Diabetes Metab J.  2019 Aug;43(4):461-473. 10.4093/dmj.2018.0081.

Lower Leg Fat Depots Are Associated with Albuminuria Independently of Obesity, Insulin Resistance, and Metabolic Syndrome (Korea National Health and Nutrition Examination Surveys 2008 to 2011)

  • 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea. hsh12@dsmc.or.kr


Although the involvement of obesity in metabolic disorders is well known, leg fat depot influences on albuminuria have not been determined.
This population-based, cross-sectional study used a nationally representative sample of 2,076 subjects aged ≥20 years from the Korea National Health and Nutrition Examination Surveys of 2008 to 2011. The ratio of leg fat to total fat (LF/TF ratio) was assessed by dual X-ray absorptiometry, and albuminuria was defined as more than one positive dipstick test or an albumin-to-creatinine ratio of ≥30 mg/g.
Individuals whose LF/TF ratio was in the lowest tertile showed a higher proportion of albuminuria than those in the highest tertile (odds ratio [OR], 2.82; 95% confidence interval [CI], 2.01 to 3.96; P<0.001). This association was observed in both sexes, all age groups, and all subgroups stratified by body mass index, waist circumference, homeostasis model assessments of insulin resistance, and the presence of metabolic syndrome (all, P<0.05). Multiple logistic regression analyses also demonstrated that the lowest LF/TF ratio was independently associated with albuminuria risk (OR, 1.55 to 2.16; all, P<0.05). In addition, the risk of albuminuria was higher in sarcopenic individuals with lower LF/TF ratios than in the highest LF/TF ratio subjects without sarcopenia (OR, 3.73; 95% CI, 2.26 to 6.13).
A lower LF/TF ratio was associated with an increased risk of albuminuria independent of obesity, insulin resistance, and metabolic syndrome, and when combined with sarcopenia, the albuminuria risk synergistically increased. Hence, our findings may have implications to improve risk stratification and recommendations on body fat distribution in the general population.


Albuminuria; Body fat distribution; Insulin resistance; Metabolic syndrome; Sarcopenia

MeSH Terms

Absorptiometry, Photon
Body Fat Distribution
Body Mass Index
Cross-Sectional Studies
Insulin Resistance*
Logistic Models
Waist Circumference


  • Fig. 1 Flow diagram of a study population in the Korean National Health and Nutrition Examination Surveys (KNHANES IV and V). DXA, dual-energy X-ray absorptiometry; BMI, body mass index.

  • Fig. 2 Differences in the prevalence of albuminuria according to the ratio of leg fat to total fat (LF/TF ratio). (A) Albuminuria prevalence by LF/TF tertiles, and (B) the association between albuminuria prevalence and LF/TF ratio by age groups. The black bars represent the lowest LF/TF ratio group, gray bars represent the 2nd lowest LF/TF ratio group, and the white bars represent the highest LF/TF ratio group.

  • Fig. 3 Differences in the prevalence of albuminuria after comorbidity stratification. (A) Obesity defined by a body mass index ≥25 kg/m2, (B) central obesity defined by waist circumference ≥90 cm for males and ≥85 cm for females, (C) metabolic syndrome, (D) insulin sensitivity defined by the homeostasis model assessment of insulin resistance (HOMA-IR) <2.5 and insulin resistance defined by HOMA-IR ≥2.5, (E) uncontrolled hypertension (HTN), and (F) impaired fasting glucose (IFG) and diabetes mellitus (DM). The black bars represent the lowest ratio of leg fat to total fat (LF/TF ratio) group, gray bars represent the 2nd lowest LF/TF ratio group, and the white bars represent the highest LF/TF ratio group.

  • Fig. 4 Differences in the prevalence and risk of albuminuria according to the lowest ratio of leg fat to total fat (LF/TF ratio) and sarcopenia. (A) LF/TF ratio by sarcopenia, and (B) sarcopenia and LF/TF ratio combination. OR, odds ratio; CI, confidence interval.

Cited by  1 articles

Albuminuria Is Associated with Steatosis Burden in Patients with Type 2 Diabetes Mellitus and Nonalcoholic Fatty Liver Disease
Eugene Han, Mi Kyung Kim, Byoung Kuk Jang, Hye Soon Kim
Diabetes Metab J. 2021;45(5):698-707.    doi: 10.4093/dmj.2020.0118.


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