For patients with type 1 diabetes, body-weight cycling—sometimes called “yo-yo dieting”—is associated with a higher long-term risk of kidney events, suggests a study in The Journal of Clinical Endocrinology & Metabolism.
The retrospective observational study included 1432 patients with type 1 diabetes enrolled in the Diabetes Control and Complications Trial (DCCT) and the follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study. Patients ranged in age from 13 to 39 years; the average duration of follow-up across both studies was 21 years. In the initial DCCT report from 1993, intensive glycemic control delayed the onset and slowed the progression of diabetic retinopathy, nephropathy, and neuropathy.
For analysis of body-weight cycling, four measures of individual body-weight variability were calculated, with variability independent of the mean (VIM) as the primary index. Six criteria for decline in kidney function and progression to chronic kidney disease (CKD) were analyzed for their association with body-weight variability.
Participants with high VIM were more likely to experience a 40% decline in the estimated glomerular filtration rate from baseline to follow-up: hazard ratio (HR), 1.25. The association was independent of baseline and follow-up CKD risk factors and use of nephroprotective medications. High VIM was also associated with doubling of serum creatinine (HR, 1.34), stage 3 CKD (HR, 1.36), and rapid decline in the estimated glomerular filtration rate (>3 mL/min/m2 per year; HR, 1.39).
Patients with high VIM were more likely to have moderate to severe increases in albuminuria, although the association was not significant after adjustment for covariates during follow-up. Other measures of body-weight cycling showed similar associations with diabetic kidney disease outcomes.
In the general population, yo-yo dieting is a CKD risk factor. In a previous study of the DCCT/EDIC cohort, the authors found that body-weight cycling is associated with increased risk of major cardiovascular events in patients with type 1 diabetes.
The new analysis shows increased long-term risk of kidney events associated with body-weight cycling in type 1 diabetes, independent of traditional risk factors and body mass index. The researchers discuss possible mechanisms of the observed associations. They conclude: “Clinically, 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” [Camoin N, et al. Body-weight cycling and risk of diabetic kidney disease in people with type 1 diabetes in the DCCT/EDIC population. J Clin Endocrinol Metab, published online February 4, 2025. doi: 10.1210/clinem/dgae852].
