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Utilization of Mind–Body Intervention for Integrative Health Care of COVID-19 Patients and Survivors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116618. [PMID: 35682203 PMCID: PMC9180827 DOI: 10.3390/ijerph19116618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/23/2022] [Accepted: 05/27/2022] [Indexed: 11/17/2022]
Abstract
Recent findings suggest a correlation between COVID-19 and diabetes, although the underlying causes are still little understood. COVID-19 infection tends to induce severe symptoms in patients with underlying diabetes, increasing their mortality rate. Moreover, COVID-19 itself appears to be a diabetogenic factor. In addition, mental health conditions, such as depression due to lockdown and anxiety about infection, were found to affect glycemic control and immunity, highlighting the importance of mental health care during the pandemic. Mind–Body Intervention (MBI), which includes meditation, yoga, and qigong, has emerged as a tool for mental health management due to its effects on stress reduction and the promotion of mental and physical well-being. Here, we review the latest randomized controlled trials to determine the effects of MBI on glycemic control and the immune system and discuss the underlying mechanisms by which MBI facilitates the virtuous cycle of stress management, glycemic control, and immune modulation. Furthermore, we examine the actual utilization of MBI during the COVID-19 pandemic era through recent studies. With proper online education, non-pharmacological MBI may be more widely used as an important tool for self-health care that complements the usual treatment of COVID-19 patients and survivors.
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Adeva-Andany MM, Fernández-Fernández C, Funcasta-Calderón R, Ameneiros-Rodríguez E, Adeva-Contreras L, Castro-Quintela E. Insulin Resistance is Associated with Clinical Manifestations of Diabetic Kidney Disease (Glomerular Hyperfiltration, Albuminuria, and Kidney Function Decline). Curr Diabetes Rev 2022; 18:e171121197998. [PMID: 34789129 DOI: 10.2174/1573399818666211117122604] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 11/22/2022]
Abstract
Clinical features of diabetic kidney disease include glomerular hyperfiltration, albuminuria, and kidney function decline towards End-Stage Kidney Disease (ESKD). There are presently neither specific markers of kidney involvement in patients with diabetes nor strong predictors of rapid progression to ESKD. Serum-creatinine-based equations used to estimate glomerular filtration rate are notoriously unreliable in patients with diabetes. Early kidney function decline, reduced glomerular filtration rate, and proteinuria contribute to identifying diabetic patients at higher risk for rapid kidney function decline. Unlike proteinuria, the elevation of urinary albumin excretion in the range of microalbuminuria is frequently transient in patients with diabetes and does not always predict progression towards ESKD. Although the rate of progression of kidney function decline is usually accelerated in the presence of proteinuria, histological lesions of diabetes and ESKD may occur with normal urinary albumin excretion. No substantial reduction in the rate of ESKD associated with diabetes has been observed during the last decades despite intensified glycemic control and reno-protective strategies, indicating that existing therapies do not target underlying pathogenic mechanisms of kidney function decline. Very long-term effects of sodium-glucose transporters- 2 inhibitors and glucagon-like peptide-1 analogs remain to be defined. In patients with diabetes, glucagon secretion is typically elevated and induces insulin resistance. Insulin resistance is consistently and strongly associated with clinical manifestations of diabetic kidney disease, suggesting that reduced insulin sensitivity participates in the pathogenesis of the disease and may represent a therapeutic objective. Amelioration of insulin sensitivity in patients with diabetes is associated with cardioprotective and kidney-protective effects.
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Affiliation(s)
- María M Adeva-Andany
- Nephrology Division, Hospital General Juan Cardona, c/ Pardo Bazán s/n, 15406 Ferrol, Spain
| | | | | | | | | | - Elvira Castro-Quintela
- Nephrology Division, Hospital General Juan Cardona, c/ Pardo Bazán s/n, 15406 Ferrol, Spain
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Mitrofanova A, Sosa MA, Fornoni A. Lipid mediators of insulin signaling in diabetic kidney disease. Am J Physiol Renal Physiol 2019; 317:F1241-F1252. [PMID: 31545927 PMCID: PMC6879940 DOI: 10.1152/ajprenal.00379.2019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/19/2019] [Accepted: 09/19/2019] [Indexed: 12/30/2022] Open
Abstract
Diabetic kidney disease (DKD) affects ∼40% of patients with diabetes and is associated with high mortality rates. Among different cellular targets in DKD, podocytes, highly specialized epithelial cells of the glomerular filtration barrier, are injured in the early stages of DKD. Both clinical and experimental data support the role of preserved insulin signaling as a major contributor to podocyte function and survival. However, little is known about the key modulators of podocyte insulin signaling. This review summarizes the novel knowledge that intracellular lipids such as cholesterol and sphingolipids are major determinants of podocyte insulin signaling. In particular, the implications of these lipids on DKD development, progression, and treatment will be addressed.
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Affiliation(s)
- Alla Mitrofanova
- Katz Family Division of Nephrology and Hypertension, Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida
- Peggy and Harold Katz Family Drug Discovery Center, Miller School of Medicine, University of Miami, Miami, Florida
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Marie Anne Sosa
- Katz Family Division of Nephrology and Hypertension, Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida
| | - Alessia Fornoni
- Katz Family Division of Nephrology and Hypertension, Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida
- Peggy and Harold Katz Family Drug Discovery Center, Miller School of Medicine, University of Miami, Miami, Florida
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Patil SG, Aithala MR, Naregal GV, Shanmukhe AG, Chopade SS. Effect of yoga on cardiac autonomic dysfunction and insulin resistance in non-diabetic offspring of type-2-diabetes parents: A randomized controlled study. Complement Ther Clin Pract 2019; 34:288-293. [PMID: 30712740 DOI: 10.1016/j.ctcp.2019.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/19/2018] [Accepted: 01/07/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The present study was aimed to determine the effect of yoga program on cardiac autonomic dysfunction and insulin resistance in non-diabetic offspring of diabetes parents. METHODS A randomized passive-controlled study was conducted on 64 non-diabetic offspring of type-2-diabetes parents (mean-age:25.17years). Yoga group participants received yoga training for 8 weeks. Heart-rate variability (HRV) indices: low frequency (LF), high frequency (HF) and LF/HF ratio; fasting blood glucose (FBG), oral glucose tolerance test (OGTT) and insulin resistance (IR) were estimated at baseline and after 8-weeks of intervention. RESULTS We found a significant decrease in LF (p = 0.005), LF/HF ratio (p = 0.004), IR (p < 0.001), OGTT (p = 0.003) and increase in HF (p = 0.022) in yoga group participants. Control group participants did not show any significant change in any variables. CONCLUSIONS Improvement in cardiac autonomic function and insulin resistance by yoga training implies that yoga can reduce the risk of development of diabetes in offspring of diabetes parents.
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Affiliation(s)
- Satish G Patil
- Department of Physiology, Shri B.M.Patil Medical College, Hospital and Research Centre, BLDE (Deemed to be University), Vijayapura, Karnataka, India.
| | - Manjunatha R Aithala
- Department of Physiology, Shri B.M.Patil Medical College, Hospital and Research Centre, BLDE (Deemed to be University), Vijayapura, Karnataka, India.
| | - Govindanagouda V Naregal
- Department of Biochemistry, Shri B.M.Patil Medical College, Hospital and Research Centre, BLDE (Deemed to be University), Vijayapura, Karnataka, India.
| | - Amarnath G Shanmukhe
- Department of Medical Surgical Nursing, BLDEA's Shri B.M.Patil Institute of Nursing Sciences, Vijayapura, Karnataka, India.
| | - Shalmon S Chopade
- Department of Medical Surgical Nursing, BLDEA's Shri B.M.Patil Institute of Nursing Sciences, Vijayapura, Karnataka, India.
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Probing insulin sensitivity in diabetic kidney disease: is there a stronger role for functional imaging? Clin Sci (Lond) 2018; 132:1085-1095. [PMID: 29871909 DOI: 10.1042/cs20171490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/25/2018] [Accepted: 05/09/2018] [Indexed: 11/17/2022]
Abstract
Clinical and experimental evidence support a cause-effect relationship between altered insulin signaling and development of kidney disease of metabolic and non-metabolic origin. However, the current criteria to measure and/or estimate the insulin resistance (IR) are available as research tool but are very difficult to implement in the clinical practice. Therefore, a better understanding of the key players contributing to IR may lead to the development of new non-invasive tools to assess organ-specific insulin sensitivity (IS). We will therefore first introduce the concept that IR and kidney disease may be causally linked as suggested by clinical and experimental studies. We will then, expand on the potential mechanisms leading to altered renal insulin signaling. After reviewing the limitation of currently available strategies to determine IR, this review article will focus on imaging techniques that could be utilized to determine renal IR and that could be tested to predict kidney disease development and progression.
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Wasik AA, Lehtonen S. Glucose Transporters in Diabetic Kidney Disease-Friends or Foes? Front Endocrinol (Lausanne) 2018; 9:155. [PMID: 29686650 PMCID: PMC5900043 DOI: 10.3389/fendo.2018.00155] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/22/2018] [Indexed: 12/16/2022] Open
Abstract
Diabetic kidney disease (DKD) is a major microvascular complication of diabetes and a common cause of end-stage renal disease worldwide. DKD manifests as an increased urinary protein excretion (albuminuria). Multiple studies have shown that insulin resistance correlates with the development of albuminuria in non-diabetic and diabetic patients. There is also accumulating evidence that glomerular epithelial cells or podocytes are insulin sensitive and that insulin signaling in podocytes is essential for maintaining normal kidney function. At the cellular level, the mechanisms leading to the development of insulin resistance include mutations in the insulin receptor gene, impairments in the phosphoinositide 3-kinase (PI3K)/AKT signaling pathway, or perturbations in the trafficking of glucose transporters (GLUTs), which mediate the uptake of glucose into cells. Podocytes express several GLUTs, including GLUT1, GLUT2, GLUT3, GLUT4, and GLUT8. Of these, the most studied ones are GLUT1 and GLUT4, both shown to be insulin responsive in podocytes. In the basal state, GLUT4 is preferentially located in perinuclear and cytosolic vesicular structures and to a lesser extent at the plasma membrane. After insulin stimulation, GLUT4 is sorted into GLUT4-containing vesicles (GCVs) that translocate to the plasma membrane. GCV trafficking consists of several steps, including approaching of the GCVs to the plasma membrane, tethering, and docking, after which the lipid bilayers of the GCVs and the plasma membrane fuse, delivering GLUT4 to the cell surface for glucose uptake into the cell. Studies have revealed novel molecular regulators of the GLUT trafficking in podocytes and unraveled unexpected roles for GLUT1 and GLUT4 in the development of DKD, summarized in this review. These findings pave the way for better understanding of the mechanistic pathways associated with the development and progression of DKD and aid in the development of new treatments for this devastating disease.
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Xin W, Li Z, Xu Y, Yu Y, Zhou Q, Chen L, Wan Q. Autophagy protects human podocytes from high glucose-induced injury by preventing insulin resistance. Metabolism 2016; 65:1307-15. [PMID: 27506738 DOI: 10.1016/j.metabol.2016.05.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 05/05/2016] [Accepted: 05/24/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Insulin resistance is correlated with the progress of albuminuria in diabetic patients, and podocytes are crucial for maintaining the normal function of the glomerular filtration barrier. In the present study, we aimed to investigate the high glucose-induced insulin resistance and cell injury in human podocytes and the putative role of autophagy in this process. METHODS Human podocytes were cultured in high glucose-supplemented medium and low glucose and high osmotic conditions were used for the controls. Autophagy in the podocytes was regulated using rapamycin or 3-methyladenine stimulation. Next, autophagy markers including LC3B, Beclin-1, and p62 were investigated using western blot and qPCR, and the insulin responsiveness was analyzed based on glucose uptake and by using the phosphorylation of the insulin receptor with Nephrin as a podocyte injury marker. RESULTS The basal autophagy level decreased under the high glucose conditions, which was accompanied by a decrease in the glucose uptake and phosphorylation of the insulin receptor in the human podocytes. More interestingly, the glucose uptake and the phosphorylation of the insulin receptor were decreased by 3-MA stimulation and increased by rapamycin, illustrating that the responsiveness of insulin was regulated by autophagy. The activation of autophagy by rapamycin also ameliorated cell injury in the human podocytes. CONCLUSIONS The presence or activation of autophagy was found to play a protective role in human podocytes against high glucose-induced insulin resistance and cell injury, which indicates a novel cellular mechanism and provides a potential therapeutic target for diabetic nephropathy (DN).
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Affiliation(s)
- Wei Xin
- Department of Central Laboratory, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, China
| | - Zhaoping Li
- Institute of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, 250012, China
| | - Ying Xu
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, China
| | - Yue Yu
- Institute of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, 250012, China
| | - Qi Zhou
- School of Medicine, Shandong University, Jinan, 250012, China
| | - Liyong Chen
- Department of Nutrition, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, China.
| | - Qiang Wan
- Department of Nephrology, Qianfoshan Hospital Affiliated to Shandong University, Jinan, 250014, China.
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Xu HZ, Cheng YL, Wang WN, Wu H, Zhang YY, Zang CS, Xu ZG. 12-Lipoxygenase Inhibition on Microalbuminuria in Type-1 and Type-2 Diabetes Is Associated with Changes of Glomerular Angiotensin II Type 1 Receptor Related to Insulin Resistance. Int J Mol Sci 2016; 17:ijms17050684. [PMID: 27164093 PMCID: PMC4881510 DOI: 10.3390/ijms17050684] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 04/18/2016] [Accepted: 04/27/2016] [Indexed: 01/06/2023] Open
Abstract
(1) BACKGROUND: 12-lipoxygenase (12-LO) is involved in the development of diabetic nephropathy (DN). In the present study, we investigated whether 12-LO inhibition may ameliorate type-2 DN (T2DN) by interfering with insulin resistance (IR); (2) METHODS: Rat glomerular mesangial cells, glomeruli and skeletal muscles were isolated and used in this study. Kidney histological changes were confirmed by periodic-acid Schiff staining; mRNA expression was detected by competitive reverse transcription polymerase chain reaction; and the protein level was determined by Western blot and the enzyme-linked immunosorbent assay, respectively; (3) RESULTS: The inhibition of 12-LO attenuated microalbuminuria (MAU) increases in type-2 diabetic rats, but not in type-1 diabetic rats. Infusion of 12(S)-hydroxyeicosatetraenoic acid (12(S)-HETE) significantly increased the expression of angiotensin II (Ang II) and Ang II type 1 receptor (AT1R), but decreased the expression of AT1R-associated protein (ATRAP) in rat glomeruli, compared to the control. An in vitro study revealed that both 12(S)-HETE and insulin upregulated AT1R expression in rat mesangial cells. In the presence of p38 mitogen-activated protein kinase (MAPK) inhibitor, SB202190, the 12(S)-HETE-induced ATRAP reduction was significantly abolished. Interestingly, 12-LO inhibition did not influence AT1R expression in type-1 diabetic rats, but significantly abolished the increased AT1R and Ang II expression in glomeruli of type-2 diabetic rats. Furthermore, the inhibition of 12-LO significantly corrected impaired insulin sensitivity and fast serum insulin level, as well as the p-AMP-activated protein kinase (AMPK) reduction in skeletal muscle of type-2 diabetic rats; (4) CONCLUSION: The inhibition of 12-LO potentially ameliorated MAU by preventing IR through the downregulation of glomerular AT1R expression in T2DN.
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MESH Headings
- 12-Hydroxy-5,8,10,14-eicosatetraenoic Acid/pharmacology
- Albuminuria/etiology
- Albuminuria/metabolism
- Animals
- Arachidonate 12-Lipoxygenase/metabolism
- Cells, Cultured
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/metabolism
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/metabolism
- Diabetic Nephropathies/metabolism
- Down-Regulation
- Insulin Resistance
- Kidney Glomerulus/drug effects
- Kidney Glomerulus/metabolism
- Lipoxygenase Inhibitors/pharmacology
- Male
- Muscle, Skeletal/drug effects
- Muscle, Skeletal/metabolism
- Protein Kinase Inhibitors/pharmacology
- Rats
- Rats, Sprague-Dawley
- Receptor, Angiotensin, Type 1/genetics
- Receptor, Angiotensin, Type 1/metabolism
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Affiliation(s)
- Hong-Zhao Xu
- Department of Nephrology, the First Hospital of Jilin University, Changchun 130021, China.
| | - Yan-Li Cheng
- Department of Nephrology, the First Hospital of Jilin University, Changchun 130021, China.
| | - Wan-Ning Wang
- Department of Nephrology, the First Hospital of Jilin University, Changchun 130021, China.
| | - Hao Wu
- Department of Nephrology, the First Hospital of Jilin University, Changchun 130021, China.
| | - Yuan-Yuan Zhang
- Department of Nephrology, the First Hospital of Jilin University, Changchun 130021, China.
| | - Chong-Sen Zang
- Department of Nephrology, the First Hospital of Jilin University, Changchun 130021, China.
| | - Zhong-Gao Xu
- Department of Nephrology, the First Hospital of Jilin University, Changchun 130021, China.
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9
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Insulin signaling: implications for podocyte biology in diabetic kidney disease. Curr Opin Nephrol Hypertens 2015; 24:104-10. [PMID: 25415617 DOI: 10.1097/mnh.0000000000000078] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Several key elements of the insulin signaling cascade contribute to podocyte function and survival. While it was initially thought that the consequences of altered insulin signaling to podocyte function was strictly related to altered glucose uptake, it has become clear that upstream signaling events involved in cell survival, lipid metabolism or nutrient sensing and modulated by insulin are strong independent contributors to podocyte function. RECENT FINDINGS Akt2, the major isoform of Akt activated following cellular insulin stimulation, protects against the progression of renal disease in nephron-deficient mice, and podocyte-specific deletion of Akt2 results in a more rapid progression of experimental glomerular disease. In diabetes, podocyte mammalian target of rapamycin activation clearly contributes to podocyte injury and regulated autophagy. Furthermore, podocyte-specific glucose transporter type 4 (GLUT4) deficiency protects podocytes by preventing mammalian target of rapamycin signaling independently of glucose uptake. Finally, intracellular lipids have been recently recognized as major modulators of podocyte insulin signaling and as a new therapeutic target. SUMMARY The identification of new contributors to podocyte insulin signaling is of extreme translational value as it may lead to new drug development strategies for diabetic kidney disease, as well as for other proteinuric kidney diseases.
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Jiménez-Corona A, Ávila-Hermosillo A, Nelson RG, Ramírez-López G. A Family History of Diabetes Modifies the Association between Elevated Urine Albumin Concentration and Hyperglycemia in Nondiabetic Mexican Adolescents. J Diabetes Res 2015; 2015:437079. [PMID: 26347891 PMCID: PMC4548133 DOI: 10.1155/2015/437079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 07/08/2015] [Indexed: 11/17/2022] Open
Abstract
We examined the frequency of elevated urine albumin concentration (UAC) and its association with metabolic syndrome (MetS) and metabolic markers in 515 nondiabetic Mexican adolescents stratified by family history of diabetes (FHD). UAC was measured in a first morning urine sample and considered elevated when excretion was ≥20 mg/mL. MetS was defined using International Diabetes Federation criteria. Fasting insulin, insulin resistance, and lipids were evaluated. Multivariate logistic regression was performed. Elevated UAC was present in 12.4% and MetS was present in 8.9% of the adolescents. No association was found between elevated UAC and MetS. Among adolescents with FHD, 18.4% were overweight and 20.7% were obese, whereas, among those without a FHD, 15.9% were overweight and 7.5% were obese. Hyperglycemia was higher in those with elevated UAC than in those without (44.4% versus 5.1%, p = 0.003). Hyperglycemia (OR = 9.8, 95% CI 1.6-59.4) and number of MetS components (OR = 4.5, 95% CI 1.5-13.3) were independently associated with elevated UAC. Among female participants, abdominal obesity was associated with elevated UAC (OR = 4.5, 95% CI 1.2-16.9). Conclusion. Elevated UAC was associated neither with MetS nor with any metabolic markers in nondiabetic adolescents. However, FHD modified the association of elevated UAC with hyperglycemia and the number of MetS components.
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Affiliation(s)
- Aida Jiménez-Corona
- General Directorate of Epidemiology, Health Secretariat, Francisco P Miranda 177, Colonia Lomas de Plateros, Delegación Álvaro Obregón, 01480 Mexico City, DF, Mexico
- Ocular Epidemiology Department, Institute of Ophthalmology Foundation Conde of Valenciana, IAP, Chimalpopoca 14, Colonia Obrera, Delegación Cuauhtémoc, 06800 Mexico City, DF, Mexico
| | - Antonio Ávila-Hermosillo
- Regional General Hospital No. 89, Mexican Institute of Social Security, Washington 1988, Colonia Moderna, Sector Juárez, 44150 Guadalajara, JAL, Mexico
| | - Robert G. Nelson
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix Epidemiology and Clinical Research Branch, 1550 East Indian School Road, Phoenix, AZ 85014, USA
| | - Guadalupe Ramírez-López
- Adolescent Epidemiological and Health Services Research Unit, Mexican Institute of Social Security, Avenida Tonalá 121, 45400 Guadalajara, JAL, Mexico
- *Guadalupe Ramírez-López:
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Pilz S, Rutters F, Nijpels G, Stehouwer CDA, Højlund K, Nolan JJ, Balkau B, Dekker JM. Insulin sensitivity and albuminuria: the RISC study. Diabetes Care 2014; 37:1597-603. [PMID: 24623021 DOI: 10.2337/dc13-2573] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Accumulating evidence suggests an association between insulin sensitivity and albuminuria, which, even in the normal range, is a risk factor for cardiovascular diseases. We evaluated whether insulin sensitivity is associated with albuminuria in healthy subjects. RESEARCH DESIGN AND METHODS We investigated 1,415 healthy, nondiabetic participants (mean age 43.9 ± 8.3 years; 54.3% women) from the RISC (Relationship between Insulin Sensitivity and Cardiovascular Disease) study, of whom 852 participated in a follow-up examination after 3 years. At baseline, insulin sensitivity was assessed by hyperinsulinemic-euglycemic clamps, expressed as the M/I value. Oral glucose tolerance test-based insulin sensitivity (OGIS), homeostasis model assessment of insulin resistance (HOMA-IR), and urinary albumin-to-creatinine ratio (UACR) were determined at baseline and follow-up. RESULTS Microalbuminuria (UACR ≥30 mg/g) was present in fewer than 2% at either study visit. After multivariate adjustments, there was no cross-sectional association between UACR and any measure of insulin sensitivity. Neither OGIS nor HOMA-IR was significantly associated with follow-up UACR, but in a multivariate regression analysis, baseline M/I emerged as an independent predictor of UACR at follow-up (β-coefficient -0.14; P = 0.001). CONCLUSIONS In healthy middle-aged adults, reduced insulin sensitivity, assessed by hyperinsulinemic-euglycemic clamp, is continuously associated with a greater risk of increasing albuminuria. This finding suggests that reduced insulin sensitivity either is simply related to or might causally contribute to the initial pathogenesis of albuminuria.
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Affiliation(s)
- Stefan Pilz
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the NetherlandsDepartment of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria
| | - Femke Rutters
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
| | - Giel Nijpels
- Department of General Practice, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine and Cardiovascular Research Institute, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Kurt Højlund
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | | | - Beverley Balkau
- INSERM, CESP Centre for Research in Epidemiology and Population Health, Epidemiology of Diabetes, Obesity and Chronic Kidney Disease over the Lifecourse and Determinants of Early Nutrition, Villejuif, FranceUniversity of Paris-Sud 11, Villejuif, France
| | - Jacqueline M Dekker
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
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Fornoni A, Merscher S, Kopp JB. Lipid biology of the podocyte--new perspectives offer new opportunities. Nat Rev Nephrol 2014; 10:379-88. [PMID: 24861084 DOI: 10.1038/nrneph.2014.87] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In the past 15 years, major advances have been made in understanding the role of lipids in podocyte biology. First, susceptibility to focal segmental glomerulosclerosis (FSGS) and glomerular disease is associated with an APOL1 sequence variant, is expressed in podocytes and encodes apolipoprotein L1, an important component of HDL. Second, acid sphingomyelinase-like phosphodiesterase 3b encoded by SMPDL3b has a role in the conversion of sphingomyelin to ceramide and its levels are reduced in renal biopsy samples from patients with recurrent FSGS. Furthermore, decreased SMPDL3b expression is associated with increased susceptibility of podocytes to injury after exposure to sera from these patients. Third, in many individuals with membranous nephropathy, autoantibodies against the phospholipase A2 (PLA2) receptor, which is expressed in podocytes, have been identified. Whether these autoantibodies affect the activity of PLA2, which liberates arachidonic acid from glycerophospholipids and modulates podocyte function, is unknown. Fourth, clinical and experimental evidence support a role for ATP-binding cassette sub-family A member 1-dependent cholesterol efflux, free fatty acids and glycerophospolipids in the pathogenesis of diabetic kidney disease. An improved understanding of lipid biology in podocytes might provide insights to develop therapeutic targets for primary and secondary glomerulopathies.
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Affiliation(s)
- Alessia Fornoni
- Peggy and Harold Katz Family Drug Discovery Center, Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, 1580 North West 10th Avenue, Miami, FL 33136, USA
| | - Sandra Merscher
- Peggy and Harold Katz Family Drug Discovery Center, Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, 1580 North West 10th Avenue, Miami, FL 33136, USA
| | - Jeffrey B Kopp
- Kidney Disease Section, Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, 10 Center Drive, 3N116 Bethesda, MD 20892-1268, USA
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13
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Gupta RK, Gupta R, Maheshwari VD, Mawliya M. Impact of smoking on microalbuminuria and urinary albumin creatinine ratio in non-diabetic normotensive smokers. Indian J Nephrol 2014; 24:92-6. [PMID: 24701041 PMCID: PMC3968616 DOI: 10.4103/0971-4065.127893] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Smoking is associated with an excessive morbidity and mortality from a variety of diseases. The aim of this study was to find out the effects of smoking on renal function study in non-diabetic, normotensive subjects. A community-based, prospective, cross-sectional cohort study was conducted on 120 subjects; 80 (66.66%) were smokers and 40 (33.33%) age matched non-smokers; with age range of 30 to 70 years. Measurement of fasting sugar, urea, creatinine, lipids and one time screening of urinary albumin and urinary creatinine was done. Smokers had significantly higher urinary albumin and albumin creatinine ratio (ACR) (52.84 ± 46.42 mg/L, 93.98 ± 78.68 μg/mg) than non-smokers (19.25 ± 7.77 mg/L, 18.99 ± 6.65 μg/mg), respectively (P =< 0.001, P =< 0.001). Microalbuminuria and urinary ACR level were directly related to the amount of smoking (pack-years). Among smokers, 73 (91.25%) had microalbuminuria (>20 mg/L) and 64 (80%) had increased urinary ACR (>30 μg/mg). Smoker had significantly lower high-density lipoprotein level (36.66 ± 10.28 mg/dl) compared to non-smokers (41.22 ± 11.72 mg/dl) (P = 0.031). Urea, creatinine, creatinine clearance, total cholesterol, low density lipoprotein, triglyceride levels were comparable (p = NS). In conclusion, smokers have a 4-fold higher prevalence of microalbuminuria than non-smokers.
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Affiliation(s)
- R K Gupta
- Department of Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - R Gupta
- Department of Paediatrics, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - V D Maheshwari
- Department of Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - M Mawliya
- Department of Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
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14
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Guzman J, Jauregui AN, Merscher-Gomez S, Maiguel D, Muresan C, Mitrofanova A, Diez-Sampedro A, Szust J, Yoo TH, Villarreal R, Pedigo C, Molano RD, Johnson K, Kahn B, Hartleben B, Huber TB, Saha J, Burke GW, Abel ED, Brosius FC, Fornoni A. Podocyte-specific GLUT4-deficient mice have fewer and larger podocytes and are protected from diabetic nephropathy. Diabetes 2014; 63:701-14. [PMID: 24101677 PMCID: PMC3900538 DOI: 10.2337/db13-0752] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Podocytes are a major component of the glomerular filtration barrier, and their ability to sense insulin is essential to prevent proteinuria. Here we identify the insulin downstream effector GLUT4 as a key modulator of podocyte function in diabetic nephropathy (DN). Mice with a podocyte-specific deletion of GLUT4 (G4 KO) did not develop albuminuria despite having larger and fewer podocytes than wild-type (WT) mice. Glomeruli from G4 KO mice were protected from diabetes-induced hypertrophy, mesangial expansion, and albuminuria and failed to activate the mammalian target of rapamycin (mTOR) pathway. In order to investigate whether the protection observed in G4 KO mice was due to the failure to activate mTOR, we used three independent in vivo experiments. G4 KO mice did not develop lipopolysaccharide-induced albuminuria, which requires mTOR activation. On the contrary, G4 KO mice as well as WT mice treated with the mTOR inhibitor rapamycin developed worse adriamycin-induced nephropathy than WT mice, consistent with the fact that adriamycin toxicity is augmented by mTOR inhibition. In summary, GLUT4 deficiency in podocytes affects podocyte nutrient sensing, results in fewer and larger cells, and protects mice from the development of DN. This is the first evidence that podocyte hypertrophy concomitant with podocytopenia may be associated with protection from proteinuria.
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Affiliation(s)
- Johanna Guzman
- Diabetes Research Institute, Miller School of Medicine, University of Miami, Miami, FL
- Department of Medicine, Division of Nephrology and Hypertension, Miller School of Medicine, University of Miami, Miami, FL
| | - Alexandra N. Jauregui
- Diabetes Research Institute, Miller School of Medicine, University of Miami, Miami, FL
| | - Sandra Merscher-Gomez
- Department of Medicine, Division of Nephrology and Hypertension, Miller School of Medicine, University of Miami, Miami, FL
| | - Dony Maiguel
- Diabetes Research Institute, Miller School of Medicine, University of Miami, Miami, FL
| | - Cristina Muresan
- Department of Medicine, Division of Nephrology and Hypertension, Miller School of Medicine, University of Miami, Miami, FL
| | - Alla Mitrofanova
- Department of Medicine, Division of Nephrology and Hypertension, Miller School of Medicine, University of Miami, Miami, FL
| | - Ana Diez-Sampedro
- Department of Physiology, Miller School of Medicine, University of Miami, Miami, FL
| | - Joel Szust
- Diabetes Research Institute, Miller School of Medicine, University of Miami, Miami, FL
| | - Tae-Hyun Yoo
- Department of Medicine, Division of Nephrology and Hypertension, Miller School of Medicine, University of Miami, Miami, FL
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL
| | - Rodrigo Villarreal
- Diabetes Research Institute, Miller School of Medicine, University of Miami, Miami, FL
- Department of Medicine, Division of Nephrology and Hypertension, Miller School of Medicine, University of Miami, Miami, FL
| | - Christopher Pedigo
- Department of Medicine, Division of Nephrology and Hypertension, Miller School of Medicine, University of Miami, Miami, FL
| | - R. Damaris Molano
- Diabetes Research Institute, Miller School of Medicine, University of Miami, Miami, FL
| | - Kevin Johnson
- Diabetes Research Institute, Miller School of Medicine, University of Miami, Miami, FL
| | - Barbara Kahn
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | - Tobias B. Huber
- Division of Nephrology, Freiburg University, Freiburg, Germany
| | - Jharna Saha
- Division of Nephrology, University of Michigan, Ann Arbor, MI
| | - George W. Burke
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL
| | - E. Dale Abel
- Division of Endocrinology, Metabolism and Diabetes and Program in Molecular Medicine, University of Utah, Salt Lake City, UT
| | | | - Alessia Fornoni
- Diabetes Research Institute, Miller School of Medicine, University of Miami, Miami, FL
- Department of Medicine, Division of Nephrology and Hypertension, Miller School of Medicine, University of Miami, Miami, FL
- Corresponding author: Alessia Fornoni,
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15
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Moura RDSSES, Vasconcelos DF, Freitas E, de Moura FJD, Rosa TT, Veiga JPR. Cystatin C, CRP, log TG/HDLc and metabolic syndrome are associated with microalbuminuria in hypertension. Arq Bras Cardiol 2014; 102:54-9. [PMID: 24162470 PMCID: PMC3987393 DOI: 10.5935/abc.20130210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 06/24/2013] [Accepted: 07/22/2013] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND In patients with systemic hypertension, microalbuminuria is a marker of endothelial damage and is associated with an increased risk for cardiovascular disease. OBJECTIVE To determine the factors that may lead to the occurrence of microalbuminuria in hypertensive patients with serum creatinine lower than 1.5 mg/dL. METHODS This cross-sectional study included 133 Brazilians with essential hypertension followed up at a hypertension outpatient clinic. Those with serum creatinine higher than 1.5 mg/dL, as well as those with diabetes mellitus, were excluded. Systolic and diastolic blood pressures were measured, and body mass index (BMI) and GFR estimated by using the CKD-EPI formula were calculated. The serum levels of the following were assessed: CysC, creatinine, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, C-reactive protein (CRP) and fasting glucose. Microalbuminuria was determined in 24-hour urine. Hypertensive patients were classified according to the presence of one or more criteria for metabolic syndrome. RESULTS In a multiple regression analysis, the serum levels of CysC and CRP, the atherogenic index log TG/HDLc and the presence of three or more criteria for metabolic syndrome were positively correlated with microalbuminuria (r2: 0.277, p < 0.05). CONCLUSION CysC, CRP, log TG/HDLc, and the presence of three or more criteria for metabolic syndrome, regardless of serum creatinine, were associated with microalbuminuria, an early marker of kidney damage and cardiovascular risk in patients with essential hypertension.
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Affiliation(s)
| | | | - Eduardo Freitas
- Departamento de Estatística, Universidade de Brasília, Brasília, DF -
Brazil
| | - Flavio José Dutra de Moura
- Área de Clínica Médica, Nefrologia, Faculdade de Medicina, Universidade
de Brasília, Brasília, DF - Brazil
| | - Tânia Torres Rosa
- Área de Clínica Médica, Nefrologia, Faculdade de Medicina, Universidade
de Brasília, Brasília, DF - Brazil
| | - Joel Paulo Russomano Veiga
- Área de Clínica Médica, Nefrologia, Faculdade de Medicina, Universidade
de Brasília, Brasília, DF - Brazil
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16
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Diez-Sampedro A, Lenz O, Fornoni A. Podocytopathy in diabetes: a metabolic and endocrine disorder. Am J Kidney Dis 2011; 58:637-46. [PMID: 21719174 DOI: 10.1053/j.ajkd.2011.03.035] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 03/04/2011] [Indexed: 12/17/2022]
Abstract
Diabetic nephropathy (DN) represents a major public health cost. Tight glycemic and blood pressure control can dramatically slow, but not stop, the progression of the disease, and a large number of patients progress toward end-stage renal disease despite currently available interventions. An early and key event in the development of DN is loss of podocyte function (or glomerular visceral epithelial cells) from the kidney glomerulus, where they contribute to the integrity of the glomerular filtration barrier. Recent evidence suggests that podocytes can be the direct target of circulating hormones, lipids, and adipokines that are affected in diabetes. We review the clinical and experimental evidence implicating novel endocrine and metabolic pathways in the pathogenesis of podocyte dysfunction and the development of DN.
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Affiliation(s)
- Ana Diez-Sampedro
- Department of Physiology and Biophysics, University of Miami Miller School of Medicine, FL, USA
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17
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O’Seaghdha CM, Hwang SJ, Upadhyay A, Meigs JB, Fox CS. Predictors of incident albuminuria in the Framingham Offspring cohort. Am J Kidney Dis 2010; 56:852-60. [PMID: 20599306 PMCID: PMC3198053 DOI: 10.1053/j.ajkd.2010.04.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 04/07/2010] [Indexed: 12/14/2022]
Abstract
BACKGROUND Predictors for incident albuminuria are not well known in population-based cohorts. The purpose of this study is to identify predictors of incident albuminuria in an unselected middle-aged population. STUDY DESIGN Observational cohort study. SETTING & PARTICIPANTS Framingham Offspring Study participants who attended both the sixth (baseline; 1995-1998) and eighth (2005-2008) examination cycles. PREDICTORS Standard clinical predictors were used. Predictors of incident albuminuria were identified using stepwise logistic regression analysis with age and sex forced into the model. OUTCOMES & MEASUREMENTS Albuminuria was defined as urine albumin-creatinine ratio (UACR) ≥ 17 mg/g (men) or ≥ 25 mg/g (women). Individuals with albuminuria at baseline were excluded. RESULTS 1,916 participants were available for analysis (mean age, 56 years; 54% women). Albuminuria developed in 10.0% of participants (n = 192) during 9.5 years. Age (OR, 2.09; P < 0.001), baseline diabetes (OR, 1.93; P = 0.01), smoking (OR, 2.09; P < 0.001), and baseline log UACR (OR per 1-SD increase in log UACR, 1.56; P < 0.001) were associated with incident albuminuria in a stepwise model. An inverse relationship with female sex (OR, 0.53; P < 0.001) and high-density lipoprotein (HDL) cholesterol level (OR, 0.80; P = 0.007) also was observed. Results were similar when participants with baseline chronic kidney disease (n = 102), defined as estimated glomerular filtration rate <60 mL/min/1.73 m(2), were excluded from the model. Age, male sex, low HDL cholesterol level, smoking, and log UACR continued to be associated with incident albuminuria when baseline diabetes (n = 107) was excluded. Age, male sex, and log UACR correlated with incident albuminuria after participants with baseline hypertension were excluded (n = 651). LIMITATIONS Causality may not be inferred because of the observational nature of the study. One-third of participants did not return for follow-up, potentially attenuating the observed risks of albuminuria. CONCLUSIONS The known cardiovascular risk factors of increasing age, male sex, diabetes, smoking, low HDL cholesterol level, and albuminuria within the reference range are correlates of incident albuminuria in the general population.
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Affiliation(s)
- Conall M. O’Seaghdha
- Renal Division, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
- National Heart, Lung and Blood Institute’s Framingham Heart Study and the Center for Population Studies, Framingham, MA
| | - Shih-Jen Hwang
- National Heart, Lung and Blood Institute’s Framingham Heart Study and the Center for Population Studies, Framingham, MA
| | - Ashish Upadhyay
- Division of Nephrology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA
| | - James B. Meigs
- General Medicine Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Caroline S. Fox
- National Heart, Lung and Blood Institute’s Framingham Heart Study and the Center for Population Studies, Framingham, MA
- Division of Endocrinology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
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18
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Role of altered insulin signaling pathways in the pathogenesis of podocyte malfunction and microalbuminuria. Curr Opin Nephrol Hypertens 2009; 18:539-45. [PMID: 19724224 DOI: 10.1097/mnh.0b013e32832f7002] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW In diabetic nephropathy, insulin resistance and hyperinsulinemia correlate with the development of albuminuria. The possibility that altered insulin signaling in glomerular cells and particularly podocytes contributes to the development of diabetic nephropathy will be discussed. RECENT FINDINGS Whereas normal podocytes take up glucose in response to insulin, diabetic podocytes become insulin resistant in experimental diabetic nephropathy prior to the development of significant albuminuria. Both clinical and experimental data suggest that insulin sensitizers may be renoprotective independent of their systemic effects on the metabolic control of diabetes. SUMMARY We will review the clinical and experimental evidence that altered insulin signaling correlates with the development of diabetic nephropathy in both type 1 and type 2 diabetes, and that insulin sensitizers may be superior to other hypoglycemic agents in the prevention of diabetic nephropathy. We will then review potential mechanisms by which altered podocyte insulin signaling may contribute to the development of diabetic nephropathy. Understanding the role of podocytes in glucose metabolism is important because it may lead to the discovery of novel pathogenetic mechanisms of diabetic nephropathy, it may affect current strategies for prevention and treatment of diabetic nephropathy, and it may allow the identification of novel therapeutic targets.
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19
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Inhibition of C-jun N-terminal kinase improves insulin sensitivity but worsens albuminuria in experimental diabetes. Kidney Int 2008; 75:381-8. [PMID: 18971923 DOI: 10.1038/ki.2008.559] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
C-jun N-terminal kinase (JNK) regulates both the development of insulin resistance and inflammation. Podocytes of the widely used db/db mouse model of diabetic nephropathy lose their ability to respond to insulin as albuminuria develops, in comparison to control db/+ mice. Here we tested whether JNK inhibition or its gene deletion would prevent albuminuria in experimental diabetes. Phosphorylated/total JNK was significantly increased in vivo in glomeruli of db/db compared to db/+ mice. Treatment of podocytes isolated from these two strains of mice with tumor necrosis factor-alpha caused greater phosphorylation of JNK in those obtained from diabetic animals. When db/db mice were treated with a cell-permeable TAT-JNK inhibitor peptide, their insulin sensitivity and glycemia significantly improved compared to controls. We induced diabetes in JNK1 knockout mice with streptozotocin and found that they had significantly better insulin sensitivity compared to diabetic wild-type or JNK2 knockout mice. Albuminuria was, however, worse in all mice treated with the JNK inhibitor and in diabetic JNK2 knockout mice compared to controls. Nephrin expression was also reduced in JNK inhibitor-treated mice compared to controls. A similar degree of mesangial expansion was found in all diabetic mice. Our study shows that targeting JNK to improve systemic insulin sensitivity does not necessarily prevent diabetic nephropathy.
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20
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Sarafidis PA, Ruilope LM. Insulin resistance, microalbuminuria, and chronic kidney disease. Curr Hypertens Rep 2008; 10:249-51. [PMID: 18625151 DOI: 10.1007/s11906-008-0046-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Pantelis A Sarafidis
- Section of Nephrology and Hypertension, First Department of Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece.
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21
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Chandie Shaw PK, Berger SP, Mallat M, Frölich M, Dekker FW, Rabelink TJ. Central obesity is an independent risk factor for albuminuria in nondiabetic South Asian subjects. Diabetes Care 2007; 30:1840-4. [PMID: 17456841 DOI: 10.2337/dc07-0028] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE South Asians have a high prevalence of central obesity. When the diagnosis of diabetes is made, they have a very high risk of developing renal failure. In the current study, we explored the hypothesis that central obesity is associated with the development of renal injury, before the manifestation of diabetes. RESEARCH DESIGN AND METHODS We invited first-degree nondiabetic relatives of South Asian type 2 diabetic patients for investigation of microalbuminuria and diabetes. Subjects who used antihypertensive or antidiabetic medication were excluded. We performed a glucose tolerance test according to the classic World Health Organization criteria. A total of 205 subjects were normoglycemic; we excluded 25 subjects because of impaired glucose tolerance, and 30 subjects were excluded because of de novo diabetes. Central obesity was measured by waist-to-hip ratio (WHR). Albuminuria was measured as albumin-to-creatinine ratio (ACR) in the early-morning urine. RESULTS Central obesity was independently related with albuminuria in the 205 normoglycemic subjects. We found no relation of fasting blood glucose or systolic blood pressure with albuminuria. Multivariate analysis for the presence of increased albuminuria (median ACR >0.31 mg/mmol) showed a relative risk of 4.1 for the highest versus the lowest tertile of WHR (P = 0.002). CONCLUSIONS Central obesity is an early and independent risk factor for increased albuminuria in normoglycemic South Asian subjects. This could explain the high incidence of diabetic renal disease in South Asians, probably by the mechanism of insulin resistance and endothelial dysfunction in the pre-diabetic state.
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Affiliation(s)
- Prataap K Chandie Shaw
- Department of Nephrology, Medical Center Haaglanden, Lijnbaan 32, P.O. Box 432, The Hague 2501 CK, The Netherlands.
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22
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Chang Y, Yoo T, Ryu S, Huh BY, Cho BL, Sung E, Park M, Yoo SH. Abdominal obesity, systolic blood pressure, and microalbuminuria in normotensive and euglycemic Korean men. Int J Obes (Lond) 2006; 30:800-4. [PMID: 16404402 DOI: 10.1038/sj.ijo.0803210] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To evaluate the relationship between abdominal obesity and microalbuminuria (MA) in normotensive, euglycemic Korean men. DESIGN A cross-sectional study at a health screening center. SUBJECTS A total of 1321 healthy, normotensive Korean men, aged 20-78 years, with a fasting plasma glucose level <100 mg/dl. MEASUREMENTS Height, weight, and waist; systolic blood pressure (SBP); diastolic blood pressures (DBP); urinary albumin to creatinine ratio (ACR); fasting glucose, insulin, lipids, C-reactive protein (CRP), and white blood cell count. Waist circumference (WC) was used to indicate abdominal obesity and a single measurement of ACR was used to estimate MA. We also calculated body mass index (BMI) based on weight and height. RESULTS Mean BMI, WC, and SBP were significantly higher in subjects with MA than in those without (24.8+/-4.1 vs 23.8+/-2.7 kg/m2, 86+/-9 vs 83+/-8 cm, and 115+/-5 vs 112+/-7 mmHg, respectively). Multiple logistic regression analyses showed that only WC and SBP were independent predictors of MA. CONCLUSION WC and SBP were positively associated with MA in normotensive and euglycemic Korean men.
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Affiliation(s)
- Y Chang
- Medical Screening Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Republic of Korea
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23
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Lindholm E, Bakhtadze E, Sjögren M, Cilio CM, Agardh E, Groop L, Agardh CD. The -374 T/A polymorphism in the gene encoding RAGE is associated with diabetic nephropathy and retinopathy in type 1 diabetic patients. Diabetologia 2006; 49:2745-55. [PMID: 16969646 DOI: 10.1007/s00125-006-0412-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2005] [Accepted: 06/21/2006] [Indexed: 11/27/2022]
Abstract
AIMS/HYPOTHESIS The receptor for AGE (RAGE) is considered to be mainly an intracellular signal-transducer or pro-inflammatory peptide of possible importance for inflammation and autoimmune diseases. Our aim was to study whether the -374 T/A polymorphism in the gene encoding RAGE (AGER) is associated with diabetes type and presence of diabetic complications. METHODS The AGER -374 T/A polymorphism was genotyped in 867 type 1 diabetic patients, 2,467 type 2 diabetic patients and 205 non-diabetic control subjects of Scandinavian origin. RESULTS AGER polymorphism was related to different HLA-DQB1 genotypes and the presence of diabetic complications. Type 1 diabetic patients had a higher frequency of the AGER -374 A/A or T/A genotypes than type 2 diabetic patients (51.1 vs 44.9%, p=0.002) and control subjects (51.1 vs 47.6%, p=0.0006). The RAGE -374 T/A polymorphism was associated with HLA-DQB1 genotypes; patients with HLA risk genotypes had a higher frequency of the A/A or T/A genotypes than patients with other HLA-DQB1 genotypes (60.3 vs 40.3%, p<0.000001). In type 1 diabetic patients, the frequency of the A/A or T/A genotypes was higher in patients with diabetic nephropathy than without (61.1 vs 46.8%, p=0.006) and with sight-threatening retinopathy than without (56.1 vs 47.6%, p=0.03). In type 2 diabetic patients with HbA(1c) values below the median, the T/T genotype was more frequent in patients with diabetic nephropathy than without (54.3 vs 38.2%, p=0.02). CONCLUSIONS/INTERPRETATION Our results show an association between the AGER -374 T/A polymorphism and type 1 diabetes. This association was HLA-DQB1-dependent. The polymorphism was associated with diabetic nephropathy in both type 1 and type 2 diabetes, in an HbA(1c)-dependent manner in the latter group, and also with sight-threatening retinopathy in type 1 diabetic patients.
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Affiliation(s)
- E Lindholm
- Department of Clinical Sciences, University Hospital MAS, Lund University, Lund, Sweden
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24
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Burgert TS, Dziura J, Yeckel C, Taksali SE, Weiss R, Tamborlane W, Caprio S. Microalbuminuria in pediatric obesity: prevalence and relation to other cardiovascular risk factors. Int J Obes (Lond) 2006; 30:273-80. [PMID: 16231019 DOI: 10.1038/sj.ijo.0803136] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Microalbuminuria (MA) has emerged as a strong predictor of cardiovascular (CV) events, even in nondiabetic adults. While the mechanisms behind this association remain to be established, most studies suggest that MA is the result of increased vascular leakage denoting endothelial dysfunction associated with early vasculopathy. OBJECTIVE To examine if a urine albumin creatinine ratio (UACR) in the microalbuminuric range is related to metabolic markers of CV risk in obese and pre-diabetic youth recruited from an obesity clinic. METHODS MA was defined as a UACR between 2.0 and 20 mg/mmol. Subjects with gross proteinuria (UACR>20 mg/mmol) were excluded from the study. Analyses were performed to assess the relationship of MA and markers of CV risk, including body mass index (BMI), % body fat, blood pressure (BP), lipid profile, inflammatory markers, insulin sensitivity indexes and degrees of oral glucose tolerance. MA was also correlated with risk factor constellations unique to the metabolic syndrome, a distinct CV risk entity. RESULTS Postchallenge alterations in glucose metabolism and overall loss in insulin sensitivity were strongly and positively correlated with the presence of MA (P = 0.002 and 0.01, respectively). Neither the metabolic syndrome nor any of the individual CV risk factors examined were associated with MA. CONCLUSIONS These data suggest that early glucose toxicity, as reflected by postchallenge elevations in plasma glucose even below the diagnostic cutoff for diabetes mellitus may contribute to the presence of MA. Whether MA is equally as predictive of CV disease in youth, as in adulthood, remains to be investigated.
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Affiliation(s)
- T S Burgert
- Department of Pediatrics and The General Clinical Research Center, Yale University School of Medicine, New Haven 06520, USA.
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25
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Sarafidis PA, Ruilope LM. Insulin resistance, hyperinsulinemia, and renal injury: mechanisms and implications. Am J Nephrol 2006; 26:232-44. [PMID: 16733348 DOI: 10.1159/000093632] [Citation(s) in RCA: 189] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2006] [Accepted: 04/24/2006] [Indexed: 12/11/2022]
Abstract
Most of the basic components of the metabolic syndrome, namely type 2 diabetes mellitus, hypertension, obesity, or low high-density lipoprotein cholesterol levels, apart from being major risk factors for cardiovascular disease have been also associated with an increased risk of chronic kidney disease. However, several epidemiologic studies conducted over the past years suggest that the central component of the syndrome, insulin resistance, as well as compensatory hyperinsulinemia are independently associated with an increased prevalence of chronic kidney disease. In addition, background studies support the existence of several pathways linking insulin resistance and hyperinsulinemia with kidney damage. Insulin per se promotes the proliferation of renal cells and stimulates the production of other important growth factors such as insulin-like growth factor-1 and transforming growth factor beta. Insulin also upregulates the expression of angiotensin II type 1 receptor in mesangial cells, thus enhancing the deleterious effects of angiotensin II in the kidney, and stimulates production and renal action of endothelin-1. Moreover, insulin resistance and hyperinsulinemia are associated with decreased endothelial production of nitric oxide and increased oxidative stress which have been also implicated in the progression of diabetic nephropathy. This review analyzes the above and other potential mechanisms, through which insulin resistance and hyperinsulinemia can contribute to renal injury.
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Affiliation(s)
- Pantelis A Sarafidis
- Hypertension/Clinical Research Center, Department of Preventive Medicine, Rush University Medical Center, Chicago, IL 60612, USA.
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26
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Frontoni S, Bracaglia D, Gigli F. Relationship between autonomic dysfunction, insulin resistance and hypertension, in diabetes. Nutr Metab Cardiovasc Dis 2005; 15:441-449. [PMID: 16314230 DOI: 10.1016/j.numecd.2005.06.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2005] [Revised: 06/15/2005] [Accepted: 06/21/2005] [Indexed: 11/23/2022]
Abstract
Sympathovagal imbalance and insulin resistance are the common underlying disorders linking hypertension and diabetes. The role of hyperinsulinemia, however, on sympathovagal balance and blood pressure has never been clearly dissected from that of hyperglycemia. Nevertheless, the study of animal models of hypertension showed that hypertension does not invariably result in the onset of insulin resistance. This suggests that insulin resistance precedes the onset of hypertension and (possibly) contributes to its pathogenesis, mainly through sympathetic activation. To examine this hypothesis, recent studies investigated the relationship between insulin sensitivity and sympathetic activity in subjects with insulin resistance but free of overt hyperglycemia and obesity, i.e., insulin-resistant offspring of type 2 diabetic patients, demonstrating a prevalence of sympathetic over vagal activity. Therefore insulin resistance and sympathovagal imbalance come before hypertension, but a clear causative role cannot be demonstrated since other mechanisms, including an inappropriate lifestyle, must be taken into account to determine clinical hypertension. Finally, several experiments in human healthy volunteers suggest that the modulation of autonomic regulation at the forearm level can regulate insulin sensitivity, tempting us to speculate that it is the primary autonomic imbalance, through vasoconstriction, that results in both insulin resistance and hypertension. In conclusion, the close relationship between autonomic imbalance, insulin resistance and hypertension is unquestionable; although logical hypothesis can be constructed, which of the three is the earliest event is still not understood, and further research is required.
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Affiliation(s)
- Simona Frontoni
- Diabetes Center, Department of Internal Medicine, University of Rome Tor Vergata, Viale Duilio Cambellotti 11, I-00133 Rome, Italy.
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Govindarajan G, Whaley-Connell A, Mugo M, Stump C, Sowers JR. The Cardiometabolic Syndrome as a Cardiovascular Risk Factor. Am J Med Sci 2005; 330:311-8. [PMID: 16355016 DOI: 10.1097/00000441-200512000-00009] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The cardiometabolic syndrome (CMS) is associated with cardiovascular disease (CVD) and includes a constellation of risk factors such as central obesity, hypertension, insulin resistance, dyslipidemia, microalbuminuria, and hypercoagulability. Collectively, these risk factors increase CVD endpoints such as stroke, congestive heart failure, chronic kidney disease (CKD), and overall mortality. The CMS is associated with endothelial dysfunction, inflammation, abnormal thrombolysis, and increased oxidative stress that accentuate progression of CVD. We will review how the varying components of the CMS relate to an increased CVD and renal disease risk.
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Affiliation(s)
- Gurushankar Govindarajan
- University of Missouri-Columbia, School of Medicine, Department of Internal Medicine and Physiology, Harry S. Truman VA Medical Center, Columbia, Missouri 65212, USA
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Pätäri A, Karhapää P, Taipale H, Salmenniemi U, Ruotsalainen E, Vanninen P, Holthöfer H, Laakso M. A 100-kDa urinary protein is associated with insulin resistance in offspring of type 2 diabetic patients. Diabetologia 2005; 48:1844-50. [PMID: 16003531 DOI: 10.1007/s00125-005-1853-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2004] [Accepted: 04/18/2005] [Indexed: 01/18/2023]
Abstract
AIMS/HYPOTHESIS One-third of normoalbuminuric type 1 diabetic patients show immunoreactive nephrin in urine. Offspring of type 2 diabetic patients are insulin-resistant and susceptible to the development of diabetes. We investigated whether the offspring of type 2 diabetic patients show nephrin in urine and whether possible nephrinuria is associated with insulin resistance. METHODS Urinary proteins from timed overnight urine collections from 128 offspring of type 2 diabetic patients and 9 control subjects were analysed by western blotting using an antibody against nephrin. Glucose metabolism was assessed by OGTT and IVGTT and the euglycaemic-hyperinsulinaemic clamp technique. RESULTS Of the offspring, 12.5% were strongly and 14.1% weakly positive for a 100-kDa urinary protein. All controls were negative. During the first 10 min of an IVGTT, the offspring strongly positive for the urinary protein had a higher insulin response than the offspring without the protein (3,700 vs 2,306 pmol l(-1)min(-1), p=0.007). Insulin sensitivity (the rate of whole-body glucose uptake divided by the steady-state insulin level x 100) was lower among the offspring strongly positive for the urinary protein than among the offspring negative for the protein (11.3 vs 15.8 micromol kg(-1)min(-1)pmol(-1)l(-1), p=0.008). CONCLUSIONS/INTERPRETATION A 100-kDa urinary protein detectable with a nephrin antibody is associated with insulin resistance in offspring of type 2 diabetic patients.
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Affiliation(s)
- A Pätäri
- Department of Bacteriology and Immunology, University of Helsinki and Research Program in Molecular Medicine, Biomedicum Helsinki, Helsinki, Finland
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Thorn LM, Forsblom C, Fagerudd J, Thomas MC, Pettersson-Fernholm K, Saraheimo M, Wadén J, Rönnback M, Rosengård-Bärlund M, Björkesten CGA, Taskinen MR, Groop PH. Metabolic syndrome in type 1 diabetes: association with diabetic nephropathy and glycemic control (the FinnDiane study). Diabetes Care 2005; 28:2019-24. [PMID: 16043748 DOI: 10.2337/diacare.28.8.2019] [Citation(s) in RCA: 312] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this study was to estimate the prevalence of the metabolic syndrome in Finnish type 1 diabetic patients and to assess whether it is associated with diabetic nephropathy or poor glycemic control. RESEARCH DESIGN AND METHODS In all, 2,415 type 1 diabetic patients (51% men, mean age 37 years, duration of diabetes 22 years) participating in the nationwide, multicenter Finnish Diabetic Nephropathy (FinnDiane) study were included. Metabolic syndrome was defined according to the National Cholesterol Education Program diagnostic criteria. Patients were classified as having normal albumin excretion rate (AER) (n = 1,261), microalbuminuria (n = 326), macroalbuminuria (n = 383), or end-stage renal disease (ESRD) (n = 164). Glycemic control was classified as good (HbA1c <7.5%), intermediate (7.5-9.0%), or poor (>9.0%). Creatinine clearance was estimated with the Cockcroft-Gault formula. RESULTS The overall prevalence of metabolic syndrome was 38% in men and 40% in women. The prevalence was 28% in those with normal AER, 44% in microalbuminuric patients, 62% in macroalbuminuric patients, and 68% in patients with ESRD (P < 0.001). Patients with metabolic syndrome had a 3.75-fold odds ratio for diabetic nephropathy (95% CI 2.89-4.85), and all of the separate components of the syndrome were independently associated with diabetic nephropathy. The prevalence of metabolic syndrome was 31% in patients with good glycemic control, 36% in patients with intermediate glycemic control, and 51% in patients with poor glycemic control (P < 0.001). Similarly, metabolic syndrome increased with worsening creatinine clearance. CONCLUSIONS The metabolic syndrome is a frequent finding in type 1 diabetes and increases with advanced diabetic nephropathy and worse glycemic control.
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Affiliation(s)
- Lena M Thorn
- Folkhälsan Research Center, Biomedicum Helsinki, University of Helsinki, POB 63, FIN-00014, Helsinki, Finland
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Narin F, Atabek ME, Karakukcu M, Narin N, Kurtoglu S, Gumus H, Coksevim B, Erez R. The association of plasma homocysteine levels with serum leptin and apolipoprotein B levels in childhood obesity. Ann Saudi Med 2005; 25:209-14. [PMID: 16119521 PMCID: PMC6147986 DOI: 10.5144/0256-4947.2005.209] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND An elevated plasma total homocysteine (tHcy) level has recently been established as an independent risk factor for thrombosis and vascular disease. However, the relationship between hyperhomocysteinemia and cardiovascular disease and obesity remains controversial. The aim of the study was to investigate a possible relationship between plasma tHcy levels and measures of childhood obesity. SUBJECTS AND METHODS Forty children and adolescents with exogenous obesity and 20 non-obese subjects in an age-and sex-matched control group were investigated. Fasting samples were collected for plasma tHcy, serum insulin, leptin, vitamin B12, folate, creatinine and lipid parameters. Anthropometric characteristics and body compositions were assessed in both groups. RESULTS The obese patients had significantly higher tHcy levels than the non-obese controls (14.3+/-11.8 micromol/L vs 8.7+/-5.9 micromol/L; P=0.017). In both groups, plasma tHcy was positively related to serum leptin, but serum apolipoprotein B (apo B) levels were positively related to plasma tHcy levels only in obese patients. CONCLUSIONS Our study demonstrates for the first time that leptin and apo B are main correlates of tHcy in obese children and adolescents and suggests that hyperleptinemia and increased apo B may contribute to impairment of tHcy metabolism in childhood obesity.
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Affiliation(s)
- Figen Narin
- Department of Biochemistry, Erciyes University Faculty of Medicine, 38039 Kayseri, Turkey
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31
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Hadjadj S, Péan F, Gallois Y, Passa P, Aubert R, Weekers L, Rigalleau V, Bauduceau B, Bekherraz A, Roussel R, Dussol B, Rodier M, Marechaud R, Lefebvre PJ, Marre M. Different patterns of insulin resistance in relatives of type 1 diabetic patients with retinopathy or nephropathy: the Genesis France-Belgium Study. Diabetes Care 2004; 27:2661-8. [PMID: 15505002 DOI: 10.2337/diacare.27.11.2661] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Insulin resistance may be a risk factor for diabetic microangiopathy, which may have a familial component. We carried out a family-based study to determine which components of the insulin resistance syndrome are associated with diabetic retinopathy and nephropathy in type 1 diabetes. RESEARCH DESIGN AND METHODS The Genesis France-Belgium Study is a multicenter binational study designed to investigate the genetic factors involved in the microvascular complications of type 1 diabetes using a family-based design. Probands were type 1 diabetic patients with diabetic retinopathy (classified as background, preproliferative, or proliferative) and possibly diabetic nephropathy (absent, incipient, established, or advanced). The insulin resistance score of their first-degree relatives was calculated according to their BMI and history of arterial hypertension, lipid disorders, and type 2 diabetes. RESULTS The insulin resistance score of relatives was positively correlated with the albumin excretion rate (P = 0.0009) and fasting plasma glucose (P = 0.0003) and HbA(1c) (P < 0.0001) concentrations. This score was higher in the relatives of probands with than in those without diabetic nephropathy (P = 0.0370). Similarly, it was higher in relatives of subjects with proliferative diabetic retinopathy than in those of probands without, even after controlling for subjects with versus without diabetic nephropathy (P = 0.0379). However, the components of the insulin resistance score in relatives differed according to the severity of diabetic retinopathy or nephropathy in the probands. Obesity and history of arterial hypertension were most common in relatives of probands with proliferative diabetic retinopathy, whereas obesity and history of lipid disorders were most common in the relatives of probands with diabetic nephropathy. CONCLUSIONS Familial insulin resistance segregates with diabetic complications: lipid disorders and obesity segregate with diabetic nephropathy, whereas arterial hypertension and obesity segregate with diabetic retinopathy.
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Affiliation(s)
- Samy Hadjadj
- Department of Endocrinology and Diabetology, University Hospital, Poitiers, France
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Tohma T, Shimabukuro M, Oshiro Y, Yamakawa M, Shimajiri Y, Takasu N. Cilostazol, a phosphodiesterase inhibitor, reduces microalbuminuria in the insulin-resistant Otsuka Long-Evans Tokushima Fatty rat. Metabolism 2004; 53:1405-10. [PMID: 15536593 DOI: 10.1016/j.metabol.2004.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We evaluated association between hyperinsulinemia/insulin resistance and microalbuminuria in the insulin-resistant Otsuka Long-Evans Tokushima Fatty (OLETF) rat. OLETF rats showed glomerular hyperfiltration (an increase in creatinine clearance and a decrease in fractional excretion of Na) and microalbuminuria at the insulin-resistant prediabetic stage, and both were related to expression of transforming growth factor (TGF)-beta(1) and extracellular matrix protein such as fibronectin and collagen (a(1)) IV. Cilostazol, a selective type III cyclic nucleotide phosphodiesterase (PDE) inhibitor, normalized glomerular hyperfiltration and microalbuminuria with a parallel decline of TGF-beta(1) and extracellular matrix protein mRNA expression. Cilostazol may be beneficial to lessen early glomerular nephropathy in a state of hyperinsulinemia/insulin resistance.
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Affiliation(s)
- Takeshi Tohma
- Second Department of Internal Medicine, University of Ryukyus, Okinawa 903-0215, Japan
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Lane JT. Microalbuminuria as a marker of cardiovascular and renal risk in type 2 diabetes mellitus: a temporal perspective. Am J Physiol Renal Physiol 2004; 286:F442-50. [PMID: 14761931 DOI: 10.1152/ajprenal.00247.2003] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Microalbuminuria is a marker for diabetic nephropathy. It also signifies cardiovascular disease, as well as nephropathy, in type 2 diabetes (DM2). Microalbuminuria may precede DM2, occurring with the insulin resistance syndrome and its components, including obesity and hypertension. Other indicators of cardiovascular risk, such as markers of inflammation, are associated with microalbuminuria in populations of patients with and without diabetes. With the rising prevalence of DM2 in minority youth, especially in Native Americans, a marker for future disease risk would allow earlier prevention strategies to be tested. Before microalbuminuria can be used in a prevention strategy, more needs to be known about the mechanism(s) of the association between elevated excretion, its relationship to glucose intolerance, and its relative contribution to cardiovascular and renal disease. These questions are especially applicable as we begin to observe the long-term complications of diabetes in youth.
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Affiliation(s)
- James T Lane
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198-3020, USA.
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Lindholm E, Klannemark M, Agardh E, Groop L, Agardh CD. Putative role of polymorphisms in UCP1-3 genes for diabetic nephropathy. J Diabetes Complications 2004; 18:103-7. [PMID: 15120704 DOI: 10.1016/s1056-8727(03)00019-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2002] [Revised: 01/26/2003] [Accepted: 01/31/2003] [Indexed: 10/25/2022]
Abstract
Increased production of reactive oxygen species (ROS) has been suggested as a cause of diabetic complications. Uncoupling proteins (UCPs) have been ascribed a role in reducing the formation of ROS, and genetic variation in genes encoding for UCPs could thus be putative candidate genes for diabetic nephropathy. To test this hypothesis we searched for association between the A-->G (-3862) variant in UCP1, the insertion/deletion (I/D) polymorphism in exon 8 in UCP2, and the C-->T (-55) polymorphism in UCP3 and diabetic nephropathy in 218 diabetic patients with normal urinary albumin excretion rate (AER), 216 with micro- or macroalbuminuria, and in 106 control subjects without a family history of diabetes. We did not find any association between the different polymorphisms and diabetic nephropathy, nor did we observe any difference in AER among carriers of different UCP1-3 genotypes. We could, however, confirm the reported association between BMI and the UCP3 -55 C-->T polymorphism; patients carrying the T allele had higher BMI than patients homozygous for the C allele (26.4+/-4.2 vs. 25.3+/-4.3 kg/m(2); P=.01). We conclude that studied polymorphisms in the UCP1-3 genes do not play a major role in the development of micro- or macroalbuminuria in Scandinavian diabetic patients.
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Affiliation(s)
- Eero Lindholm
- Department of Endocrinology, University Hospital MAS, SE-205 02 Malmo, Sweden
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35
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Sowers JR, Frohlich ED. Insulin and insulin resistance: impact on blood pressure and cardiovascular disease. Med Clin North Am 2004; 88:63-82. [PMID: 14871051 DOI: 10.1016/s0025-7125(03)00128-7] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Cardiovascular disease is a major cause of mortality in individuals with diabetes. Many factors, including hypertension, contribute to the high prevalence of CVD in this population. Hypertension occurs approximately twice as frequently in patients with diabetes compared with patients without diabetes. Conversely, recent data suggest that hypertensive persons are more likely to develop diabetes than normotensive persons. In addition, up to 75% of CVD in patients with diabetes may be attributed to hypertension, leading to recommendations for more aggressive blood pressure control (ie, < 130/85 mm Hg) in persons with coexistent diabetes and hypertension. Increasing obesity further contributes to both diabetes and hypertension and significantly increases CVD morbidity and mortality. Other important risk factors for CVD in these patients include atherosclerosis, dyslipidemia, microalbuminuria, endothelial dysfunction, platelet hyperaggregability, coagulation abnormalities, and diabetic cardiomyopathy. The current knowledge regarding these risk factors has been reviewed, placing special emphasis on the metabolic syndrome, hypertension, microalbuminuria, and the role of obesity in these disorders. Although not discussed in detail, it is acknowledged that both hygienic measures (weight loss and aerobic exercise) and treatment strategies that include aspirin, statins, INS sensitizers, and antihypertensive agents that reduce renin-angiotensin-aldosterone system activity have been shown to reduce inflammation, coagulation abnormalities, endothelial function, proteinuria, and in some cases reduce CVD and renal disease progression. Additional therapeutic agents are currently being developed specifically to improve INS sensitivity and other CVD risk factors that are components of the cardiometabolic syndrome.
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Affiliation(s)
- James R Sowers
- Division of Endocrinology, Diabetes and Hypertension, SUNY Downstate and VAMC, 450 Clarkson Avenue, Box 1205, Brooklyn, NY 11203, USA.
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Frontoni S, Bracaglia D, Baroni A, Pellegrini F, Perna M, Cicconetti E, Ciampittiello G, Menzinger G, Gambardella S. Early autonomic dysfunction in glucose-tolerant but insulin-resistant offspring of type 2 diabetic patients. Hypertension 2003; 41:1223-7. [PMID: 12743012 DOI: 10.1161/01.hyp.0000073062.29546.01] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In type 2 diabetes, both insulin resistance and hyperglycemia are considered responsible for autonomic dysfunction, but the specific role of these two abnormalities is not clear. To test the specific role of insulin resistance on autonomic dysfunction, we studied 69 glucose-tolerant offspring of type 2 diabetic patients, comparing the most insulin-resistant tertile (IR) with the most insulin-sensitive tertile (IS) and comparable control subjects, all undergoing the oral glucose tolerance test, impedentiometry, 24-hour blood pressure and ECG monitoring, and an intravenous glucose tolerance test (IVGTT) followed by a euglycemic hyperinsulinemic clamp, with continuous blood pressure and ECG measurements. Sympathovagal balance was evaluated as low- to high-frequency ratio (LF:HF) by spectral analysis on R-R intervals. The change of systolic and diastolic blood pressure was calculated as [(day-night/d)]x100. In IR, the changes of systolic and diastolic blood pressure were significantly lower versus IS (9.2+/-5.0% versus 12.4+/-3.6%, P<0.02; 13.2+/-6.5% versus 17.4+/-5.2%, P<0.02). During the night, LF:HF fall was reduced in IR (43.1+/-21.0 versus 61.4+/-16.9, P<0.02). Hyperinsulinemia (IVGTT) rapidly and significantly increased LF:HF in IR (4.9+/-3.3 versus basal: 2.3+/-1.4, P=0.03) but not in IS. In offspring of type 2 diabetic patients with normal glucose tolerance and normal blood pressure values, insulin resistance is associated with abnormal control of blood pressure and sympathetic activation. Insulin resistance may therefore be responsible for some early derangements of the autonomic nervous tone control and thus contributes to increase the incidence of arterial hypertension and/or diabetes.
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Affiliation(s)
- Simona Frontoni
- Diabetes Center, University of Rome Tor Vergata, Viale Duilio Cambellotti, 11, I-00133 Rome, Italy.
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Abstract
An array of metabolic, hemodynamic, and renal abnormalities constitutes the cardiometabolic syndrome. A hallmark of this syndrome is visceral obesity and associated insulin resistance/hyperinsulinemia. The syndrome is also associated with essential hypertension, abnormalities in the circadian rhythm of blood pressure and heart rate, the diabetic dyslipidemic syndrome, hypercoagulability, hyperuricemia, increased cardiovascular inflammation, and microalbuminuria, all of which contribute to an increased risk of cardiovascular disease morbidity and mortality. This article reviews current knowledge about the interrelationship of the various factors that make up the cardiometabolic syndrome and its implications for individuals with and without diabetes mellitus.
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Affiliation(s)
- J R Sowers
- Division of Endocrinology, Diabetes, and Hypertension, State University of New York Downstate, Veterans Administration Medical Center, Brooklyn, New York, USA.
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Sambataro M, Maioli M, Tonolo G, Stehouwer C, van Hinsbergh V, Piarulli F, Nosadini R, Pacini G. Insulin sensitivity correlates with glycogen synthesis rate, but not with von Willebrand factor in type 2 diabetes. Eur J Intern Med 2002; 13:439. [PMID: 12384133 DOI: 10.1016/s0953-6205(02)00133-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND: Whether insulin resistance in type 2 (non-insulin-dependent) diabetes is due to compromised endothelial insulin migration or to impaired intracellular hormone action or both is unclear. Coexistent microalbuminuria reflects possible endothelial pathogenesis in insulin resistance. METHODS: Insulin sensitivity (S(I)) was calculated from an intravenous glucose tolerance test in 23 type 2 albuminuric (AER+), 11 type 2 normoalbuminuric (AER-), and 17 control subjects. Cultured fibroblasts from skin biopsies from these subjects were used to study intracellular insulin action on glycogen synthesis. Endothelial damage in type 2 diabetes was evaluated by plasma concentrations of von Willebrand factor (vWf). Results: S(I) and glycogen synthesis in fibroblasts were lower in AER+ and AER- than in controls. Glycogen synthesis in vitro was related to S(I) in vivo (r=0.55, P<0.001). vWf was 169+/-12% in AER+ and 140+/-5% in AER-, P<0.051. No correlation was observed between vWf and S(I) or plasma insulin clearance. CONCLUSIONS: This study demonstrates that reduced insulin-mediated glucose removal in type 2 diabetes is strictly associated with a decreased glycogen synthesis of cultured skin fibroblasts in vitro, but not with markers of endothelial damage in vivo.
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Affiliation(s)
- Maria Sambataro
- Department of General Medicine, City Hospital, Via dei Lotti, 40, 36061 Vicenza, Bassano del Grappa, Italy
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Hoehner CM, Greenlund KJ, Rith-Najarian S, Casper ML, McClellan WM. Association of the insulin resistance syndrome and microalbuminuria among nondiabetic native Americans. The Inter-Tribal Heart Project. J Am Soc Nephrol 2002; 13:1626-34. [PMID: 12039992 DOI: 10.1097/01.asn.0000015762.92814.85] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
This study investigated the association between microalbuminuria and the insulin resistance syndrome (IRS) among nondiabetic Native Americans. In a cross-sectional survey, age-stratified random samples were drawn from the Indian Health Service clinic lists for one Menominee and two Chippewa reservations. Information was collected from physical examinations, personal interviews, and blood and urine samples. The urinary albumin:creatinine ratio (ACR) was measured using a random spot urine sample. The IRS was defined by the number of composite traits: hypertension, impaired fasting glucose (IFG), high fasting insulin, low HDL cholesterol, and hypertriglyceridemia. Among the 934 eligible nondiabetic participants, 15.2% exhibited microalbuminuria. The prevalence of one, two, and three or more traits was 27.0, 16.6, and 7.4%, respectively. After controlling for age, sex, smoking, body mass index, education, and family histories of diabetes and kidney disease, the odds ratio (OR) for microalbuminuria was 1.8 (95% confidence interval [CI], 1.1 to 2.8) for one IRS trait, 1.8 (95% CI, 1.0 to 3.2) for two traits, and 2.3 (95% CI, 1.1 to 4.9) for three or more traits (versus no traits). The pattern of association appeared weaker among women compared with men. Of the individual IRS traits, only hypertension and IFG were associated with microalbuminuria. Among these nondiabetic Native Americans, the IRS was associated with a twofold increased prevalence of microalbuminuria. Health promotion efforts should focus on lowering the prevalence of hypertension, as well as glucose intolerance and obesity, in this population at high risk for renal and cardiovascular disease.
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Affiliation(s)
- Christine M Hoehner
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia 30329, USA
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Pedrinelli R, Dell'Omo G, Di Bello V, Pontremoli R, Mariani M. Microalbuminuria, an integrated marker of cardiovascular risk in essential hypertension. J Hum Hypertens 2002; 16:79-89. [PMID: 11850764 DOI: 10.1038/sj.jhh.1001316] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2001] [Revised: 07/13/2001] [Accepted: 10/13/2001] [Indexed: 01/01/2023]
Abstract
This paper reviews the existing epidemiological and clinical evidence about the relationships of non-diabetic microalbuminuria with cardiovascular risk factors such as elevated blood pressure (BP), systolic particularly, cardiac hypertrophy, adverse metabolic status, smoking habits, elevated angiotensin II levels, endothelial dysfunction, acute and perhaps subclinical inflammation. Because of that unique property of reflecting the influence of so many clinically relevant parameters, microalbuminuria may legitimately be defined as an integrated marker of cardiovascular risk, an unique profile among the several prognostic predictors available to stratify risk in hypertensive patients. Recent cohort studies also showed associations with cardiovascular morbidity and mortality independently from conventional atherogenic factors. This behaviour, whose understanding still needs further elucidation, suggests to measure albuminuria and to screen patients at a higher absolute risk in whom preventive treatment is expected to be more beneficial than in those with a lower absolute risk.
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Affiliation(s)
- R Pedrinelli
- Dipartimento Cardiotoracico, Università di Pisa, Italy.
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41
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Meigs JB, Jacques PF, Selhub J, Singer DE, Nathan DM, Rifai N, D'Agostino RB, Wilson PW. Fasting plasma homocysteine levels in the insulin resistance syndrome: the Framingham offspring study. Diabetes Care 2001; 24:1403-10. [PMID: 11473077 DOI: 10.2337/diacare.24.8.1403] [Citation(s) in RCA: 232] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Insulin resistance, associated metabolic abnormalities, and elevated homocysteine levels are risk factors for cardiovascular disease (CVD). We examined relationships between homocysteine levels and features of insulin resistance syndrome (IRS). RESEARCH DESIGN AND METHODS We measured clinical characteristics, plasma levels of fasting homocysteine, folate, B vitamins, creatinine, and fasting and 2-h insulin and glucose levels after a 75-g oral glucose tolerance test in 2,214 subjects without CVD at the fifth examination (1991-1995) of the Framingham Offspring Study. After excluding 203 subjects with diabetes, the remaining 2,011 subjects were categorized as having none, one, two, or all three of the phenotypes of IRS: impaired glucose tolerance, hypertension, and/or a central metabolic syndrome (two or more traits: obesity, dyslipidemia, or hyperinsulinemia). In addition, in 1,592 subjects attending the sixth examination (1995-1998), we measured the urine albumin/creatinine ratio (UACR). Age-, sex-, creatinine-, vitamin-, and UACR-adjusted mean homocysteine levels or proportions with homocysteine >14 micromol/l in each phenotypic category and differences between categories were assessed with regression models. RESULTS The mean age of the subjects was 54 years (range 28-82); 55% were women, 12.3% had hyperinsulinemia, and 15.9% had two or more of the IRS phenotypes. Adjusted mean homocysteine levels were higher comparing those with hyperinsulinemia (9.8 micromol/l) and those without (9.4 micromol/l, P = 0.04) and were higher among subjects with two or more IRS phenotypes (9.9 micromol/l) compared with those with 1 or no phenotype (9.3 micromol/l, P = 0.003). Mean UACR levels were also higher among subjects with two or more IRS phenotypes (7.2 mg/g) compared with those with 1 or no phenotype (5.5 mg/g, P = 0.007). CONCLUSIONS Hyperhomocysteinemia and abnormal urinary albumin excretion are both associated with hyperinsulinemia and may partially account for increased risk of CVD associated with insulin resistance. Because hyperhomocysteinemia and microalbuminuria also reflect endothelial injury, these observations also support the hypothesis that endothelial dysfunction is associated with expression of the IRS.
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Affiliation(s)
- J B Meigs
- General Medicine Division and Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA.
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Smith A. THE TREATMENT OF HYPERTENSION IN PATIENTS WITH DIABETES. Nurs Clin North Am 2001. [DOI: 10.1016/s0029-6465(22)02548-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hoffmann IS, Jimenez E, Cubeddu LX. Urinary albumin excretion in lean, overweight and obese glucose tolerant individuals: its relationship with dyslipidaemia, hyperinsulinaemia and blood pressure. J Hum Hypertens 2001; 15:407-12. [PMID: 11439316 DOI: 10.1038/sj.jhh.1001193] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2000] [Revised: 12/20/2000] [Accepted: 01/17/2001] [Indexed: 11/08/2022]
Abstract
The presence of microalbuminuria has become an important tool for therapeutic intervention. In this study we investigated whether the dysmetabolic syndrome of obesity was associated with or could occur in the absence of microalbuminuria. The study was conducted in 71 clinically healthy, glucose tolerant Hispanics (age: 43 +/- 1.4 years, body mass index (BMI): 28.7 +/- 0.6 kg/m(2), systolic blood pressure (SBP): 117 +/- 2 mm Hg, diastolic blood pressure (DBP): 77 +/- 1.3 mm Hg, urinary albumin excretion: 10.2 +/- 0.6 mg/24 h). Subjects were classified as lean (BMI <25), overweight (BMI >25 <30) and obese (BMI >30 kg/m(2)). Greater BMI was associated with higher body weight, waist-to-hip ratio (WHR), BP, fasting insulin, triglyceride, post glucose load insulin and glucose, and lower high-density lipoprotein (HDL) cholesterol levels. However, no significant differences in the urinary albumin excretion (mg/24 h) were found between lean (9.0 +/- 0.9; median: 9.1), overweight (11.3 +/- 1.2; median: 10.5) and obese (11.1 +/- 1.2; median: 9.7) subjects. In addition, microalbuminuria (urinary albumin excretion >30 mg/24 h) was not found in any of the study subjects. For all subjects combined, as well as for each of the groups separately, the urinary albumin excretion was unrelated to the BMI, WHR, body weight, triglyceride, cholesterol (total, LDL or HDL), fasting or post-load glucose and insulin plasma concentrations. Neither in females nor in males, abdominal fat accumulation was associated with an increase in the urinary albumin excretion. However, in the obese groups, urinary albumin excretion was strongly related to the level of SBP (r(2): 0.67; P < 0.0001) and DBP (r(2): 0.55; P < 0.0001). In summary, obesity, hyperinsulinaemia and dyslipidaemia per se are not determinants of increased albumin excretion. However, in the obese subjects, the BP, particularly the SBP, was a strong determinant of the level of albumin in the urine. Microalbuminuria may occur later in the course of the dysmetabolic syndrome, due to worsening of hypertension and development of hyperglycaemia.
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Affiliation(s)
- I S Hoffmann
- Center for the Detection and Treatment of Silent Risk Factors for Metabolic and Cardiovascular Disease, Division of Clinical Pharmacology, School of Pharmacy, Central University of Venezuela
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Kim YI, Kim CH, Choi CS, Chung YE, Lee MS, Lee SI, Park JY, Hong SK, Lee KU. Microalbuminuria is associated with the insulin resistance syndrome independent of hypertension and type 2 diabetes in the Korean population. Diabetes Res Clin Pract 2001; 52:145-52. [PMID: 11311969 DOI: 10.1016/s0168-8227(01)00228-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
To investigate whether microalbuminuria is associated with the insulin resistance syndrome independent of hypertension and type 2 diabetes, we studied the association between microalbuminuria and features of insulin resistance syndrome in Korean general population. We selected 1006 subjects by a random cluster sampling among residents aged >40 years living in the Chung-Up district, a rural area of South Korea. Subjects were stratified by oral glucose tolerance status [normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and diabetes mellitus], and by the presence or absence of hypertension. Urinary albumin excretion rate (UAER) was determined using timed overnight urine collection. Various cardiovascular risk factors including anthropometric indices, serum lipid, true insulin and proinsulin concentrations were also measured. The prevalence of microalbuminuria (UAER between 20 and 200 microg/min) increased as the glucose tolerance worsened (6.0% in NGT, 11.8% in IGT, and 21.8% in diabetes; chi(2) trend=25.9, P<0.001). Subjects with microalbuminuria had a higher body mass index (BMI), waist-to-hip circumference ratio (WHR), systolic and diastolic blood pressure (BP), fasting and 2 h plasma glucose, fasting plasma insulin and proinsulin levels, and lower HDL-cholesterol level than subjects without microalbuminuria. In multiple regression analysis, BMI, diastolic BP, 2 h plasma glucose, and fasting plasma insulin levels were found to be independent factors associated with UAER. Multiple logistic regression analysis showed that not only diabetes mellitus and hypertension, but also fasting hyperinsulinemia and waist-to-hip ratio were independent factors associated with the presence of microalbuminuria. When the normotensive, non-diabetic subjects were analyzed separately, fasting hyperinsulinemia and impaired glucose tolerance remained independent variables associated with the presence of microalbuminuria. These results show that microalbuminuria in the Korean general population is associated with hyperinsulinemia and central obesity, and suggest that microalbuminuria is a feature of the insulin resistance syndrome independent of hypertension or type 2 diabetes.
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Affiliation(s)
- Y I Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, South Korea
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Affiliation(s)
- S I McFarlane
- Division of Endocrinology, Diabetes, and Hypertension, State University of New York Downstate and Brooklyn Veterans Affairs Medical Center, Brooklyn, New York 11203, USA
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Bell DS. Should angiotensin-converting enzyme inhibitors be added to the water supply of patients with diabetes? Endocr Pract 2001; 7:59-61. [PMID: 11250771 DOI: 10.4158/ep.7.1.59] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- D S Bell
- University of Alabama at Birmingham School of Medicine, USA
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Festa A, D'Agostino R, Howard G, Mykkänen L, Tracy RP, Haffner SM. Inflammation and microalbuminuria in nondiabetic and type 2 diabetic subjects: The Insulin Resistance Atherosclerosis Study. Kidney Int 2000; 58:1703-10. [PMID: 11012904 DOI: 10.1046/j.1523-1755.2000.00331.x] [Citation(s) in RCA: 260] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Microalbuminuria is a risk factor for cardiovascular disease, but the underlying pathomechanisms are still poorly understood. A relationship between C-reactive protein (CRP), a sensitive marker of inflammation, and atherosclerotic disease has been reported recently. METHODS We hypothesized that microalbuminuria might be associated with chronic inflammation and investigated the relationship of urinary albumin excretion, as assessed from the albumin-to-creatinine ratio (ACR), in an untimed morning urine specimen, and two inflammatory markers (CRP and fibrinogen) in the large, triethnic population of the Insulin Resistance Atherosclerosis Study (IRAS). After exclusion of subjects with macroalbuminuria, 1481 subjects were studied. RESULTS Both inflammatory markers were related to urinary ACR (r = 0.17 for CRP and r = 0.14 for fibrinogen, both P = 0.0001), an association that remained significant after adjustment for demographic variables, diabetic status, smoking, and use of angiotensin-converting enzyme inhibitors (P < 0.01). Mean levels of CRP and fibrinogen were elevated in microalbuminuric (N = 262) versus normoalbuminuric (N = 1219) subjects (5.37 +/- 0.47 vs. 3.80 +/- 0.15 mg/L and 295.7 +/- 4. 0 vs. 278.2 +/- 1.6 mg/dL, both P < 0.0001). The associations were consistent among nondiabetic and type 2 diabetic subjects and among the three ethnic groups of the IRAS (non-Hispanic whites, blacks, Hispanics). In a logistic regression model, fibrinogen was independently associated with microalbuminuria (P = 0.047), along with hypertension, female gender, waist circumference, and fasting blood glucose, while CRP was not independently related to microalbuminuria in this model (P = 0.26). CONCLUSION We have shown an association of CRP and fibrinogen with urinary albumin excretion in the microalbuminuric range in type 2 diabetic and nondiabetic individuals. Chronic inflammation therefore emerges as a potential mediator between microalbuminuria and macrovascular disease.
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Affiliation(s)
- A Festa
- Department of Medicine, Division of Clinical Epidemiology, University of Texas Health Science Center at San Antonio, Texas 78228-3900, USA
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Pinto-Sietsma SJ, Janssen WMT, Hillege HL, Navis G, Zeeuw DDE, Jong PEDE. Urinary albumin excretion is associated with renal functional abnormalities in a nondiabetic population. J Am Soc Nephrol 2000; 11:1882-1888. [PMID: 11004219 DOI: 10.1681/asn.v11101882] [Citation(s) in RCA: 244] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Microalbuminuria (MA) is an important early sign of diabetic nephropathy. Hyperfiltration and impaired filtration in relation to albuminuria has been well investigated in diabetic subjects. This study tested the hypothesis that an increased urinary albumin excretion (UAE) is associated with renal functional abnormalities also in nondiabetic subjects. The relation between UAE and creatinine clearances (Ccr) in 7728 nondiabetic subjects was studied. Subjects were divided in four groups according to UAE (mg/24 h): 0 to 15 (control), 15 to 30 (high-normal albuminuria [HNA]), 30 to 300 (MA), >300 (macroalbuminuria). An elevated filtration and a diminished filtration were defined as a Ccr exceeding or below 2x the SD of the control group corrected for age and gender. Ccr followed a parabolic trend, with a higher Ccr in the HNA as compared with control and a lower Ccr in the MA and macroalbuminuria group as compared with HNA. With each increasing UAE level, male sex, age, body mass index, minimal waist circumference, systolic and diastolic BP, plasma glucose, and a positive family history for diabetes all followed a significant linear increasing trend (P < 0.001). After adjustment for age, gender, body mass index, plasma glucose, a positive family history for diabetes, systolic and diastolic BP, antihypertensive medication, and smoking in a multivariate analysis, HNA and MA were independently associated with an elevated filtration (RR 1.8 [95% confidence interval, 1.30 to 2.51] and 1.7 [1.17 to 2. 45]). Macroalbuminuria was independently associated with a diminished filtration (4.3 [range, 1.97 to 9.36]). In conclusion, an elevated UAE might be an important and early sign for progressive renal function loss in a nondiabetic population.
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Affiliation(s)
- Sara-Joan Pinto-Sietsma
- Department of Internal Medicine, Division of Nephrology, University Hospital Groningen, and Groningen University Institute for Drug Exploration (GUIDE), Groningen, The Netherlands
| | - Wilbert M T Janssen
- Department of Internal Medicine, Division of Nephrology, University Hospital Groningen, and Groningen University Institute for Drug Exploration (GUIDE), Groningen, The Netherlands
| | - Hans L Hillege
- Department of Clinical Pharmacology, University Hospital Groningen, and Groningen University Institute for Drug Exploration (GUIDE), Groningen, The Netherlands
| | - Gerjan Navis
- Department of Internal Medicine, Division of Nephrology, University Hospital Groningen, and Groningen University Institute for Drug Exploration (GUIDE), Groningen, The Netherlands
- Department of Clinical Pharmacology, University Hospital Groningen, and Groningen University Institute for Drug Exploration (GUIDE), Groningen, The Netherlands
| | - Dick DE Zeeuw
- Department of Internal Medicine, Division of Nephrology, University Hospital Groningen, and Groningen University Institute for Drug Exploration (GUIDE), Groningen, The Netherlands
- Department of Clinical Pharmacology, University Hospital Groningen, and Groningen University Institute for Drug Exploration (GUIDE), Groningen, The Netherlands
| | - Paul E DE Jong
- Department of Internal Medicine, Division of Nephrology, University Hospital Groningen, and Groningen University Institute for Drug Exploration (GUIDE), Groningen, The Netherlands
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Fagerudd JA, Pettersson-Fernholm KJ, Riska MK, Grönhagen-Riska C, Groop PH. Albuminuria in nondiabetic relatives of IDDM patients with and without diabetic nephropathy. Kidney Int 2000; 58:959-65. [PMID: 10972659 DOI: 10.1046/j.1523-1755.2000.00252.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND In non-insulin-dependent diabetes mellitus (NIDDM), there is a clustering of an elevated urinary albumin excretion rate (U-AER) in nondiabetic relatives of albuminuric patients. Whether this is also the case in insulin-dependent diabetes mellitus (IDDM) is unknown. METHODS Overnight U-AER was measured in 186 nondiabetic first-degree relatives of 80 IDDM patients with diabetic nephropathy (U-AER > 200 microg/min or 300 mg/24 hours; DN+) and in 52 relatives of 25 IDDM patients without nephropathy (U-AER < 20 microg/min; DN-). The two groups of relatives were comparable regarding gender distribution, age, obesity, blood pressure, prevalence of antihypertensive therapy, and smoking habits. RESULTS No difference was found in overnight U-AER between relatives of patients with DN+ and DN- [median (range), 3.4 (0.1 to 372) vs. 4.0 (0.2 to 62) microg/min, respectively, P = NS]. The proportion of relatives with a U-AER = 10 microg/min was 12% in DN+ compared with 8% in DN- (P = NS). Among relatives of DN+, those with antihypertensive treatment (AHT+) had higher U-AER compared with those without [AHT+ vs. AHT-, 5.0 (0.5 to 372) vs. 3.4 (0.1 to 26.5) microg/min, P < 0.01], a phenomenon that was not seen among relatives of DN-[AHT + vs. AHT-, 3.6 (2.1 to 24.3) vs. 4.0 (0. 2 to 61.5) microg/min, P = NS]. However, this analysis was impaired by the small number of relatives of DN- with hypertension (N = 7). CONCLUSIONS In IDDM, we found no clustering of elevated U-AER in nondiabetic relatives of patients with nephropathy. This is different from what has been reported in NIDDM, and suggests heterogeneity in the genesis of albuminuria in diabetes.
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Affiliation(s)
- J A Fagerudd
- Division of Nephrology, Department of Medicine, Helsinki University Central Hospital, Finland
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Abstract
The clustering of cardiovascular risk factors such as abdominal obesity, hypertension, dyslipidaemia and glucose intolerance in the same persons has been called the metabolic or insulin-resistance syndrome. In 1998 WHO proposed a unifying definition for the syndrome and chose to call it the metabolic syndrome rather than the insulin-resistance syndrome. Although insulin resistance has been considered as a common denominator for the different components of the syndrome, there is still debate as to whether it is pathogenically involved in all of the different components of the syndrome. Clustering of the syndrome in families suggests a genetic component. It is plausible that so-called thrifty genes, which have ensured optimal storage of energy during periods of fasting, could contribute to the phenotype of the metabolic syndrome. Common variants in a number of candidate genes influencing fat and glucose metabolism can probably, together with environmental triggers, increase susceptibility to the syndrome. Among these, the genes for beta 3-adrenergic receptor, hormone-sensitive lipase, lipoprotein lipase, IRS-1, PC-1, skeletal muscle glycogen synthase, etc. appear to increase the risk of the metabolic syndrome. In addition, novel genes may be identified by genome-wide searches.
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Affiliation(s)
- L Groop
- Department of Endocrinology, University Hospital MAS, Lund University, Malmö, Sweden.
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