Unravelling gender specific factors that link obesity to albuminuria.

BACKGROUND Obesity is a major public health problem, which continues to be diagnosed and classified by BMI, excluding the most elemental concepts of the precision medicine approach. Obesity does not equally affect males and females, even with the same BMI. Microalbuminuria is a risk marker of cardiovascular disease closely related to obesity. The aim of this study is to evaluate the gender-dependent differences in the development of early obesity-related disease, focusing on pathologic microalbuminuria. MATERIAL AND METHODS We developed a single center cross-sectional study between including 1068 consecutive adults from May 2016 and January 2018, divided into two groups, one including the first 787 patients attended, evaluated as a description-population; the second group included 281 subjects analyzed as an external-validation population. Collected data included medical history, anthropometric measures, abdominal bioimpedance and routine lab tests. RESULTS First, we confirmed the lack of accuracy of classic obesity-measures in predicting microalbuminuria. Second, we tested the utility of a tailored evaluation to predict pathologic-microalbuminuria, with an area under the ROC curve of 0.78 for females and 0.82 for males. We also confirmed the different physiology of visceral adiposity for males when compared with females, in which small variations of fat-mass, entail major changes in the clinical repercussion. Third, we performed an external-validation of our results, achieving a 77% accuracy-rate. CONCLUSIONS Our findings support that there is an individual threshold of fat amount necessary to develop obesity-dependent pathologic microalbuminuria, and that gender plays a major role in the interplay between pathologic microalbuminuria and adiposity.