Related Experiment Videos
Birth weight and renal disease in Pima Indians with type 2 diabetes mellitus
R G Nelson1, H Morgenstern, P H Bennett
1Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ 85014-4972, USA.
Insights
Birth weight impacts kidney disease risk in Pima Indians with type 2 diabetes. Both low and high birth weights are associated with increased urinary albumin excretion, a marker of kidney damage.
Area of Science:
- Nephrology
- Endocrinology
- Public Health
Background:
- Congenital renal development issues can elevate kidney disease risk.
- Diabetes mellitus exacerbates kidney damage, increasing susceptibility to renal disease.
Purpose of the Study:
- To investigate the association between birth weight and albuminuria in Pima Indians with type 2 diabetes.
- To explore the influence of intrauterine factors on kidney health in diabetic individuals.
Main Methods:
- Cross-sectional study of 308 Pima Indians with type 2 diabetes.
- Analysis of urinary albumin excretion prevalence across birth weight categories (low, normal, high).
- Logistic regression models adjusted for age, sex, diabetes duration, HbA1c, and blood pressure.
Main Results:
- A U-shaped association was observed between birth weight and elevated albuminuria (p=0.04).
- High birth weight (>=4,500g) and low birth weight (<2,500g) were linked to higher albuminuria prevalence compared to normal birth weight (2,500-4,499g).
- Maternal diabetes explained the increased albuminuria risk in high birth weight offspring, while intrauterine growth retardation may explain the risk in low birth weight offspring.
Conclusions:
- Birth weight is a significant factor associated with kidney disease risk in type 2 diabetes.
- Intrauterine factors, including maternal diabetes and growth retardation, play a crucial role in the observed associations.
Abstract:
Congenital retardation of renal development may increase the risk of renal disease, and this risk may be enhanced by diseases, such as diabetes, that damage the kidney. In this study, the prevalence of urinary albumin excretion, determined in 308 Pima Indians with type 2 diabetes, was 63% in subjects with low birth weight (<2,500 g), 41% in those with normal birth weight (2,500-4,499 g), and 64% in those with high birth weight (> or =4,500 g). When examined as a continuous variable by generalized additive logistic regression, birth weight had a U-shaped association with the prevalence of elevated urinary albuminuria (p = 0.04) after adjustment for age, sex, duration of diabetes, glycosylated hemoglobin, and blood pressure. The odds of elevated albuminuria in subjects of low birth weight was 2.3 times (95% confidence interval 0.72-7.2) that in subjects of normal birth weight, and the odds in subjects of high birth weight was 3.2 times (95% confidence interval 0.75-13.4) as high. Sixty-four percent of the subjects with high birth weight and none of those with low birth weight were offspring of diabetic mothers. After maternal diabetes during pregnancy was controlled for, the odds of elevated albuminuria in subjects of high birth weight was no longer higher (odds ratio = 1.0, 95% confidence interval 0.22-4.9). The higher prevalence of elevated albuminuria in diabetic Pima Indians with high birth weight may be due to intrauterine diabetes exposure, whereas the higher prevalence in those with low birth weight may be due to the effects of intrauterine growth retardation.