular disease.
References
Bashir B, Iqbal Z, Adam S, et al. Microvascular complications of diabetes and obesity – role of bariatric surgery. Obes Rev 2023; 24(10) :e13602. Epub ahead of print. https://doi.org/10.1111/obr.13602
Callaghan BC, Gao L, Li Y, et al. Diabetes and obesity are the main metabolic drivers of peripheral neuropathy. Ann Clinical Translational Neurology 2018;5(4): 397-405. https://doi.org/10.1002/acn3.531
Callaghan BC, Xia R, Reynolds E, et al. Association between metabolic syndrome components and polyneuropathy in an obese population. JAMA Neurol 2016;73(12):1468-76. https://doi.org/10.1001/jamaneurol.2016.3745
Hanewinckel R, Drenthen J, Ligthart S, etal. Metabolic syndrome is related to polyneuropathy and impaired peripheral nerve function: a prospective population-based cohort study. J Neurol Neurosurg Psychiatry 2016;87(12):1336–42. https://doi.org/10.1136/jnnp-2016-314171
Azmi S, Ferdousi M, Liu Y, et al. Bariatric surgery leads to an improvement in small nerve fibre damage in subjects with obesity. Int Journal Obesity Lond 2021;45(3):631-8.
Zhang L, Krzentowski G, Albert A, et al. Risk of developing retinopathy in Diabetes Control and Complications Trial type 1 diabetic patients with good or poor metabolic control. Diabetes Care 2001;24(7):1275-9. https://doi.org/10.2337/diacare.24.7.1275
Henricsson M, Nyström L, Blohmé G, et al. The incidence of retinopathy 10 years after diagnosis in young adult people with diabetes: results from the nationwide population-based Diabetes Incidence Study in Sweden. Diabetes Care 2003;26(2):349-54. https://doi.org/10.2337/diacare.26.2.349
Chao JR, Lai MY, Azen SP, et al. Retinopathy in persons without diabetes: the Los Angeles Latino Eye Study. Invest Ophthalmol Vis Sci 2007;48(9):4019-25. https://doi.org/10.1167/iovs.07-0206
Gray N, Picone G, Sloan F, et al. The relationship between BMI and onset of diabetes mellitus and its complications. SouthMedJ 2015; 108(1):29-36.
van Leiden HA, Dekker JM, Moll AC, etal. Blood pressure, lipids, and obesity are associated with retinopathy: the Hoorn Study. Diabetes Care 2002;25(8):1320-5. https://doi.org/10.2337/diacare.25.8.1320
Dirani M, Xie J, Fenwick E, etal. Are obesity and anthropometry risk factors for diabetic retinopathy? The Diabetes Management Project. Invest Ophthalmol Vis Sci 2011;52(7):4416-21. https://doi.org/10.1167/iovs.11-7208
Ejerblad E, Fored CM, Lindblad P, etal. Obesity and risk for chronic renal failure. J Am Soc Nephrol 2006;17(6):1695-702. https://doi.org/10.1681/ASN.2005060638
Peters AM, Ciapryna MB, Bowles PF, et al. Obesity does not accelerate the decline in glomerular filtration rate associated with advancing age. Int J Obesity (Lond) 2009;33(3):379–81. https://doi.org/10.1038/ijo.2009.6
Iseki K, Ikemiya Y, Kinjo K, et al. Body mass index and the risk of development of end-stage renal disease in a screened cohort. Kidney Internat 2004;65(5):1870–6. https://doi.org/10.1111/j.1523-1755.2004.00582.x
Gelber RP, Kurth T, Kausz AT, et al. Association between body mass index and CKD in apparently healthy men. Am Journal Kidney Diseases 2005;46(5):871–80. https://doi.org/10.1053/j.ajkd.2005.08.015
Taylor EN, Stampfer MJ, Curhan GC. Obesity, weight gain, and the risk of kidney stones. JAMA 2005;293(4):455–62. https://doi.org/10.1001/jama.293.4.455
Oh SW, Yoon YS, Shin SA. Effects of excess weight on cancer incidences depending on cancer sites and histologic findings among men: Korea National Health Insurance Corporation Study. J Clin Oncology 2005l;23(21):4742–54. https://doi.org/10.1200/JCO.2005.11.726
van Dijk BA, Schouten LJ, Kiemeney LA, et al. Relation of height, body mass, energy intake, and physical activity to risk of renal cell carcinoma: results from the Netherlands Cohort Study. Am J Epidemiol 2004; 160(12): 1159-67. https://doi.org/10.1093/aje/kwh344
Vivante A, Golan E, Tzur D, et al. Body mass index in 1.2 million adolescents and risk for end-stage renal disease. Arch Int Med 2012; 172(21):1644–50. https://doi.org/10.1001/2013.jamainternmed.85
Hsu CY, Iribarren C, McCulloch CE, et al. Risk factors for end-stage renal disease: 25-year follow-up. Arch Int Med 2009;169(4):342–50. https://doi.org/10.1001/archinternmed.2008.605
Munkhaugen J, Lydersen S, Widerøe TE, et al. Prehypertension, obesity, and risk of kidney disease: 20-year follow-up of the HUNT I study in Norway. Am J Kidney Dis 2009;54(4):638–46. https://doi.org/10.1053/j.ajkd.2009.03.023
Chandie Shaw PK, Berger SP, Mallat M, etal. Central obesity is an independent risk factor for albuminuria in nondiabetic South Asian subjects. Diabetes Care 2007;30(7):1840–4. https://doi.org/10.2337/dc07-0028
Kramer H, Luke A, Bidani A, et al. Obesity and prevalent and incident CKD: the Hypertension Detection and Follow-Up Program. Am J Kidney Diseases 2005;46(4):587-94. https://doi.org/10.1053/j.ajkd.2005.06.007
Polemiti E, Baudry J, Kuxhaus O, et al. BMI and BMI change following incident type 2 diabetes and risk of microvascular and macrovascular complications: the EPIC-Potsdam study. Diabetology 2021;64(4):814-
https://doi.org/10.1007/s00125-020-05362-7
Perkovic V, Jardine MJ, Neal B, et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med 2019; 380(24): 2295-2306. https://doi.org/10.1056/NEJMoa1811744
Heerspink HJL, Stefánsson BV, Correa-Rotter R, etal. Dapagliflozin in patients with chronic kidney disease. N Engl J Med 2020;383(15): 1436-46. https://doi.org/10.1056/NEJMoa2024816
Zinman B, Lachin JM, Inzucchi SE. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 2016; 374(11):1094. https://doi.org/10.1056/NEJMc1600827
Neal B, Perkovic V, Mahaffey KW, et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med 2017;377(7):644-57. https://doi.org/10.1056/NEJMoa1611925
Wiviott SD, Raz I, Bonaca MP, etal. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med 2019;380(4):347-57. https://doi.org/10.1056/NEJMoa1812389
Marso SP, Bain SC, Consoli A, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med 2016; 375(19):1834-44. https://doi.org/10.1056/NEJMoa1607141
Marso SP, Daniels GH, Brown-Frandsen K, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med 2016; 375(4):311-22. https://doi.org/10.1056/NEJMoa1603827
Bosch C, Carriazo S, Soler MJ, et al. Tirzepatide and prevention of chronic kidney disease. Clin Kidney J 2022;16(5):797–808. https://doi.org/10.1093/ckj/sfac274
Coleman KJ, Haneuse S, Johnson E, etal. Long-term microvascular disease outcomes in patients with type 2 diabetes after bariatric surgery: evidence for the legacy effect of surgery. Diabetes Care 2016;39(8):1400-07. https://doi.org/10.2337/dc16-0194
O'Brien R, Johnson E, Haneuse S, et al. Microvascular outcomes in patients with diabetes after bariatric surgery versus usual care: a matched cohort study. Ann Intern Med 2018;169(5):300-10.
Carlsson LM, Romeo S, Jacobson P, et al. The incidence of albuminuria after bariatric surgery and usual care in Swedish Obese Subjects (SOS): a prospective controlled intervention trial. Int J Obes 2015;39(1):169–75. https://doi.org/10.1038/ijo.2014.72
Miras AD, Chuah LL, Khalil N, et al. Type 2 diabetes mellitus and microvascular complications 1 year after Roux-en-Y gastric bypass: a case-control study. Diabetologia 2015;58(7):1443-7. https://doi.org/10.1007/s00125-015-3595-7
Adam S, Azmi S, Ho JH, etal. Improvements in diabetic neuropathy and nephropathy after bariatric surgery: a prospective cohort study. Obesity Surgery 2021;31(2):554-63. https://doi.org/10.1007/s11695-020-05052-8
Reynolds EL, Watanabe M, Banerjee M, etal. The effect of surgical weight loss on diabetes complications in individuals with class II/III obesity. Diabetologia 2023;66(7):1192-1207. https://doi.org/10.1007/s00125-023-05899-3
Merlotti C, Ceriani V, Morabito A, etal. Bariatric surgery and diabetic retinopathy: a systematic review and meta-analysis of controlled clinical studies. Obes Rev 2017;18(3):309–16. https://doi.org/10.1111/obr.12490
Adam S, Ho JH, Syed AA, et al. Response to letter to the Editor concerning: Adam S et al. Improvements in diabetic neuropathy and nephropathy after bariatric surgery: a prospective cohort study. Obesity Surgery 2022;32(10):3460-2.
Docherty NG, le Roux CW. Bariatric surgery for the treatment of chronic kidney disease in obesity and type 2 diabetes mellitus. Nature reviews Nephrology 2020;16(12):709-20. https://doi.org/10.1038/s41581-020-0323-4
Li K, Zou J, Ye Z, etal. Effects of bariatric surgery on renal function in obese patients: a systematic review and meta analysis. PLoSOne 2016;11(10):e0163907 https://doi.org/10.1371/journal.pone.0163907
Scheurlen KM, Probst P, Kopf S, et al. Metabolic surgery improves renal injury independent of weight loss: a meta-analysis. Surgery Obesity Related Dis 2019;15(6):1006-20. https://doi.org/10.1016/j.soard.2019.03.013
Friedman AN, Wahed AS, Wang J, et al. Effect of bariatric surgery on CKD risk. J Am Soc Nephrol 2018;29(4):1289-300.
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