Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

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On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

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Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

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Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

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Calcutta National Medical College & Hospital , Kolkata

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Best regards,
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Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : November | Volume : 17 | Issue : 11 | Page : BC05 - BC09 Full Version

Correlation of HbA1c and Insulin Resistance with Urine Albumin Excretion in Non Diabetic Obese Population: A Cross-sectional Study

Published: November 1, 2023 | DOI:
Sujaya Pooyath, Sajeevan Kundila Chandran, Shajee Sivasankaran Nair

1. Associate Professor, Department of Biochemistry, Palakkad Institute of Medical Sciences, Walayar, Kerala, India. 2. Professor, Department of Biochemistry, Government Medical College, Manjeri, Kerala, India. 3. Associate Professor, Department of Biochemistry, Government Medical College, Manjeri, Kerala, India.

Correspondence Address :
Dr. Shajee Sivasankaran Nair,
Associate Professor, Department of Biochemistry, Government Medical College, Manjeri, Kerala, India.


Introduction: A number of metabolic disorders are linked to obesity, which is a global health concern. Although renal impairment is a serious side-effect of obesity, its connection to insulin resistance is still a subject of discussion.

Aim: To assess the correlation between microalbuminuria and HbA1c levels, as well as the association between Insulin Resistance (IR) and renal function in obese individuals.

Materials and Methods: The present study was a cross-sectional study conducted in patients attending the obesity clinic, in Endocrinology department, of a tertiary hospital in Kerala, India. A total of 144 obese individuals participated, meeting age, Body Mass Index (BMI), and health-related. Insulin resistance was measured using Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), while renal function was measured using the Urine Albumin Creatinine Ratio (UACR). Correlation analysis was conducted to investigate relationships between variables.

Results: The study found a weak association between UACR and HbA1c levels and insulin resistance (r-value=0.159, p-value=0.056). Subjects with insulin resistance had significantly higher levels of microalbuminuria. Despite these connections, the mean UACR levels remained within the typical reference range.

Conclusion: This study emphasises the importance of early renal health screening in obese individuals, with HbA1c and microalbuminuria measurements as promising methods for preventing kidney impairment. To establish causation in the complex interplay between metabolic variables and renal function in obesity and insulin resistance, future research should focus on understanding the underlying mechanisms and conducting longitudinal examinations.


Microalbuminuria, Renal function, Urine albumin creatinine ratio

The global health epidemic of obesity has far-reaching effects on both the general public’s health and individuals’ personal well-being. The onset of IR, characterised by cells that are less responsive to insulin and resulting in higher blood sugar levels, is a particularly concerning side-effect of obesity. IR plays a crucial role in the development of type 2 diabetes mellitus and is associated with various metabolic abnormalities. Recent studies have examined the complex interaction between obesity, IR, and renal impairment, shedding light on the underlying mechanisms and emphasising the urgent need to understand this intricate interplay (1),(2).

The relationship between obesity and IR involves intricate interactions between adipose tissue, inflammation, and metabolic processes, which have multiple facets (3). The accumulation of excess fat, particularly in visceral adipose tissue, is a hallmark of obesity and can lead to cell-autonomous abnormalities in insulin signaling. These abnormalities may be triggered by an excess of fatty acids released from visceral adipose tissue into the portal vein, setting off a cascade of events that promote IR (3). Infiltrating macrophages in adipose tissue and the kidney release inflammatory cytokines, including Interleukin-6 (IL-6) and Tumour Necrosis Factor-Alpha (TNF-a), which worsen IR and contribute to the development of renal impairment (1),(4).

Moreover, the complex interaction between obesity and IR also affects the vascular system, particularly endothelial function. Endothelial dysfunction can result from obesity-induced IR, disrupting the balance between the vasodilator Nitric Oxide (NO) and the Reactive Oxygen Species (ROS). It is believed that this widespread vascular endothelial dysfunction and ongoing low-grade inflammation play a role in renal impairment (5). Microalbuminuria, an indicator of injury to both the renal and systemic vascular beds, can be a manifestation of renal damage (6). Additionally, IR directly damages the kidneys by causing relaxation of the afferent arteriole, leading to glomerular hyperfiltration, podocyte destruction, and renal damage (1). Furthermore, IR promotes angiogenesis and mesangial cell growth, further exacerbating nephropathy (1). These findings highlight the causal relationship between IR, increased adiposity, and renal vascular damage (7). In order to develop effective therapies, it is crucial to understand the molecular pathways driving IR in obesity. One important mediator in this context is inducible Nitric Oxide Synthase (iNOS), which plays a critical role in increasing IR in skeletal muscle and inhibiting adiponectin release by adipose tissue (8).

The accumulation of intracellular lipid derivatives and the activation of kinases such as Protein Kinase C (PKCs) and c-Jun NH (2)-Terminal Kinase (JNK) are two additional ways in which saturated fatty acids have been linked to the development of IR. These kinases phosphorylate Insulin Receptor Substrate (IRS) serine residues, inhibiting their function and disrupting insulin signaling (9). It has been hypothesised that the Randle cycle, also known as the Glucose Fatty-Acid cycle, contributes to IR. This metabolic pathway results in impaired glucose utilisation, further exacerbating IR (10). It also involves competition between glucose and fatty acids for substrates.

Finally, the complex interaction between IR, obesity, and renal impairment is a multifaceted phenomenon. It is crucial to understand the underlying causes of issues including inflammation, endothelial dysfunction, and molecular pathways in order to develop effective defenses against the increasing threat of obesity-related health consequences. To provide comprehensive insights into this crucial health concern, this research explores these mechanisms in more detail by utilising a plethora of scientific data and evidence from relevant publications. The present study was conducted to advance knowledge of these interconnected factors and their effects on public health by investigating the connections between obesity, IR, and renal impairment.

Material and Methods

This cross-sectional investigation was conducted at the obesity clinic of the endocrinology department in a tertiary hospital. The duration of the study was from February 2014 to May 2015. Ethical clearance was obtained from Amritha Institute of Medical Sciences, kochi Hospital, Kerala, Ethical Committee with IEC Number -Dissertation review/ MD/MS/2013/1. Informed consent was obtained from all study participants.

Inclusion criteria:

- Age group: 18 to 65 years
- BMI ≥25.0 km/m2 for both sexes
- No history of Type 2 Diabetes (T2DM)
- No presence of Red Blood Cells (RBCs), pus cells, or proteinuria in urine (as per standard dipstick urine screening)
- No history of physically demanding activity in the 24 hours prior to the test
- HbA1c < 6.5%
- Serum creatinine level of 1.4 mg%.

Exclusion criteria:

- HbA1c ≥ 6.5%
- Clinical suspicion of urinary tract infection
- Known Cardiovascular Disease (CVD)
- Chronic Kidney Disease (CKD)
- Chronic Liver Disease (CLD)
- Hypertension
- Fever or any other acute or chronic illnesses
- Use of antidiabetic drugs, antiobesity drugs, antihypertensive drugs, nephrotoxic drugs, corticosteroids, and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
- Pregnancy
- Women on birth control pills or in the menstruation phase of the menstrual cycle
- Subjects who were in an upright position for a prolonged duration before the test.

Sample size: Based on results from available literature on two important variables namely UACR and BMI with 95% confidence and 80% power minimum sample size calculated came to be 140.

Data collection: A spot urine sample was collected and placed in a sterile container. The UACR was calculated by determining the ratio of urine albumin (mg/dL) to urine creatinine (g/dL).

Blood sample collection:

• Blood samples were drawn into fluoride-filled vacuum tubes to calculate Fasting Plasma Glucose (FPG). After centrifuging samples at 3000 g for 15 minutes, plasma was transferred to labeled vials.
• Ethylenediamine Tetra Acetic Acid (EDTA) was used as an anticoagulant while collecting blood samples for the HbA1c test in vacuum tubes. The analysis was conducted on whole blood.
• Blood samples without anticoagulant were obtained in vacuum tubes to test various biochemical markers.
• FPG samples were obtained following a 12-hour overnight fast.

Laboratory analysis:

• The Beckman Coulter Olympus AU2700 was used to analyse serum creatinine and FPG.
• A BIO-RAD D-10 analysis of HbA1c was conducted.
• Urine creatinine was determined using Jaffe’s kinetic method, and urine albumin estimate was determined using an immunoturbidimetric test.
• The formula (serum insulin (IU/mL) plasma glucose (mg/dL)) / 405 was used to calculate the HOMA-IR using fasting insulin levels. The authors used Chemiluminescent Microparticle Immuno Assay (CMIA) technology to measure plasma insulin levels.

Statistical Analysis

Statistical analysis was performed using International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) Statistics 20.0 for Windows (SPSS Inc., Chicago, USA). The mean values of continuous variables and their related standard deviations were used for summarisation. For normally distributed continuous parameters, the Student’s independent samples t-test was used to compare the means between two groups. The Mann-Whitney U test was performed to compare means for parameters that did not have a normal distribution. Pearson’s correlation coefficient was used to calculate the correlation between two parameters when both variables had a normal distribution. Spearman’s correlation was used to analyse the relationship between non normally distributed parameters. The significance level was set at p-value<0.05. The study’s statistical power was set at 80% to ensure sufficient data identification for identifying important links and differences.


The characteristics of the study participants are summarised in (Table/Fig 1), which shows that the majority of the subjects were obese, with an average BMI of 36.78. Additionally, the fact that most patients had HbA1c values around 5.9 indicates successful glycemic management (Table/Fig 2). The distribution of patients by IR is shown in (Table/Fig 3), demonstrating that a significant majority of participants (83.8%) were classified as having aberrant IR, while only 16.2% had normal IR. This indicates a significant frequency of IR in the study population. (Table/Fig 4) shows the Pearson correlation coefficients, which demonstrate weak relationships between various variables and the UACR.

Particularly, HbA1c (r-value=0.159, p-value=0.056) and IR showed a weak connection with UACR (r-value=0.187, p-value=0.050). Although statistically significant, these correlations merely imply a tenuous relationship between these factors. (Table/Fig 5) compares participants with normal and abnormal insulin resistance in terms of UACR. In this case, it is clear that UACR was markedly greater among people with aberrant IR, highlighting a possible connection between IR and renal function.

While there were no significant differences in UACR, fasting insulin, IR, or SBP between the groups, (Table/Fig 6) compares various degrees of obesity and shows that DBP was significantly higher in the severely obese group (BMI >35 kg/m2). This shows that DBP may be specifically affected by severe obesity. The prevalence of obesity and IR in the research population is highlighted by all these findings. Even though there are statistically significant associations, particularly between insulin resistance, HbA1c, and UACR, their practical applicability may be constrained by the small effect sizes. Nevertheless, the findings highlight the need to track metabolic variables in people with obesity and IR, with an emphasis on glycaemic control and central obesity in particular. Furthermore, the higher DBP seen in patients who are extremely obese, points to the need for thorough cardiovascular risk assessment in this subgroup.

The scatter diagram in (Table/Fig 7) emphasises the connection between UACR and IR, as shown in (Table/Fig 4). Therefore, the findings of this study offer important new understandings of the intricate interactions between obesity, IR, and renal function. Despite the statistical significance of these relationships, further research into their clinical consequences is necessary due to their small effect sizes. These findings nevertheless highlight the significance of careful monitoring of metabolic parameters in people with obesity and insulin resistance, as well as the requirement to take cardiovascular risk factors into account, particularly in cases of severe obesity.


In a population with varying degrees of obesity, the current study explores the complex interactions between IR, obesity, and UACR. This study’s high incidence of IR (83.8%) among participants showed an elevated HOMA-IR score, a marker of insulin resistance, which is an important finding (Table/Fig 3). Importantly, this study demonstrated that individuals with IR excrete more urine albumin, as shown by higher UACR levels (Table/Fig 5). These results are consistent with earlier studies, which highlighted the crucial part played by IR in the pathogenesis of microalbuminuria in the context of obesity (11).

The minor but statistically significant correlations between UACR and variables like IR (r-value=0.187, p-value <0.05) and HbA1c (r-value=0.159, p-value=0.056) are important aspects of this investigation (Table/Fig 4). Despite the fact that these connections are statistically significant, it is important to note their small sizes. However, this does not lessen their clinical importance, as even slight alterations in renal function can have a significant impact on long-term health.

According to Kim YI et al., type 2 diabetes and hypertension have little impact on the microalbuminuria caused by IR in obese individuals (11). The study by Anan F et al., further highlighted that the HOMA-IR index functions as an independent predictor of elevated urine albumin excretion (12). Collectively, the present results show that IR can contribute to renal impairment even in the absence of overt diabetes. Obesity may be considered a significant risk factor for renal impairment since it often underlies IR, especially in the context of chronic hyperinsulinemia (11).

Another important factor to consider in the context of obesity-related renal impairment is inflammation. Adipose tissue functions as an endocrine organ in obesity and releases proinflammatory cytokines that can worsen IR (4). Additionally, endothelial dysfunction is linked to obesity and can increase IR (5). According to Lambert E et al., (2010), subclinical organ damage may result from increased sympathetic nervous system activity, which is frequently observed in obesity (13). These studies highlight the intricate interaction between IR, inflammation, and renal function in the context of obesity.

Further supporting the association between IR and obesity is the Insulin Resistance Atherosclerosis Study conducted by Wagenknecht LE et al., (1995). They found that elevated IR was associated with an increased risk of type 2 diabetes, a condition closely related to obesity (6). Importantly, the present study found that Waist Circumference (WC) and Fasting Plasma Glucose (FPG) were both significant predictors of UACR (p-value=0.014 for both WC and FPG) (Table/Fig 4). This emphasises the importance of these metabolic factors in determining the likelihood of microalbuminuria in the context of IR caused by obesity.

The connection between IR, obesity, and renal impairment may be explained by several molecular pathways. One such mechanism is the effect of fatty acids on mitochondrial activity, which can lead to IR, as proposed by Martins AR et al., (14). Furthermore, cytokines, especially those produced by adipose tissue, can influence glucose transport and promote IR (8). The Randle cycle, which controls how lipids and carbohydrates interact, might also be involved in IR (10). Metabolic syndrome and IR have been linked to visceral adiposity, which is typically seen in obese individuals (15). These pathways demonstrate how intricately IR, obesity, and renal function interact with each other.

Although this study provides insight into the connection between insulin resistance, obesity, and renal function, it is important to recognize both its weaknesses and advantages. One notable advantage is the thorough evaluation of several metabolic markers and their relationships to UACR. This approach provides valuable information on the complex nature of the relationship under investigation. Additionally, the large sample size improves the study’s statistical power, enabling the identification of minor relationships (11),(12).

The importance of assessing renal health in individuals with obesity and IR is highlighted by this study, which also sheds light on possible relationships between microalbuminuria, HbA1c, and other variables (5),(16). These results suggest that obese populations should undergo early screening procedures, such as microalbuminuria and HbA1c evaluations, to prevent kidney impairment. The report also emphasises the crucial role of governments and healthcare practitioners in translating research evidence into practice. It underscores the intricate connection between metabolic variables and renal function in obesity and IR and calls for further research to investigate the underlying mechanisms and establish causality.


However, there are a few limitations to consider. Firstly, the study’s cross-sectional design makes it impossible to establish a causal link between microalbuminuria, obesity, and insulin resistance. Longitudinal research would be helpful to clarify the temporal correlations between these components (17). Secondly, the study population includes individuals with varying degrees of obesity, which increases variability. More detailed insights could be gained through stratified analysis or subgroup studies based on the severity of obesity (18). Finally, it is possible that other variables not considered in this study may have an impact on renal function, given the very small effect sizes observed in the correlations between various variables and UACR (14).


The results of this study highlight the strong correlation between UACR and IR in obese individuals. The higher UACR values in individuals with IR indicate the possibility of early signs of renal failure in this cohort. Monitoring these variables should be a key component of healthcare interventions for obese individuals, given the weak connections between UACR and both IR and HbA1c. Obesity is becoming increasingly prevalent worldwide, and its association with Chronic Kidney Disease (CKD) has significant public health implications. It is crucial to translate the evidence generated from obesity research into knowledge that healthcare practitioners and policymakers can utilise. A critical first step in preventing renal injury and its associated problems could be the early detection of microalbuminuria and high blood sugar levels in all obese individuals. Future studies should investigate the underlying pathways linking obesity, IR, and renal function to further advance this field of study. To establish causation and gain a better understanding of the course of renal impairment in obese individuals, longitudinal studies are required. Additionally, future research and healthcare policies should focus on therapies and strategies to manage insulin resistance and prevent or mitigate kidney impairment. Therefore, this study emphasises the importance of considering obesity, insulin resistance, and renal function. The findings highlight the potential for early intervention through consistent UACR and HbA1c monitoring, providing an opportunity to mitigate the effects of renal failure in this high-risk population. By being proactive and implementing tailored therapies, the clinicians can strive to reduce the burden of chronic kidney disease in individuals with obesity and insulin resistance.


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DOI and Others

DOI: 10.7860/JCDR/2023/67615.18667

Date of Submission: Sep 21, 2023
Date of Peer Review: Oct 05, 2023
Date of Acceptance: Oct 26, 2023
Date of Publishing: Nov 01, 2023

Author declaration:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Sep 21, 2023
• Manual Googling: Oct 07, 2023
• iThenticate Software: Oct 24, 2023 (8%)

Etymology: Author Origin

Emendations: 4

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