Effects of sleep duration and changes in body mass index on diabetic kidney disease: a prospective cohort study

Cong Liu; Jia Zhang; Xing Wei; Juan Shi; Qianhua Fang; Weiwei Zhou; Lin Sun; Zhuomeng Hu; Jie Hong; Weiqiong Gu; Weiqing Wang; Ying Peng; Yifei Zhang

doi:10.3389/fendo.2023.1278665

Effects of sleep duration and changes in body mass index on diabetic kidney disease: a prospective cohort study

Front Endocrinol (Lausanne). 2023 Oct 26:14:1278665. doi: 10.3389/fendo.2023.1278665. eCollection 2023.

Authors

Cong Liu^#^{1

2}, Jia Zhang^#^{1

2}, Xing Wei^#^{1

2}, Juan Shi^{1

2}, Qianhua Fang^{1

2}, Weiwei Zhou^{1

2}, Lin Sun^{1

2}, Zhuomeng Hu^{1

2}, Jie Hong^{1

2}, Weiqiong Gu^{1

2}, Weiqing Wang^{1

2}, Ying Peng^{1

2}, Yifei Zhang^{1

2}

Affiliations

¹ Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

^# Contributed equally.

Abstract

Aims: To examine the associations of sleep duration and changes in BMI with the onset of diabetic kidney disease (DKD).

Materials and methods: 2,959 participants with type 2 diabetes were divided into three groups based on sleep duration: short (<7 h/day), intermediate (7-9 h/day), or long (>9 h/day). Changes in BMI during follow-up were trisected into loss, stable, or gain groups. DKD was defined as either the urinary albumin/creatinine ratio (UACR) ≥ 3.39 mg/mmol or the estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73m², or both. Cox regression models were used to assess hazard ratios (HRs) and 95% confidence intervals (CIs).

Results: During a mean follow-up of 2.3 years, DKD occurred in 613 participants (20.7%). A J-shaped curve was observed between sleep duration and DKD. Compared to intermediate sleep duration, long sleep duration was associated with higher risks of DKD (HR 1.47; 95% CI: 1.19-1.81). In the joint analyses, compared to participants with intermediate sleep duration and stable BMI, long sleep duration with BMI gain had the highest risks of DKD (HR 2.04; 95% CI: 1.48-2.83). In contrast, short or intermediate sleep duration accompanied by decrease in BMI was associated with a reduced risk of DKD, with HRs of 0.50 (95% CI: 0.31-0.82) and 0.61 (95% CI:0.47-0.80), respectively.

Conclusions: Long sleep duration is significantly associated with an increased risk of DKD, which is further amplified by obesity or BMI gain. These findings suggest that both proper sleep duration and weight control are essential to preventing DKD.

Keywords: changes in BMI; diabetic kidney disease; obesity; sleep duration; type 2 diabetes.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Body Mass Index
Diabetes Mellitus, Type 2* / complications
Diabetes Mellitus, Type 2* / epidemiology
Diabetic Nephropathies* / complications
Diabetic Nephropathies* / etiology
Humans
Prospective Studies
Sleep Duration

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by grants from the National Natural Science Foundation of China (grant no. 82270896 to YZ), “Management strategy of the tertiary prevention and treatment of diabetes based on DIP system” supported by China Health Promotion Foundation (to WW), the Capacity building for multidisciplinary cooperation in diagnosis and treatment of major metabolic diseases (grant no. Z155080000004 to WW), the Shanghai Medical and Health Development Foundation (grant no. DMRFP_II_01 to YZ, grant no. DMRFP_II_02 to WZ), the Program for Shanghai Outstanding Medical Academic Leader (grant no. 2019LJ07 to YZ), and Innovative research team of high-level local universities in Shanghai.