Yo-Yo Dieting Linked to Chronic Kidney Disease in Type 1 Diabetes

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A retrospective analysis found that body-weight cycling — also known as yo-yo dieting — is associated with an increased risk of chronic kidney disease (CKD) in individuals with type 1 diabetes, regardless of traditional risk factors and body mass index (BMI).

Fluctuations in weight due to yo-yo dieting affect as many as 20% to 35% of men and 20% to 55% of women. Previous research has shown body-weight cycling can increase the risk of developing type 2 diabetes, cardiovascular events and all-cause mortality.

“Despite the increasing interest on the impact of body-weight variability on health and disease, data on body-weight cycling and CKD are scarce,” wrote a team of investigators including Kamel Mohammedi, M.D., Ph.D., associated with the Department of Endocrinology, Diabetes and Nutrition at Bordeaux University Hospital in France.

Mohammedi and his team had previously studied the impact of yo-yo dieting on major cardiovascular evens — including nonfatal myocardial infarction, stroke or cardiovascular death — as well as all-cause death, results of which demonstrated an increased risk regardless of BMI and traditional risk factors among patients with type 1 diabetes. They hypothesized that the pathophysiological mechanisms behind this connection may also impact the development of CKD.

Investigators used data from the Diabetes Control and Complications Trial (DCCT) and Epidemiology of Diabetes Interventions and Complications (EDIC) cohorts to determine any potential link between repeated weight loss and gain over time and the risk of renal events in 1,432 adults with type 1 diabetes. Eligible patients were aged 18 years or older and were not pregnant during the follow-up period. The average duration of DCCT follow-up was six years, and the average duration of DCCT plus EDIC follow-up was 21 years.

Investigators calculated multiple indices of weight variability and found that higher weight fluctuations were significantly linked to key markers of kidney decline, including a 40% drop in estimated glomerular filtration rate (eGFR) among 18.8% of patients during the follow-up period, with an incidence rate of 9.2 per 1,000 person-years. These associations remained significant even after adjusting for traditional CKD risk factors and nephroprotective drug use.

Additionally, doubling of serum creatinine from baseline was observed in 8.6% of patients with fluctuating body weight and progression to CKD stage 3 was diagnosed in 8.9% of patients.

The findings highlight the importance of stable weight management in reducing kidney disease risk for people with type 1 diabetes.

Investigators noted the long follow-up period using structured clinical protocol as a strength of the study. To mitigate the impact of body weight during early changes in glycemic control, any measures taken during the first year were not included when calculating the variability of body weight. However, they were unable to determine the causal relationship between fluctuating body weight cycling and the outcomes and they could not ascertain the underlying cause of weight variability. Additionally, the retrospective, observational nature of the study design limited findings. Investigators encourage the use of more recent data to confirm these results, as the management of type 1 diabetes and diabetic kidney disease has significantly improved in recent decades.

“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,” investigators concluded.