Visceral fat is better related to impaired glucose metabolism than body mass index after kidney transplantation

The role of visceral adipose tissue (VAT) in post‐transplant hyperglycaemia is not known. We evaluated 167 patients without diabetes 8‐10 weeks after kidney transplantation, performing oral glucose tolerance tests and measuring VAT content from dual‐energy X‐ray absorptiometry scans. Median VAT weight in normal glucose tolerance patients was 0.9 kg, impaired fasting glucose patients 1.0 kg, impaired glucose tolerance patients 1.3 kg and patients with post‐transplant diabetes (PTDM) 2.1 kg (P = 0.004, indicating a difference between groups). Percentage VAT of total body fat was associated with fasting (R² = 0.094, P < 0.001) and 2‐h glucose concentration (R² = 0.062, P = 0.001), while BMI was only associated with 2‐h glucose concentration (R² = 0.029, P = 0.028). An association between BMI and 2‐h glucose concentration was lost in adjusted models, as opposed to the associations between VAT as percentage of total body fat and glucose concentrations (R² = 0.132, P < 0.001 and R² = 0.097, P = 0.001, respectively for fasting and 2‐h glucose concentration). In conclusion, VAT is more closely related to impaired glucose metabolism than BMI after kidney transplantation. The association with central obesity should encourage additional studies on lifestyle interventions to prevent PTDM.