some clinical studies have identified an alteration of cardiac diastolic function in healthy obese patients . it has been demonstrated that obesity could be associated with increased left ventricular ( lv ) end - diastolic pressure , which suggests an association between obesity and diastolic dysfunction . these two abnormalities can be observe in obesity and can contribute to the prevalence of heart failure and chronic kidney disease in obese patients ( 1 ) . if there is any correlation between two factors , physicians should assess second factor when they found first . micro albuminuria and impaired diastolic function in addition to ventricular remodeling and elevated filling pressures can contribute to the prevalence of heart failure in obese patients ( 1 ) . these early subclinical abnormalities in lv structure and function might have important implications for explaining the diastolic myocardial dysfunction in obese individuals ( 2 , 3 ) . thus , weight control might reduce these adverse abnormalities such as lv remodeling and preserve lv function ( 4 ) . hypertension ( htn ) and diabetes are independently associated with impaired lv diastolic function ( 5 ) . several reports have shown that lv diastolic dysfunction is present in patients with diabetes or htn , even in the absence of the alterations of ventricular systolic function ( 6 - 9 ) . however , some evidences indicated diastolic dysfunction with unknown processes in normotensive or non - diabetic subjects ( 10 , 11 ) . micro proteinuria is a powerful and independent risk factor for cardiovascular morbidity and mortality in diabetic and no diabetic individuals . body mass index ( bmi ) has been shown to be significantly correlated with albumin excretion rate and kidney volume and therefore , severe obesity is associated with increased renal plasma flow and glomerular filtration rate ( 12 ) . in addition , obesity - related glomerular hyper filtration ameliorates after weight loss and the improvement in hyper filtration can prevent the development of overt obesity - related glomerulopathy ( 13 ) . some investigators revealed that an elevated albumin excretion rate was associated with an increased diastolic dysfunction ( 14 - 16 ) . we aimed to assess the association between diastolic function and appearance of micro albuminuria in normotensive no diabetic obese individuals . the current cross - sectional study was conducted on consecutive obese individuals ( bmi  30 kg / m ) who were older than 18 years and attended the outpatient health clinic at the tehran municipality in 2011 . exclusion criteria were history of diabetes mellitus , htn , hyperlipidemia , cigarette smoking , any renal or liver disorders , urinary tract infections , or menstruation phase of the menstrual cycle . the study was conducted after taking the required ethical clearance from the ethic review board and all patients signed an informed consent . baseline data were collected through face - to - face interview and included demographic characteristics and educational level . weight was measured using a balance standard scale and standing height was measured using a single tape measure . all of the obese patients were referred to one cardiologist and one device was used for echocardiography . hence , interpersonal and inter - device variability were omitted . around 5 ml of spot urine sample in a sterile container the urinary albumin was measured by immunonephelometric assay , and urinary creatinine was calculated by automated enzymatic assay . micro albuminuria was defined as abnormal values of uacr (  30 mg / g ) . after ten to 12 hours of overnight fasting , blood samples were collected for estimation of fasting blood sugar ( fbs ) and serum creatinine . results were reported as mean  standard deviation ( sd ) for the quantitative variables and percentages for the categorical variables . the groups were compared using the student 's t test and the chi square test ( or fisher 's exact test if required ) for the continuous and categorical variables , respectively . predictors that exhibited a statistically significant association with micro albuminuria were taken for multivariate logistic regression analysis to investigate their independence as predictors . odds ratio ( or ) and 95% confidence intervals ( 95% ci ) were calculated . all the statistical analyses were performed using spss 13.0 ( spss inc . , chicago , il , usa ) and sas 9.1 for windows the mean age of the subjects was 39.4 years ( range , 19 - 66 ) with the majority of them being female . the mean bmi was 32.8 kg / m and among them , 17.7% had severe obesity ( bmi  35 kg / m ) . on the first admission day , systolic and diastolic blood pressures were controlled in the normal ranges in all study population . no significant difference in demographic characteristics was found between those with or without micro albuminuria . there were also no significant differences in the baseline laboratory indices including fbs as well as serum creatinine level between two groups .   in univariate regression analysis , a significant correlation between uacr and diastolic function , male sex , age , bmi , serum creatinine , and fbs ( p < 0.05 ) was found . however , the correlation between uacr and weight or educational level was insignificant ( p > 0.05 ) . therefore , we used multivariate regression analysis for uacr and diastolic function , male sex , age , bmi , creatinine , and fbs to investigate their independence as predictor ( table 2 ) and only a significant correlation between uacr and diastolic function was found ; hence , so diastolic function was independent factor . a reverse significant linear correlations was found between the uacr and diastolic function ( r = -0.184 and p = 0.012 ) , while the correlation between uacr and systolic function was insignificant ( r = 0.007 and p = 0.926 ) . multivariable linear regression analysis ( table 2 ) showed that the uacr had a significant reverse correlation with diastolic function ( standardized beta = -0.218 and p = 0.006 ) . abbreviationsuacr , urinary albumin to creatinine ratio ; bmi , body mass index ; and fbs , fasting blood sugar . we observed a reverse association between diastolic dysfunction and uacr , which indicated a negative association between micro albuminuria and diastolic function . some observations have shown that the more relevant impairment in diastolic function in patients with micro albuminuria could be related to the increased lv mass index with concentric remodeling ( 14 ) . on the other hand , lv mass and lv wall thickness can be significantly increased and lv relaxation might be impaired in micro albuminuria ( 14 ) . revealed that an elevated urinary albumin excretion rate was associated with an increased lv mass index , a higher prevalence of a concentric lv hypertrophy pattern , a depressed mid - wall systolic performance , and a markedly impaired diastolic function ( 15 , 16 ) . these evidences can confirm potential association between micro albuminuria and diastolic dysfunction . according to this fact that the diastolic function can be directly dependent to some pointed structural and functional indices , these cardiac indices should be assessed in those with the evidences of micro albuminuria , especially those who are suspected to have ventricular diastolic dysfunction . our study focused on the presence of micro albuminuria in obese no diabetic normotensive patients ; therefore , our finding was adjusted for other potential predisposing factors of micro albuminuria such as htn and diabetes mellitus . in addition , the role of obesity in the development and progression of diastolic dysfunction has been more highlighted . some studies revealed that obesity might be more important than micro albuminuria for the prediction and prevention of diastolic dysfunction in no diabetic patients ( 17 ) . in this context , mediating role of inflammatory processes , particularly in normotensive no diabetic individuals , should not be ignored . it has been demonstrated that inflammatory fibrosis of the myocardium is a major cause of myocardial stiffening , which leads to dysfunction . the higher prevalence of proinflammatory conditions as well as higher levels of inflammatory markers can be often found in those with myocardial stiffening and diastolic dysfunction ( 18 - 22 ) . moreover , in acute inflammation , micro albuminuria might be a result of the endothelial glomerular leak in the kidneys , which is a manifestation of the systemic increases in capillary permeability due to an intense inflammatory onslaught on the endothelium ( 23 , 24 ) . each acute inflammatory condition might lead to endothelial glomerular defects and finally result in micro albuminuria . thus , the association between impaired diastolic function and micro albuminuria might be mediated by inflammatory processes . therefore , those who are suspected of concurrent micro albuminuria and diastolic dysfunction , especially those with any evidence of heart failure , should be screened for acute or chronic inflammatory disorders . in summary , our results obtained some evidences regarding association between micro albuminuria and diastolic dysfunction in obese no diabetic normotensive individuals ; however , more assessments are necessary for obtaining the casualty in this association .
background : recently , an association between impaired diastolic function and increased urinary albumin excretion has been hypothesized.objectives:we tried to assess the association between diastolic function and micro albuminuria in normotensive no diabetic obese individuals.patients and methods : this cross - sectional study was conducted on 186 consecutive obese normotensive no diabetic individuals who were older than 18 years and attended the outpatient health clinic at the tehran municipality in 2011 . 
 systolic and diastolic blood pressures were measured using a standard mercury sphygmomanometer . 
 micro albuminuria was defined as abnormal urinary albumin to creatinine ratio ( uacr ) between 30 and 300 mg / g / d.results : an adverse significant linear correlations was found between the uacr measurement and diastolic function ( r = -0.184 and p = 0.012 ) ; however , this correlation was insignificant for systolic function ( r = 0.007 and p = 0.926 ) . 
 multivariable linear regression analysis showed that uacr index had a significant reverse correlation with diastolic function ( standardized beta = -0.218 and p = 0.006).conclusions : our study obtained some evidences on the association of micro albuminuria with diastolic dysfunction in obese normotensive no diabetic individuals . 
 nonetheless , more assessment is necessary for obtaining a causal relationship between micro albuminuria and diastolic dysfunction .