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Vanholder R, Van Laecke S, Glorieux G, Verbeke F, Castillo-Rodriguez E, Ortiz A. Deleting Death and Dialysis: Conservative Care of Cardio-Vascular Risk and Kidney Function Loss in Chronic Kidney Disease (CKD). Toxins (Basel) 2018; 10:E237. [PMID: 29895722 PMCID: PMC6024824 DOI: 10.3390/toxins10060237] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/11/2018] [Indexed: 02/07/2023] Open
Abstract
The uremic syndrome, which is the clinical expression of chronic kidney disease (CKD), is a complex amalgam of accelerated aging and organ dysfunctions, whereby cardio-vascular disease plays a capital role. In this narrative review, we offer a summary of the current conservative (medical) treatment options for cardio-vascular and overall morbidity and mortality risk in CKD. Since the progression of CKD is also associated with a higher cardio-vascular risk, we summarize the interventions that may prevent the progression of CKD as well. We pay attention to established therapies, as well as to novel promising options. Approaches that have been considered are not limited to pharmacological approaches but take into account lifestyle measures and diet as well. We took as many randomized controlled hard endpoint outcome trials as possible into account, although observational studies and post hoc analyses were included where appropriate. We also considered health economic aspects. Based on this information, we constructed comprehensive tables summarizing the available therapeutic options and the number and kind of studies (controlled or not, contradictory outcomes or not) with regard to each approach. Our review underscores the scarcity of well-designed large controlled trials in CKD. Nevertheless, based on the controlled and observational data, a therapeutic algorithm can be developed for this complex and multifactorial condition. It is likely that interventions should be aimed at targeting several modifiable factors simultaneously.
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Affiliation(s)
- Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, 9000 Ghent, Belgium.
| | - Steven Van Laecke
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, 9000 Ghent, Belgium.
| | - Griet Glorieux
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, 9000 Ghent, Belgium.
| | - Francis Verbeke
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, 9000 Ghent, Belgium.
| | | | - Alberto Ortiz
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, 28040 Madrid, Spain.
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202
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Suppression of Elp2 prevents renal fibrosis and inflammation induced by unilateral ureter obstruction (UUO) via inactivating Stat3-regulated TGF-β1 and NF-κB pathways. Biochem Biophys Res Commun 2018; 501:400-407. [DOI: 10.1016/j.bbrc.2018.04.227] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 04/29/2018] [Indexed: 01/02/2023]
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203
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Nurwanti E, Uddin M, Chang JS, Hadi H, Syed-Abdul S, Su ECY, Nursetyo AA, Masud JHB, Bai CH. Roles of Sedentary Behaviors and Unhealthy Foods in Increasing the Obesity Risk in Adult Men and Women: A Cross-Sectional National Study. Nutrients 2018; 10:nu10060704. [PMID: 29857537 PMCID: PMC6024814 DOI: 10.3390/nu10060704] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/28/2018] [Accepted: 05/30/2018] [Indexed: 11/16/2022] Open
Abstract
Sedentary behaviors and dietary intake are independently associated with obesity risk. In the literature, only a few studies have investigated gender differences for such associations. The present study aims to assess the association of sedentary behaviors and unhealthy foods intake with obesity in men and women in a comparative manner. The analysis presented in this study was based on the data from a population-based, cross-sectional, nationally representative survey (Indonesian Basic Health Research 2013/RISKESDAS 2013). In total, 222,650 men and 248,590 women aged 19–55 years were enrolled. A validated questionnaire, physical activity card, and food card were used for the assessments. The results showed that the prevalence of obesity (body mass index of ≥27.5 kg/m2) was higher in women (18.71%) than in men (8.67%). The mean body mass index in women tended to be higher than in men. After adjusting for age and education, the gender effect on obesity persisted in women and was more significant than in men. There was also a positive and significant effect on obesity of sedentary behaviors and unhealthy foods intake. Moreover, fatty and fried foods displayed a positive multiplicative interaction, increasing obesity risk in women more than in men and indicating a possible dietary risk in in women in relation to obesity. The study suggests that the implementation of educational programs on nutrition and physical activity is particularly important for promoting a healthy body weight among Indonesian women.
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Affiliation(s)
- Esti Nurwanti
- International PhD Program in Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
- Department of Nutrition, Faculty of Health Science, Universitas Alma Ata, Yogyakarta 55183, Indonesia.
| | - Mohy Uddin
- King Abdullah International Medical Research Center, King Saud bin Abdul Aziz University for Health Sciences, Executive Office, King Abdul Aziz Medical City, Ministry of National Guard Health Affairs, Riyadh 11426, Kingdom of Saudi Arabia.
| | - Jung-Su Chang
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei 11031, Taiwan.
- Graduate Institute of Metabolism and Obesity Sciences, College of Nutrition, Taipei Medical University, Taipei 11031, Taiwan.
| | - Hamam Hadi
- Department of Nutrition, Faculty of Health Science, Universitas Alma Ata, Yogyakarta 55183, Indonesia.
| | - Shabbir Syed-Abdul
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei 10675, Taiwan.
| | - Emily Chia-Yu Su
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei 10675, Taiwan.
| | - Aldilas Achmad Nursetyo
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei 10675, Taiwan.
| | - Jakir Hossain Bhuiyan Masud
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei 10675, Taiwan.
| | - Chyi-Huey Bai
- International PhD Program in Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
- Department of Public Health, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
- School of Public Health, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan.
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204
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Denic A, Mathew J, Nagineni VV, Thompson RH, Leibovich BC, Lerman LO, Lieske JC, Alexander MP, Augustine JJ, Kremers WK, Rule AD. Clinical and Pathology Findings Associate Consistently with Larger Glomerular Volume. J Am Soc Nephrol 2018; 29:1960-1969. [PMID: 29789431 DOI: 10.1681/asn.2017121305] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 04/17/2018] [Indexed: 11/03/2022] Open
Abstract
Background Glomerular volume increases when demand exceeds nephron supply, which may lead to glomerulosclerosis. It is unclear if determinants of glomerular volume are consistent between populations that differ by severity of comorbidities.Methods We studied kidney biopsy specimens from living kidney donors (n=2453) and patients who underwent radical nephrectomy for a renal tumor (n=780). We scanned specimen sections into high-resolution digital images, manually traced glomerular profiles, and calculated mean glomerular volumes using the Weibel-Gomez stereologic formula (separately for nonsclerosed glomeruli and globally sclerosed glomeruli). We then assessed the relationship of glomerular volume with age, clinical characteristics, and nephrosclerosis on biopsy specimen.Results Compared with kidney donors, patients with tumors were older and more frequently men, obese, diabetic, or hypertensive, had more glomerulosclerosis and interstitial fibrosis on biopsy specimen, and had 12% larger nonsclerosed glomeruli (P<0.001). In both populations, male sex, taller height, obesity, hypertension, and proteinuria associated with larger nonsclerosed glomeruli to a similar extent. In patients with tumors, diabetes, glomerulosclerosis >25%, and interstitial fibrosis >25% also associated with larger nonsclerosed glomeruli. Independent clinical predictors of larger nonsclerotic glomeruli were family history of ESRD, male sex, taller height, obesity, diabetes, and proteinuria. After adjustment for these characteristics, nonsclerotic glomerular volume did not differ between populations and was stable up to age 75 years, after which it decreased with age. Many of these findings were also evident with globally sclerotic glomerular volume.Conclusions Characteristics associated with glomerular volume are consistent between patient populations with low and high levels of comorbidity.
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Affiliation(s)
| | | | | | | | | | | | - John C Lieske
- Divisions of Nephrology and Hypertension.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; and
| | - Mariam P Alexander
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; and
| | | | | | - Andrew D Rule
- Divisions of Nephrology and Hypertension, .,Epidemiology, and
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205
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Schragenheim J, Bellner L, Cao J, Singh SP, Bamshad D, McClung JA, Maayan O, Meissner A, Grant I, Stier CT, Abraham NG. EET enhances renal function in obese mice resulting in restoration of HO-1-Mfn1/2 signaling, and decrease in hypertension through inhibition of sodium chloride co-transporter. Prostaglandins Other Lipid Mediat 2018; 137:30-39. [PMID: 29787809 DOI: 10.1016/j.prostaglandins.2018.05.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 04/12/2018] [Accepted: 05/14/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND We have previously reported that epoxyeicosatrienoic acid (EET) has multiple beneficial effects on renal and adipose tissue function, in addition to its vasodilatory action; it increases insulin sensitivity and inhibits inflammation. In an examination of the signaling mechanisms by which EET reduces renal and peri-renal fat function, we hypothesized that EET ameliorates obesity-induced renal dysfunction by improving sodium excretion, reducing the sodium-chloride cotransporter NCC, lowering blood pressure, and enhancing mitochondrial and thermogenic gene levels in PGC-1α dependent mice. METHODS EET-agonist treatment normalized glucose metabolism, renal ENaC and NCC protein expression, urinary sodium excretion and blood pressure in obese (db/db) mice. A marked improvement in mitochondrial integrity, thermogenic genes, and PGC-1α-HO-1-adiponectin signaling occurred. Knockout of PGC-1α in EET-treated mice resulted in a reversal of these beneficial effects including a decrease in sodium excretion, elevation of blood pressure and an increase in the pro-inflammatory adipokine nephroblastoma overexpressed gene (NOV). In the elucidation of the effects of EET on peri-renal adipose tissue, EET increased adiponectin, mitochondrial integrity, thermogenic genes and decreased NOV, i.e. "Browning' peri-renal adipose phenotype that occurs under high fat diets. Taken together, these data demonstrate a critical role of an EET agonist in the restoration of healthy adipose tissue with reduced release of inflammatory molecules, such as AngII and NOV, thereby preventing their detrimental impact on sodium absorption and NCC levels and the development of obesity-induced renal dysfunction.
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Affiliation(s)
- Joseph Schragenheim
- Department of Pharmacology, New York Medical College, Valhalla, NY, 10595, United States
| | - Lars Bellner
- Department of Pharmacology, New York Medical College, Valhalla, NY, 10595, United States
| | - Jian Cao
- Chinese PLA General Hospital, Beijing, 100853, China
| | - Shailendra P Singh
- Department of Pharmacology, New York Medical College, Valhalla, NY, 10595, United States
| | - David Bamshad
- Department of Medicine, New York Medical College, Valhalla, NY, 10595, United States
| | - John A McClung
- Department of Medicine, New York Medical College, Valhalla, NY, 10595, United States
| | - Omri Maayan
- Department of Pharmacology, New York Medical College, Valhalla, NY, 10595, United States
| | - Aliza Meissner
- Department of Medicine, New York Medical College, Valhalla, NY, 10595, United States
| | - Ilana Grant
- Department of Medicine, New York Medical College, Valhalla, NY, 10595, United States
| | - Charles T Stier
- Department of Pharmacology, New York Medical College, Valhalla, NY, 10595, United States.
| | - Nader G Abraham
- Department of Pharmacology, New York Medical College, Valhalla, NY, 10595, United States; Department of Medicine, New York Medical College, Valhalla, NY, 10595, United States; Department of Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, 25701, United States.
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206
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Pastor S, Coll E, Rodríguez-Ribera L, Stoyanova E, Corredor ZF, Marcos R. Influence of Carnicor, Venofer, and Sevelamer on the levels of genotoxic damage in end-stage renal disease patients. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 2018; 59:302-311. [PMID: 29359355 DOI: 10.1002/em.22170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 12/01/2017] [Accepted: 12/23/2017] [Indexed: 06/07/2023]
Abstract
End-stage renal disease (ESRD) patients present high levels of phosphorus and calcium products in serum, which contribute to the development of vascular calcification and cardiovascular disease, and to low iron stores and carnitine deficiency. For these reasons, ESRD patients are generally supplemented with different medicines. Some of the most common treatments include the use of Carnicor, Venofer, and Sevelamer drugs. Carnicor is used as a source of L-carnitine, acting as antioxidant and neuroprotector. Venofer is used to reduce the deficit of iron. Sevelamer is used to treat hyperphosphatemia. To determine the potential harmful genotoxic effects of these drugs, a group of 214 patients included in a hemodialysis program with different intakes of Carnicor, Venofer, and Sevelamer were evaluated. The levels of basal and oxidative DNA damage, as well as chromosomal damage, were measured in all individuals using the comet and the micronucleus assays, respectively. Our results indicate that Carnicor administration was associated with low but significant increases in the frequency of basal DNA damage and micronuclei. Environ. Mol. Mutagen. 59:302-311, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Susana Pastor
- Grup de Mutagènesi, Departament de Genètica i de Microbiologia, Edifici Cn, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, 08193, Spain
- CIBER Epidemiología y Salud Pública, ISCIII, Spain
| | | | - Lara Rodríguez-Ribera
- Grup de Mutagènesi, Departament de Genètica i de Microbiologia, Edifici Cn, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, 08193, Spain
| | - Elitsa Stoyanova
- Grup de Mutagènesi, Departament de Genètica i de Microbiologia, Edifici Cn, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, 08193, Spain
| | - Zuray F Corredor
- Grup de Mutagènesi, Departament de Genètica i de Microbiologia, Edifici Cn, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, 08193, Spain
| | - Ricard Marcos
- Grup de Mutagènesi, Departament de Genètica i de Microbiologia, Edifici Cn, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, 08193, Spain
- CIBER Epidemiología y Salud Pública, ISCIII, Spain
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207
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Bae JY, Woo J, Kang S, Shin KO. Effects of detraining and retraining on muscle energy-sensing network and meteorin-like levels in obese mice. Lipids Health Dis 2018; 17:97. [PMID: 29703203 PMCID: PMC5924483 DOI: 10.1186/s12944-018-0751-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 04/19/2018] [Indexed: 11/16/2022] Open
Abstract
Background Increased intramuscular peroxisome proliferator-activated receptor gamma coactivator-1α (PGC-1α) with exercise directly or indirectly affects other tissues, but the effector pathway of PGC-1α has not been clearly elucidated. The purpose of this study was to investigate the effect of exercise and/or dietary change on the protein levels of the soleus muscle energy-sensing network and meteorin-like (Metrnl), and additionally to analyze the detraining and retraining effects in high-fat diet (HFD)-induced obese mice. Methods One hundred male C57BL/6 mice were divided into normal-diet + sedentary (CO, n = 20) and HFD + sedentary (HF, n = 80) groups, and obesity was induced in the HF group through consumption of a 45% HFD for 6 weeks. The HF group was subdivided into HF only (n = 20), HF + training (HFT, n = 20), dietary change + sedentary (HFND, n = 20), and HFND + training (HFNDT, n = 20) groups, and the mice in the training groups underwent a treadmill training for 8 weeks, 5 times per week, 40 min per day. The HFT and HFNDT groups underwent 8-week training, 8-week detraining, and 4-week retraining. Results An 8-week training was effective in increasing the protein levels of soleus muscle AMP-activated protein kinase (AMPK), PGC-1α, and plasma Metrnl in the obese mice (P < 0.05). Moreover, exercise in obesity reduced body weight (P < 0.05), and exercise with dietary conversion was effective in reducing body weight (P < 0.05) and fat mass (P < 0.05) after 8-week training. 8-week detraining restored the increased protein level to the pre-exercise state, but, the previous exercise effect in body weight and fat mass (P < 0.05) of the HFNDT group remained until the end of 4-week detraining. 4-week retraining was effective in increasing the protein levels of soleus muscle AMPK, PGC-1α, blood Metrnl (P < 0.05), and reducing in body weight (P < 0.05) and fat mass (P < 0.05), when retraining with dietary change. Conclusions The results of this study suggest that regular exercise is indispensable to reduce body weight and fat mass through upregulation of the muscle energy-sensing network and Metrnl protein levels, and retraining with dietary change is necessary to obtain the retraining effects more quickly. Electronic supplementary material The online version of this article (10.1186/s12944-018-0751-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ju Yong Bae
- Laboratory of Exercise Biochemistry, Department of Physical Education, College of Arts and Physical Education, Dong-A University, 37 Nakdong-daero 550 beon-gil, Hadan-dong, Saha-gu, Busan, 604-714, Republic of Korea
| | - Jinhee Woo
- Laboratory of Exercise Biochemistry, Department of Physical Education, College of Arts and Physical Education, Dong-A University, 37 Nakdong-daero 550 beon-gil, Hadan-dong, Saha-gu, Busan, 604-714, Republic of Korea
| | - Sunghwun Kang
- Laboratory of Exercise Physiology, Division of Sport Science, Kangwon National University, 1 Kangwondaehak-gil, Chuncheon-si, Gangwon-do, 24341, Republic of Korea
| | - Ki Ok Shin
- Laboratory of Exercise Biochemistry, Department of Physical Education, College of Arts and Physical Education, Dong-A University, 37 Nakdong-daero 550 beon-gil, Hadan-dong, Saha-gu, Busan, 604-714, Republic of Korea.
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208
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Larkin BP, Glastras SJ, Chen H, Pollock CA, Saad S. DNA methylation and the potential role of demethylating agents in prevention of progressive chronic kidney disease. FASEB J 2018; 32:5215-5226. [PMID: 29688808 DOI: 10.1096/fj.201800205r] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Chronic kidney disease (CKD) is a global epidemic, and its major risk factors include obesity and type 2 diabetes. Obesity not only promotes metabolic dysregulation and the development of diabetic kidney disease but also may independently lead to CKD by a variety of mechanisms, including endocrine and metabolic dysfunction, inflammation, oxidative stress, altered renal hemodynamics, and lipotoxicity. Deleterious renal effects of obesity can also be transmitted from one generation to the next, and it is increasingly recognized that offspring of obese mothers are predisposed to CKD. Epigenetic modifications are changes that regulate gene expression without altering the DNA sequence. Of these, DNA methylation is the most studied. Epigenetic imprints, particularly DNA methylation, are laid down during critical periods of fetal development, and they may provide a mechanism by which maternal-fetal transmission of chronic disease occurs. Our current review explores the evidence for the role of DNA methylation in the development of CKD, diabetic kidney disease, diabetes, and obesity. DNA methylation has been implicated in renal fibrosis-the final pathophysiologic pathway in the development of end-stage kidney disease-which supports the notion that demethylating agents may play a potential therapeutic role in preventing development and progression of CKD.-Larkin, B. P., Glastras, S. J., Chen, H., Pollock, C. A., Saad, S. DNA methylation and the potential role of demethylating agents in prevention of progressive chronic kidney disease.
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Affiliation(s)
- Benjamin P Larkin
- Renal Research Laboratory, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Sarah J Glastras
- Renal Research Laboratory, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.,Department of Diabetes, Endocrinology, and Metabolism, Royal North Shore Hospital, Sydney, New South Wales, Australia; and
| | - Hui Chen
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Carol A Pollock
- Renal Research Laboratory, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Sonia Saad
- Renal Research Laboratory, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.,School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, New South Wales, Australia
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209
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Adeosun SO, Gordon DM, Weeks MF, Moore KH, Hall JE, Hinds TD, Stec DE. Loss of biliverdin reductase-A promotes lipid accumulation and lipotoxicity in mouse proximal tubule cells. Am J Physiol Renal Physiol 2018; 315:F323-F331. [PMID: 29631357 DOI: 10.1152/ajprenal.00495.2017] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Obesity and increased lipid availability have been implicated in the development and progression of chronic kidney disease. One of the major sites of renal lipid accumulation is in the proximal tubule cells of the kidney, suggesting that these cells may be susceptible to lipotoxicity. We previously demonstrated that loss of hepatic biliverdin reductase A (BVRA) causes fat accumulation in livers of mice on a high-fat diet. To determine the role of BVRA in mouse proximal tubule cells, we generated a CRISPR targeting BVRA for a knockout in mouse proximal tubule cells (BVRA KO). The BVRA KO cells had significantly less metabolic potential and mitochondrial respiration, which was exacerbated by treatment with palmitic acid, a saturated fatty acid. The BVRA KO cells also showed increased intracellular triglycerides which were associated with higher fatty acid uptake gene cluster of differentiation 36 as well as increased de novo lipogenesis as measured by higher neutral lipids. Additionally, neutrophil gelatinase-associated lipocalin 1 expression, annexin-V FITC staining, and lactate dehydrogenase assays all demonstrated that BVRA KO cells are more sensitive to palmitic acid-induced lipotoxicity than wild-type cells. Phosphorylation of BAD which plays a role in cell survival pathways, was significantly reduced in palmitic acid-treated BVRA KO cells. These data demonstrate the protective role of BVRA in proximal tubule cells against saturated fatty acid-induced lipotoxicity and suggest that activating BVRA could provide a benefit in protecting from obesity-induced kidney injury.
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Affiliation(s)
- Samuel O Adeosun
- Department of Physiology & Biophysics, Mississippi Center for Obesity Research, University of Mississippi Medical Center , Jackson, Mississippi
| | - Darren M Gordon
- Department of Physiology and Pharmacology, University of Toledo College of Medicine , Toledo, Ohio
| | - Mary Frances Weeks
- Department of Physiology & Biophysics, Mississippi Center for Obesity Research, University of Mississippi Medical Center , Jackson, Mississippi
| | - Kyle H Moore
- Department of Physiology & Biophysics, Mississippi Center for Obesity Research, University of Mississippi Medical Center , Jackson, Mississippi
| | - John E Hall
- Department of Physiology & Biophysics, Mississippi Center for Obesity Research, University of Mississippi Medical Center , Jackson, Mississippi
| | - Terry D Hinds
- Department of Physiology and Pharmacology, University of Toledo College of Medicine , Toledo, Ohio
| | - David E Stec
- Department of Physiology & Biophysics, Mississippi Center for Obesity Research, University of Mississippi Medical Center , Jackson, Mississippi
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210
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Carnagarin R, Matthews V, Gregory C, Schlaich MP. Pharmacotherapeutic strategies for treating hypertension in patients with obesity. Expert Opin Pharmacother 2018; 19:643-651. [DOI: 10.1080/14656566.2018.1458092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Revathy Carnagarin
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - Vance Matthews
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - Cynthia Gregory
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - Markus P. Schlaich
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Australia
- Department of Nephrology, Royal Perth Hospital, Perth, Australia
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211
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Makhija P, Wilson C, Garimella S. Utility of Doppler sonography for renal artery stenosis screening in obese children with hypertension. J Clin Hypertens (Greenwich) 2018; 20:807-813. [PMID: 29575497 DOI: 10.1111/jch.13241] [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: 09/01/2017] [Revised: 01/02/2018] [Accepted: 01/12/2018] [Indexed: 11/28/2022]
Abstract
Pediatric hypertension guidelines recommend Doppler renal ultrasonography as a screening study for the evaluation of possible renal artery stenosis (RAS) in normal-weight children ≥ 8 years of age who are suspected of having RAS and who will cooperate with the procedure. Obese children are excluded because of technical and vascular concerns. There are no data on RI in obese children. This is a retrospective review of children aged 1.5-18 who received Doppler imaging studies over a 10-year period. A total of 174 patients were studied. There was no significant difference between the RI values based on BMI. Of the 174 individuals in the study 22 obtained follow-up CT/MRA after abnormal Doppler ultrasounds. On advanced imaging 3 were confirmed to have RAS. Obesity does not seem to influence RI.RI alone should not be used as a screening tool for RAS. An approach toward diagnosis is suggested based on BMI, renin levels, and ultrasound.
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Affiliation(s)
- Pooja Makhija
- Department of Pediatrics, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Christopher Wilson
- Department of Mathematical Sciences, Clemson University College of Engineering and Sciences, Clemson, SC, USA
| | - Sudha Garimella
- University of South Carolina School of Medicine, Greenville Health System, Greenville, SC, USA
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Jaikumkao K, Pongchaidecha A, Chueakula N, Thongnak L, Wanchai K, Chatsudthipong V, Chattipakorn N, Lungkaphin A. Renal outcomes with sodium glucose cotransporter 2 (SGLT2) inhibitor, dapagliflozin, in obese insulin-resistant model. Biochim Biophys Acta Mol Basis Dis 2018; 1864:2021-2033. [PMID: 29572114 DOI: 10.1016/j.bbadis.2018.03.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 03/05/2018] [Accepted: 03/19/2018] [Indexed: 02/08/2023]
Abstract
A growing body of evidence indicates that obesity and insulin resistance contribute to the progression of renal disease. This study was performed to determine the effects of dapagliflozin, a novel sodium glucose cotransporter 2 (SGLT2) inhibitor, on renal and renal organic anion transporter 3 (Oat3) functions in high-fat diet fed rats, a model of obese insulin-resistance. Twenty-four male Wistar rats were divided into two groups, and received either a normal diet (ND) (n = 6) or a high-fat diet (HFD) (n = 18) for 16 weeks. At week 17, the HFD-fed rats were subdivided into three subgroups (n = 6/subgroup) and received either a vehicle (HFD), dapagliflozin (HFDAP; 1.0 mg/kg/day) or metformin (HFMET; 30 mg/kg/day), by oral gavage for four weeks. Metabolic parameters, renal function, renal Oat3 function, renal oxidative stress, and renal morphology were determined. The results showed that obese insulin-resistant rats induced by HFD feeding had impaired renal function and renal Oat3 function together with increased renal oxidative injury. Dapagliflozin or metformin treatment decreased insulin resistance, hypercholesterolemia, creatinine clearance and renal oxidative stress leading to improved renal function. However, dapagliflozin treatment decreased blood pressure, serum creatinine, urinary microalbumin and increased glucose excretions, and showed a greater ability to ameliorate impaired renal insulin signaling and glomerular barrier damage than metformin. These data suggest that dapagliflozin had greater efficacy than metformin for attenuating renal dysfunction and improving renal Oat3 function, at least in part by reducing renal oxidative stress and modulating renal insulin signaling pathways, and hence ameliorating renal injury.
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Affiliation(s)
- Krit Jaikumkao
- Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Anchalee Pongchaidecha
- Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nuttawud Chueakula
- Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Laongdao Thongnak
- Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Keerati Wanchai
- Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; School of Medicine, Mae Fah Luang University, Chiang Rai, Thailand
| | | | - Nipon Chattipakorn
- Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Anusorn Lungkaphin
- Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Center for Research and Development of Natural Products for Health, Chiang Mai University, Thailand.
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213
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Botchlett R, Wu C. Diet Composition for the Management of Obesity and Obesity-related Disorders. JOURNAL OF DIABETES MELLITUS AND METABOLIC SYNDROME 2018; 3:10-25. [PMID: 30972384 PMCID: PMC6452864 DOI: 10.28967/jdmms.2018.01.18002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Healthy nutrition is essential for prevention of disease and for maintenance or promotion of health; although healthy nutrition remains to be precisely defined. Over the past several decades, various types of nutrients have been functionally validated and considered as critical components of healthy nutrition, which commonly include fiber-enriched carbohydrates, mono- or poly-unsaturated fatty acids, essential amino acids, and certain micronutrients. When managing obesity and obesity-associated metabolic diseases, much attention has been paid to the content of nutrients that is considered as healthy nutrition. Accumulating evidence also suggests that nutrient composition could be more important than the content of individual nutrients in the context of reducing body weight and obesity-associated risk for metabolic diseases. Consistently, it would be more important to focus on diet with differences in nutrient ratios rather than individual type(s) of nutrients in terms of managing obesity and metabolic diseases. In this review, recent advances in dietary management of obesity and obesity-related metabolic diseases have been discussed. This review also has highlighted several specific diet compositions and their differences in managing hypertension, type 2 diabetes, and non-alcoholic fatty liver disease.
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Affiliation(s)
- Rachel Botchlett
- Pinnacle Clinical Research, Live Oak, TX, 78233, USA
- For Correspondence Rachel Botchlett, Pinnacle Clinical Research, Live Oak, TX, 78233, USA, , Fax: 210 572 5766
| | - Chaodong Wu
- Department of Nutrition and Food Science, Texas A&M University, College Station, TX, 77843, USA
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214
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Neves JS, Guerreiro V, Carvalho D, Serrão R, Sarmento A, Freitas P. Metabolically Healthy or Metabolically Unhealthy Obese HIV-Infected Patients: Mostly a Matter of Age? Front Endocrinol (Lausanne) 2018; 9:681. [PMID: 30505292 PMCID: PMC6250744 DOI: 10.3389/fendo.2018.00681] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 10/30/2018] [Indexed: 12/27/2022] Open
Abstract
Background: Life expectancy of HIV-infected patients has increased with antiretroviral treatment (ART). Chronic diseases associated with aging, including metabolic and cardiovascular diseases are becoming more prevalent in this population. We aimed to evaluate the association of obesity and aging with cardiometabolic comorbidities and metabolic health status among patients with HIV infection. Methods: We evaluated 580 HIV-1 infected patients (71.7% male, mean age of 47.7 ± 11.5 years). We analyzed the association of age and obesity (defined by and by central obesity) with gender, duration of HIV infection, and ART, anthropometric parameters, cardiometabolic comorbidities, Framingham risk score (FRS), blood pressure, lipid profile, uric acid, liver biochemical tests, and glycemic profile. Furthermore, we analyzed the above-mentioned associations according to the category and central obesity into the metabolically healthy (MH) and unhealthy (MUH) categories. To evaluate the association of anthropometric parameters with cardiometabolic comorbidities, we performed unadjusted and adjusted logistic regression models. Results: The prevalence of excessive weight and cardiometabolic comorbidities increased with age. Patients with normal weight were younger and there was a higher proportion of female patients in the obesity group. The prevalence of hypertension and metabolic syndrome were higher among patients who were overweight or with obesity. The FRS was higher among patients with obesity. The proportion of MUH patients was higher among patients with excessive weight and central obesity. MUH patients had more cardiometabolic comorbidities and a higher FRS. In the normal weight group, MUH patients were older, and in the obesity group they were more likely to be male. The anthropometric parameter most associated with metabolic syndrome was waist circumference and that most associated with hypertension was waist-to-height ratio. The anthropometric parameter most associated with diabetes and FRS was waist-to-hip ratio. Conclusion: Patients with HIV present a high prevalence of obesity and related comorbidities. Ageing significantly contributes to metabolic dysfunction in this population. The proportion of MUH patients is higher among groups with excessive weight and central obesity, with those patients presenting a higher cardiovascular risk. Our results highlight the importance of evaluating and addressing obesity in patients with HIV, as well as metabolic comorbidities and cardiovascular risk.
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Affiliation(s)
- João Sérgio Neves
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
- Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- *Correspondence: João Sérgio Neves
| | - Vanessa Guerreiro
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
- Faculdade de Medicina, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Rosário Serrão
- Faculdade de Medicina, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
| | - António Sarmento
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
| | - Paula Freitas
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
- Faculdade de Medicina, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
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215
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Abstract
Obesity is a complex disease with many causal factors, associated with multiple comorbidities that contribute to significant morbidity and mortality. It is a highly prevalent disease that poses an enormous health and economic burden to society. This article reviews the mechanisms of obesity and its related comorbidities.
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Affiliation(s)
- Jagriti Upadhyay
- Section of Endocrinology, Diabetes and Metabolism, Boston VA Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA; Division of Endocrinology, Boston Medical Center, Boston University, 88 East Newton Street, Boston, MA 02118; Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
| | - Olivia Farr
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Nikolaos Perakakis
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Wael Ghaly
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Christos Mantzoros
- Section of Endocrinology, Diabetes and Metabolism, Boston VA Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA; Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
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216
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Elshaer SS, Anwar HM. Relevance of megalin receptor injury with nuclear factor-kappa B upregulation in acute kidney injury induced in rats. J Biochem Mol Toxicol 2017; 32. [PMID: 29286200 DOI: 10.1002/jbt.22014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 11/04/2017] [Accepted: 11/20/2017] [Indexed: 12/22/2022]
Abstract
Proximal tubule protein take-up is interceded by 2 receptors, megalin and cubilin. These receptors rescue an assortment of filtered ligands including fundamental vitamins and hormones. The objective of this study was to investigate the potential relation of megalin receptor injury with nuclear factor-kappa B (NF-κB) upregulation in acute kidney injury rat model. Twenty four rats were allocated into two groups: control group received saline, while the second group was intoxicated with cadmium chloride (2.4 mg Cd/kg/day i.p) for 30 days. Blood urea nitrogen, serum creatinine, tissue oxidant-antioxidant parameters (malondialdehyde [MDA] and reduced glutathione [GSH]) and expression levels for NF-κB, toll like receptor-2 (TLR2), toll like receptor-4 (TLR4), and megalin receptor were estimated. Noticeable downregulation of megalin receptor versus upregulation of NF-κB, TLR2, and TLR4 were observed in AKI rat model together with significant elevation in MDA as well as significant reduction in GSH. The study concluded that the oxidative stress in kidney tissue leads to megalin receptor damage, which indeed motivates upregulation of NF-κB through TLRs 2 and 4 pathways.
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Affiliation(s)
- Shereen Saeid Elshaer
- Department of Biochemistry, Pharmacy Faculty for Girls, Al-Azhar University, Cairo, Egypt
| | - Hend Mohamed Anwar
- Department of Biochemistry, National Organization for Drug Control and Research (NODCAR), Giza, Egypt
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217
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Zhu Q, Scherer PE. Immunologic and endocrine functions of adipose tissue: implications for kidney disease. Nat Rev Nephrol 2017; 14:105-120. [PMID: 29199276 DOI: 10.1038/nrneph.2017.157] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Excess adiposity can induce adverse sequelae in multiple cell types and organ systems. The transition from the lean to the obese state is characterized by fundamental cellular changes at the level of the adipocyte. These changes affect the local microenvironment within the respective adipose tissue but can also affect nonadipose systems. Adipocytes within fat pads respond to chronic nutrient excess through hyperplasia or hypertrophy, which can differentially affect interorgan crosstalk between various adipose depots and other organs. This crosstalk is dependent on the unique ability of the adipocyte to coordinate metabolic adjustments throughout the body and to integrate responses to maintain metabolic homeostasis. These actions occur through the release of free fatty acids and metabolites during times of energy need - a process that is altered in the obese state. In addition, adipocytes release a wide array of signalling molecules, such as sphingolipids, as well as inflammatory and hormonal factors (adipokines) that are critical for interorgan crosstalk. The interactions of adipose tissue with the kidney - referred to as the adipo-renal axis - are important for normal kidney function as well as the response of the kidney to injury. Here, we discuss the mechanistic basis of this interorgan crosstalk, which clearly has great therapeutic potential given the increasing rates of chronic kidney disease secondary to obesity and type 2 diabetes mellitus.
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Affiliation(s)
- Qingzhang Zhu
- Touchstone Diabetes Center, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75390-8549, USA
| | - Philipp E Scherer
- Touchstone Diabetes Center, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75390-8549, USA.,Touchstone Diabetes Center, Department of Cell Biology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75390-8549, USA
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218
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Medeiros T, do Rosário NF, Gama NA, Mérida LAD, Storch AS, Ferraz L, de Fátima Lopes P, da Silva AA, Almeida JR. Metabolic syndrome components and estimated glomerular filtration rate based on creatinine and/or cystatin C in young adults: A gender issue? Diabetes Metab Syndr 2017; 11 Suppl 1:S351-S357. [PMID: 28284908 DOI: 10.1016/j.dsx.2017.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/03/2017] [Indexed: 10/20/2022]
Abstract
AIMS This work aims to identify correlations between estimated glomerular filtration rate (eGFR) based on creatinine and/or cystatin C (Cr, CysC) with metabolic syndrome (MS) components in young adults, according to gender. MATERIAL AND METHODS This is a cross sectional study, where young adults aged between 18 and 30 were matched by gender, age and body mass index. All subjects underwent clinical evaluation and blood sampling for laboratory measurements. MS was determined according to the JIS criteria. The eGFR was estimated using CKD-EPI equations (eGFRCr; eGFRCysC; eGFRCr-CysC). RESULTS We evaluated 78 subjects with a mean age of 24.5 years. 10.2% had MS, with higher incidence among males (15.4% ♂ vs. 5.1% ♀). Elevated waist circumference was the MS component most observed. Significant correlations (Pearson; p<0.05) between eGFR and metabolic markers were observed only in males. In addition, we observed a significant association between the increase of MS components and the decay of eGFRCr and eGFRCr-CysC (zero vs. two or more components, ANOVA, p<0.05) only among males. CONCLUSION eGFR decay associated with components of MS and insulin resistance in young male adults could represent a worrying specific risk and indicate that further studies are needed to better understand these findings.
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Affiliation(s)
- Thalia Medeiros
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal Fluminense, Rio de Janeiro, Brazil.
| | - Natalia Fonseca do Rosário
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal Fluminense, Rio de Janeiro, Brazil.
| | - Nycole Abreu Gama
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal Fluminense, Rio de Janeiro, Brazil.
| | - Lyris Anunciata Demétrio Mérida
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal Fluminense, Rio de Janeiro, Brazil.
| | - Amanda Sampaio Storch
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal Fluminense, Rio de Janeiro, Brazil.
| | - Leda Ferraz
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal Fluminense, Rio de Janeiro, Brazil.
| | - Patricia de Fátima Lopes
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal Fluminense, Rio de Janeiro, Brazil; Departamento de Patologia, Faculdade de Medicina, Universidade Federal Fluminense, Rio de Janeiro, Brazil.
| | - Andrea Alice da Silva
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal Fluminense, Rio de Janeiro, Brazil; Departamento de Patologia, Faculdade de Medicina, Universidade Federal Fluminense, Rio de Janeiro, Brazil.
| | - Jorge Reis Almeida
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal Fluminense, Rio de Janeiro, Brazil; Serviço de Nefrologia, Departamento de Medicina Clínica, Faculdade de Medicina, UFF, Rio de Janeiro, Brazil.
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219
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Owens EA, Jie L, Reyes BA, Van Bockstaele EJ, Osei-Owusu P. Elastin insufficiency causes hypertension, structural defects and abnormal remodeling of renal vascular signaling. Kidney Int 2017; 92:1100-1118. [DOI: 10.1016/j.kint.2017.04.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/29/2017] [Accepted: 04/13/2017] [Indexed: 01/24/2023]
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220
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Lai YJ, Hu HY, Lee YL, Ku PW, Yen YF, Chu D. Association between obesity and risk of chronic kidney disease: A nationwide Cohort study in Taiwan. Nutr Metab Cardiovasc Dis 2017; 27:1008-1014. [PMID: 28986076 DOI: 10.1016/j.numecd.2017.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/05/2017] [Accepted: 08/17/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS Increased body fat relates to enhanced inflammatory cytokine production, which, in turn, activates the renin-angiotensin-aldosterone system and increases the risk of chronic kidney disease (CKD). Herein, we aimed to examine the association between obesity and the risk of CKD in a population-representative cohort in Taiwan. METHODS AND RESULTS A multistage systematic sampling process was applied in the National Health Interview Survey (NHIS) 2000, 2005, and 2009. Participants were interviewed by a standardized face-to-face questionnaire to obtain information on their demographics, socioeconomic status, lifestyle factors, and body mass index (BMI). The BMI values were classified as follows: underweight (<18.5 kg/m2), normal (18.5-23.9 kg/m2), overweight (24-26.9 kg/m2), and obesity (≥27 kg/m2). The NHIS dataset was linked to National Health Insurance claims data to identify the incidence of CKD. Univariate and multivariate Cox proportional hazard models with competing risks were used to investigate the association between BMI and CKD incidence. We analyzed 45,012 subjects (mean age, 42.03 years; 50.09% males). During 374,254 person-years of follow-up, a total of 1913 new-onset CKD cases were identified. Kaplan-Meier curves comparing the four BMI groups revealed a significant difference (p < 0.01, log-rank test). After controlling for confounding factors, the relative risk of incident CKD was significantly higher in the obese group compared to the normal-weight group (adjusted hazard ratio = 1.32; 95% confidence interval: 1.17-1.49), with a significant linear trend (p < 0.01). CONCLUSION Obesity was suggested as an independent risk factor for CKD. Further studies focusing on the effect of losing weight on CKD prevention are warranted.
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Affiliation(s)
- Y-J Lai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Endocrinology and Metabolism, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, Nantou, Taiwan; Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan
| | - H-Y Hu
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan; Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Y-L Lee
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan; Department of Dentistry, Taipei City Hospital, Taipei, Taiwan; Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan
| | - P-W Ku
- Graduate Institute of Sports and Health, National Changhua University of Education, Changhua, Taiwan
| | - Y-F Yen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Section of Infectious Diseases, Taipei City Hospital, Taipei City Government, Taipei, Taiwan; Department of Health and Welfare, College of City Management, University of Taipei, Taiwan; Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - D Chu
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan; Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan; Department of Neurosurgery, Taipei City Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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221
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Chung HF, Al Mamun A, Huang MC, Long KZ, Huang YF, Shin SJ, Hwang SJ, Hsu CC. Obesity, weight change, and chronic kidney disease in patients with type 2 diabetes mellitus: A longitudinal study in Taiwan. J Diabetes 2017; 9:983-993. [PMID: 27976508 DOI: 10.1111/1753-0407.12514] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 10/10/2016] [Accepted: 12/06/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The aim of the present study was to investigate relationships between the risk of chronic kidney disease (CKD) and obesity and weight changes in Asian patients with type 2 diabetes. METHODS At baseline (2003-05), 1187 diabetic patients aged 30-70 years were recruited to the study, with follow-up surveys completed in 2008, 2009, and 2010. Chronic kidney disease was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min per 1.73 m2 ; body mass index (BMI) was categorised as normal (18.5-22.9 kg/m2 ), overweight (23-27.4 kg/m2 ), or obese (≥27.5 kg/m2 ); waist circumference (WC) ≥80 cm for women and ≥90 cm for men was taken to indicate abdominal obesity. Changes in weight and WC were calculated from baseline to each follow-up survey. Relative risk (RR) and 95% confidence intervals (CIs) of CKD were estimated. To estimate the risk for incident CKD, associations were examined in patients without CKD at baseline (n = 881). RESULTS Over 7 years of follow-up, obesity (RR 1.48; 95% CI 1.08-2.04; P = 0.015) and high WC (RR 1.23; 95% CI 1.00-1.52; P = 0.049) were associated with CKD after adjusting for covariates. Among participants without CKD at baseline, those who gained >10% weight (RR 1.43; 95% CI 1.07-1.90; P = 0.015) and in whom WC increased >15% (RR 1.37; 95% CI 1.01-1.85; P = 0.045) had a higher risk of incident CKD than those who remained stable (±5% changes in weight or WC). CONCLUSIONS Diabetic patients who are obese and those with excessive central fat were more likely to have CKD. Large weight gain (>10%) and increases in WC (>15%) independently predicted incident CKD.
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Affiliation(s)
- Hsin-Fang Chung
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Abdullah Al Mamun
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Meng-Chuan Huang
- Department of Public Health and Environmental Medicine, Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Nutrition and Dietetics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Kurt Z Long
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Ya-Fang Huang
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Shyi-Jang Shin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University and University Hospital, Kaohsiung, Taiwan
| | - Shang-Jyh Hwang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University and University Hospital, Kaohsiung, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan
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222
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Dowell AE, Badaan SR, Smith TG. Contemporary Role of Open Surgery in the Management of High-Grade Renal Injury. CURRENT TRAUMA REPORTS 2017. [DOI: 10.1007/s40719-017-0109-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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223
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Affiliation(s)
- Peter F Mount
- Department of Nephrology and .,Department of Medicine, Austin Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia; and.,Institute of Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia
| | - Luis A Juncos
- Departments of Internal Medicine/Nephrology and.,Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi
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224
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A non-laboratory-based risk score for predicting diabetic kidney disease in Chinese patients with type 2 diabetes. Oncotarget 2017; 8:102550-102558. [PMID: 29254270 PMCID: PMC5731980 DOI: 10.18632/oncotarget.21684] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 09/22/2017] [Indexed: 01/19/2023] Open
Abstract
Aim To construct a simple screening tool for predicting diabetic kidney disease in Chinese patients with type 2 diabetes. Materials and Methods In the development cohort, the clinical and procedural characteristics of the 4,795 patients were considered as candidate univariate predictors of diabetic kidney disease. The β-coefficients derived from a multiple logistic regression model predicting the presence of DKD were used to calculate the risk score. The performance of the risk score was validated in a cross-sectional and a prospective cohort population. Results The risk score included sex, body mass index, systolic blood pressure, and duration of diabetes. The total point ranged from 0 to 39. In the development cohort, compared with participants with risk score < 10, those with risk score between 10 to 20, 21 to 30, and > 30 had ORs of 3.21, 7.92 and 17.55 for developing diabetic kidney disease, respectively. In the prospective cohort, 60.9% patients with risk score over 30 were expected to develop DKD at 72 months of follow-up. Conclusions Sex, body mass index, systolic blood pressure, and duration of diabetes were independent predictors of diabetic kidney disease, and the derived risk equation was a simple screening tool for screening diabetic kidney disease in Chinese patients with type 2 diabetes.
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Tamanji MT, Ngwakum DA, Mbouemboue OP. A Profile of Renal Function in Northern Cameroonians with Essential Hypertension. Cardiorenal Med 2017; 7:324-333. [PMID: 29118771 PMCID: PMC5662973 DOI: 10.1159/000455680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 12/12/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIM The two-way cause and effect relationship existing between high blood pressure and kidney dysfunction is currently a well-documented phenomenon with patients in either category being almost equally predisposed to the other pathology. Our goal was to assess the renal function capacity of hypertensive patients in our setting. METHODS This cross-sectional descriptive study involved the determination of blood pressure levels and the collection of blood and urine samples for the measurement of renal function markers. Hypertensive patients who came for medical follow-up constituted the study participants, and were enrolled consecutively into the study from February to May 2015. Data analysis was performed using the SPSS 20.0 software, and significant differences were determined at p < 0.05. RESULTS The prevalence of elevated creatinine and urea levels were 35 and 27%. Eighty percent of the participants had a decreased glomerular filtration rate (≤90 mL/min/1.73 m3), with at least 36% recording less than 60 mL/min/1.73 m3. Proteinuria and glucosuria were recorded in 15% and 8% of the participants, respectively. The mean diastolic pressure was observed to be significantly higher in participants with proteinuria (p = 0.016), and participants' weight directly correlated with systolic blood pressure (p = 0.015). Furthermore, the mean estimated glomerular filtration rate was relatively lower in participants >60 years compared to those <60 years (p < 0.001). CONCLUSION Renal function is often perturbed in hypertensive patients, and good blood pressure control may reduce the progression of renal impairment. Thus, a systematic evaluation of renal function in addition to blood pressure control in hypertensive patients is indispensable towards effectively reducing the occurrence of renal events and preventing end-stage renal disease.
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Affiliation(s)
- Marcel Tangyi Tamanji
- Faculty of Science, University of Buea, Buea, Cameroon
- Medical Laboratory Service, University of Ngaoundere, Ngaoundere, Cameroon
| | | | - Olivier Pancha Mbouemboue
- General Medicine Service, Regional Hospital Ngaoundere, University of Ngaoundere, Ngaoundere, Cameroon
- Department of Biomedical Sciences, University of Ngaoundere, Ngaoundere, Cameroon
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Yong J, Lin D, Tan XR. Primary prevention of cardiovascular disease in older adults in China. World J Clin Cases 2017; 5:349-359. [PMID: 29026833 PMCID: PMC5618113 DOI: 10.12998/wjcc.v5.i9.349] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 05/22/2017] [Accepted: 06/13/2017] [Indexed: 02/05/2023] Open
Abstract
Over the past two decades, the percentage of Chinese who is 60 years or older has increased from 5.2% in 1995 to 10.5% in 2015. Approximately 16% of the population in China was 60 years old and above in 2015. Since 1990, cardiovascular disease (CVD) has been the leading cause of death in China. Cardiovascular medications of older adults are usually more complicated than younger age groups due to polypharmacy, the presence of comorbidities and more susceptible to treatment-related adverse outcomes. Therefore, effective primary prevention of CVD for older adults is important in sustaining the health of older adults and reducing the burden of the healthcare system. Proper management of CVD-related risk factors, such as hypertension, dyslipidemia, diabetes and obesity, can remarkably reduce risks of CVDs in older Chinese. These risk factors can be modified by managing blood pressure, glucose and lipids via lifestyle modifications or receiving medications. Smoking cessation, healthy diets, strict alcohol intake and moderate physical exercise are examples of recommended lifestyle changes for remarkably recovering health conditions of older adults who have hypertension, dyslipidemia, obesity, diabetes or complications. Treatment prescriptions of older adults, in general, are recommended to be individualized and to be initiated at a low dose. The future directions for better primary CVD prevention in older adults include establishing guidelines for primary prevention of CVD for different older adults and further research on better management strategies of CVD risks for elderly Chinese.
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Affiliation(s)
- Jian Yong
- First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
| | - Dong Lin
- First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
| | - Xue-Rui Tan
- First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
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227
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Feng L, Wei DM, Lin ST, Maddison R, Ni Mhurchu C, Jiang Y, Gao Y, Wang HJ. Systematic review and meta-analysis of school-based obesity interventions in mainland China. PLoS One 2017; 12:e0184704. [PMID: 28910362 PMCID: PMC5598996 DOI: 10.1371/journal.pone.0184704] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 08/29/2017] [Indexed: 12/12/2022] Open
Abstract
Background Numerous school-based interventions for childhood obesity have been emerging in mainland China in recent decades, but little is known about the effectiveness of such interventions. This study aims to assess the effectiveness of school-based interventions for childhood obesity conducted in mainland China. Methods A systematic search was undertaken in eight databases to identify both randomized and non-randomized controlled trials from January 1990 to December 2015 examining the effectiveness of school-based obesity interventions. A random effects meta-analysis was conducted assessing the impact of included interventions on (body mass index) BMI. The quality of each included studies were assessed using Effective Public Health Practice Project Quality Assessment Tool. A P value <0.05 (two-sided) was considered statistically significant. Result Of the seventy-six included studies, we found physical activity and health education were the two most common components of interventions. More treatment studies were effective compared with prevention studies (85.0% vs. 58.3%). Comprehensive interventions involving physical activity and health education appeared more effective than the physical activity only interventions in both obesity treatment and prevention studies. The meta-analyses showed comprehensive interventions involving physical activity and health education had larger effect on the change of BMI than physical activity only interventions (treatment studies: -1.80 kg/m2 (95% CI: -2.15,-1.44) vs. -0.91 kg/m2 (95% CI: -1.15,-0.67); prevention studies: -0.19 kg/m2 (95% CI: -0.27, -0.11) vs. +0.05 kg/m2 (95% CI: -0.04, +0.15)). Conclusions Comprehensive school-based interventions may assist in tackling the rising prevalence of childhood obesity in mainland China.
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Affiliation(s)
- Lin Feng
- School of Public Health, Peking University, Beijing, China
| | - Dong-Mei Wei
- Institute of Child and Adolescent Health, Department of Child, Adolescent and Women’s Health, School of Public Health, Peking University, Beijing, China
| | - Shen-Ting Lin
- Institute of Child and Adolescent Health, Department of Child, Adolescent and Women’s Health, School of Public Health, Peking University, Beijing, China
- Health and Family Planning Bureau of Nanshan District, Shenzhen, China
| | - Ralph Maddison
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Cliona Ni Mhurchu
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Yang Gao
- Department of Physical Education, Hong Kong Baptist University, Hong Kong, China
| | - Hai-Jun Wang
- Institute of Child and Adolescent Health, Department of Child, Adolescent and Women’s Health, School of Public Health, Peking University, Beijing, China
- * E-mail:
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Association Between Body Mass Index Combined with Albumin: creatinine Ratio and All-cause Mortality in Chinese Population. Sci Rep 2017; 7:10878. [PMID: 28883431 PMCID: PMC5589898 DOI: 10.1038/s41598-017-11084-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 08/16/2017] [Indexed: 12/19/2022] Open
Abstract
The association between body mass index (BMI) combined with albumin: creatinine ratio (ACR) and all-cause mortality in the general population has not been established. To address this, we examined a representative sample from the general population of China. The study included 46,854 participants with a follow-up of 4.6 years. Compared to the normal weight with ACR <10 mg/g group (the reference group), the crude hazard ratios (HRs) for all-cause mortality for the underweight with ACR >10 mg/g, normal weight with ACR >10 mg/g, overweight with ACR >10 mg/g, and obese with ACR >10 mg/g groups, were 2.22 (95% CI, 1.41 to 3.49), 1.70 (95% CI, 1.42 to 2.04), 1.52 (95% CI, 1.22 to 1.89), and 2.05 (95% CI, 1.45 to 2.89), respectively. After multivariable adjustments for age, race, comorbidities, and baseline eGFR, the HRs for the underweight with ACR >10 mg/g and normal weight with ACR >10 mg/g groups were 1.85 (95% CI, 1.17 to 2.91) and 1.36 (95% CI, 1.13 to 1.63), respectively. The results indicate that BMI combined with ACR can better predict all-cause mortality than BMI alone in the general Chinese population. Underweight and normal weight people with elevated ACR are at a higher risk of all-cause mortality than those in the same BMI category with ACR <10 mg/g.
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High-fat diet increases pain behaviors in rats with or without obesity. Sci Rep 2017; 7:10350. [PMID: 28871134 PMCID: PMC5583349 DOI: 10.1038/s41598-017-10458-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 08/08/2017] [Indexed: 02/07/2023] Open
Abstract
Obesity is associated with increased risk for chronic pain. Basic mechanisms for this association are poorly understood. Using a milder version of a radicular pain model, local inflammation of the dorsal root ganglion (DRG), we observed marked increases in mechanical and cold allodynia in rats of both sexes that were maintained on a high-fat diet (HFD) for 6 weeks prior to DRG inflammation. Notably, this increase in pain-related behaviors occurred in both Long-Evans and Sprague-Dawley rats despite the fact that the 6-week HFD exposure induced obesity (e.g., increased insulin, leptin, weight, and percent body fat) in the Long-Evans, but not Sprague-Dawley, strains. This suggested that HFD, rather than obesity per se, increased pain behaviors. Increased pain behaviors were observed even after a much shorter (1 week) exposure to the HFD but the effect was smaller. HFD also increased behavioral responses and paw swelling to paw injection of complete Freund’s adjuvant, a model of peripheral inflammatory pain. No change was detected in plasma cytokine levels in HFD rats. However, increased macrophage infiltration of the DRG was observed in response to the HFD, absent any pain model. The results suggest that HFD can increase pain even when it does not cause obesity.
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Abstract
Purpose of Review The etiology of hypertension, a critical public health issue affecting one in three US adults, involves the integration of the actions of multiple organ systems, including the renal sympathetic nerves. The renal sympathetic nerves, which are comprised of both afferent (sensory input) and efferent (sympathetic outflow) arms, have emerged as a major potential therapeutic target to treat hypertension and disease states exhibiting excess renal sympathetic activity. Recent Findings This review highlights recent advances in both clinical and basic science that have provided new insight into the distribution, function, and reinnervation of the renal sympathetic nerves, with a focus on the renal afferent nerves, in hypertension and hypertension-evoked disease states including salt-sensitive hypertension, obesity-induced hypertension, and chronic kidney disease. Summary Increased understanding of the differential role of the renal afferent versus efferent nerves in the pathophysiology of hypertension has the potential to identify novel targets and refine therapeutic interventions designed to treat hypertension.
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Kim YJ, Hwang SD, Oh TJ, Kim KM, Jang HC, Kimm H, Kim HC, Jee SH, Lim S. Association Between Obesity and Chronic Kidney Disease, Defined by Both Glomerular Filtration Rate and Albuminuria, in Korean Adults. Metab Syndr Relat Disord 2017; 15:416-422. [PMID: 28832275 DOI: 10.1089/met.2017.0053] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) has often been defined based on glomerular filtration rate (GFR) alone. The Kidney Disease: Improving Global Outcomes guideline highlights albuminuria in the CKD definition. Thus, we investigated the association between obesity and CKD, as defined by both GFR and albuminuria, in Korean adults. METHODS We used Korea National Health and Nutrition Examination Survey 2011-2014 data (N = 19,331, ≥19 years old) representing the national Korean population. CKD was classified by (1) estimated GFR (eGFR) < 60 mL/min/1.73 m2 (CKDGFR); (2) albumin-to-creatinine ratio (ACR) ≥30 mg/gram (CKDACR); and (3) eGFR < 60 mL/min/1.73 m2 or ACR ≥30 mg/gram (CKDRisk). Associations between obesity and each CKD category were evaluated using multivariate logistic regression analysis. RESULTS The prevalence rates of CKDGFR, CKDACR, and CKDRisk were 2.2%, 6.7%, and 8.1%, respectively. Compared with the normal body mass index (BMI; 18.5-22.9 kg/m2) group, men with BMI ≥ 25 kg/m2 had 1.88 times greater risk of CKDGFR in the adjusted model [95% confidence interval (CI), 1.26-2.80; P = 0.002]; BMI was not significantly associated with CKDGFR in women. In contrast, both men and women with BMI ≥ 25 kg/m2 had 1.58 and 1.40 times higher risk of CKDACR (95% CI, 1.21-2.07 and 1.08-1.81, respectively, both P < 0.01). Obese men and women had 1.65 and 1.38 times higher risk of CKDRisk (95% CI, 1.29-2.12 and 1.09-1.75, respectively, both P < 0.01). CONCLUSIONS Obesity was significantly associated with an increased ACR-based CKD risk. Longitudinal studies are needed to investigate the role of overweight and obesity in the development and progression of CKD.
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Affiliation(s)
- Yoon Ji Kim
- 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Mediplex Sejong Hospital , Incheon, South Korea
| | - Seun Deuk Hwang
- 2 Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine , Incheon, South Korea
| | - Tae Jung Oh
- 3 Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam, South Korea
| | - Kyoung Min Kim
- 3 Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam, South Korea
| | - Hak Chul Jang
- 3 Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam, South Korea
| | - Heejin Kimm
- 4 Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University , Seoul, South Korea
| | - Hyeon Chang Kim
- 5 Department of Preventive Medicine, Yonsei University College of Medicine , Seoul, South Korea .,6 Department of Preventive Medicine, Cardiovascular and Metabolic Diseases Etiology Research Center, Yonsei University College of Medicine , Seoul, South Korea
| | - Sun Ha Jee
- 4 Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University , Seoul, South Korea
| | - Soo Lim
- 3 Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam, South Korea
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232
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Lu HK, Chen YY, Yeh C, Chuang CL, Chiang LM, Lai CL, Casebolt KM, Huang AC, Lin WL, Hsieh KC. Discrepancies between leg-to-leg bioelectrical Impedance analysis and computerized tomography in abdominal visceral fat measurement. Sci Rep 2017; 7:9102. [PMID: 28831095 PMCID: PMC5567333 DOI: 10.1038/s41598-017-08991-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 07/20/2017] [Indexed: 01/10/2023] Open
Abstract
The aim of this study was to evaluate leg-to-leg bioelectrical impedance analysis (LBIA) using a four-contact electrode system for measuring abdominal visceral fat area (VFA). The present study recruited 381 (240 male and 141 female) Chinese participants to compare VFA measurements estimated by a standing LBIA system (VFALBIA) with computerized tomography (CT) scanned at the L4-L5 vertebrae (VFACT). The total mean body mass index (BMI) was 24.7 ± 4.2 kg/m2. Correlation analysis, regression analysis, Bland-Altman plot, and paired sample t-tests were used to analyze the accuracy of the VFALBIA. For the total subjects, the regression line was VFALBIA = 0.698 VFACT + 29.521, (correlation coefficient (r) = 0.789, standard estimate of error (SEE) = 24.470 cm2, p < 0.001), Lin's correlation coefficient (CCC) was 0.785; and the limit of agreement (LOA; mean difference ±2 standard deviation) ranged from -43.950 to 67.951 cm2, LOA% (given as a percentage of mean value measured by the CT) was 48.2%. VFALBIA and VFACT showed significant difference (p < 0.001). Collectively, the current study indicates that LBIA has limited potential to accurately estimate visceral fat in a clinical setting.
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Affiliation(s)
- Hsueh-Kuan Lu
- Sport Science Research Center, National Taiwan University of Sport, Taichung, 40404, Taiwan
| | - Yu-Yawn Chen
- Department of Physical Education, National Taiwan University of Sport, Taichung, 40404, Taiwan.,Department of Nursing, St. Mary's Junior College of Medicine, Nursing and Management, Yilan County, 26644, Taiwan
| | - Chinagwen Yeh
- Department of Dance, National Taiwan University of Sport, Taichung, 40404, Taiwan
| | - Chih-Lin Chuang
- Department of Radiology, Jen-Ai Hospital, Taichung, 41265, Taiwan
| | - Li-Ming Chiang
- Hospitality, Recreation, and Tourism Management Department, East Stroudsburg University ofPennsylvania, East Stroudsburg, PA, 18301, USA
| | - Chung-Liang Lai
- Department of Physical Medicine and Rehabilitation, Taichung Hospital, Ministry of Health and Welfare, Taichung, 40343, Taiwan
| | - Kevin M Casebolt
- Physical Education Teacher Certification Department, East Stroudsburg University of Pennsylvania, East Stroudsburg, PA, 18301, USA
| | - Ai-Chun Huang
- Department of Leisure, Recreation, and Tourism Management, Tzu-Hui Institute of Technology, Pingtung, 92601, Taiwan
| | - Wen-Long Lin
- Department of Sport Management, National Taiwan University of Sport, Taichung, 40404, Taiwan
| | - Kuen-Chang Hsieh
- Office of Physical Education and Sport, National Chung Hsing University, Taichung, 40227, Taiwan. .,Research Center, Charder Electronic Co., Ltd, Taichung, 41262, Taiwan.
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233
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Le Jemtel TH, Richardson W, Samson R, Jaiswal A, Oparil S. Pathophysiology and Potential Non-Pharmacologic Treatments of Obesity or Kidney Disease Associated Refractory Hypertension. Curr Hypertens Rep 2017; 19:18. [PMID: 28243928 DOI: 10.1007/s11906-017-0713-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW The review assesses the role of non-pharmacologic therapy for obesity and chronic kidney disease (CKD) associated refractory hypertension (rf HTN). RECENT FINDINGS Hypertensive patients with markedly heightened sympathetic nervous system (SNS) activity are prone to develop refractory hypertension (rfHTN). Patients with obesity and chronic kidney disease (CKD)-associated HTN have particularly heightened SNS activity and are at high risk of rfHTN. The role of bariatric surgery is increasingly recognized in treatment of obesity. Current evidence advocates for a greater role of bariatric surgery in the management of obesity-associated HTN. In contrast, renal denervation does not appear have a role in the management of obesity or CKD-associated HTN. The role of baroreflex activation as adjunctive anti-hypertensive therapy remains to be defined.
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Affiliation(s)
- Thierry H Le Jemtel
- Division of Cardiology, Tulane University Medical Center, New Orleans, Louisiana, USA. .,Division of Cardiology, Tulane University School of Medicine, 1430 Tulane Ave SL-42, New Orleans, LA, 70112, USA.
| | - William Richardson
- Department of Surgery, Ochsner Health System, New Orleans, Louisiana, USA
| | - Rohan Samson
- Division of Cardiology, Tulane University Medical Center, New Orleans, Louisiana, USA
| | - Abhishek Jaiswal
- Division of Cardiology, Tulane University Medical Center, New Orleans, Louisiana, USA
| | - Suzanne Oparil
- Division of Cardiovascular Disease, University of Alabama, Birmingham, AL, USA
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Abstract
Obesity greatly increases the risk for cardiovascular, metabolic, and renal diseases and is one of the most significant and preventable causes of increased blood pressure (BP) in patients with essential hypertension. This review highlights recent advances in our understanding of central nervous system (CNS) signaling pathways that contribute to the etiology and pathogenesis of obesity-induced hypertension. We discuss the role of excess adiposity and activation of the brain leptin-melanocortin system in causing increased sympathetic activity in obesity. In addition, we highlight other potential brain mechanisms by which increased weight gain modulates metabolic and cardiovascular functions. Unraveling the CNS mechanisms responsible for increased sympathetic activation and hypertension and how circulating hormones activate brain signaling pathways to control BP offer potentially important therapeutic targets for obesity and hypertension.
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235
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Jiang EX, Gogineni HC, Mayerson JL, Glassman AH, Magnussen RA, Scharschmidt TJ. Acute Kidney Disease After Total Hip and Knee Arthroplasty: Incidence and Associated Factors. J Arthroplasty 2017; 32:2381-2385. [PMID: 28392132 DOI: 10.1016/j.arth.2017.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/23/2017] [Accepted: 03/06/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The development of acute kidney disease (AKD) following total joint arthroplasty has not been well characterized in the literature. We sought to calculate the incidence and identify risk factors associated with postoperative AKD for patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). METHODS A total of 1000 consecutive cases (860 unique patients, including revisions) of TKA or THA performed between January 2010 and May 2016 were identified. Seventy-nine cases were excluded due to pre-existing kidney dysfunction and 23 additional cases were excluded due to incomplete data, resulting in 898 cases included in the study. There were 492 females and 406 males with a mean age of 58.1 years (range, 14-93 years). The Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease criteria and serum creatinine values were used to determine AKD status. Multiple logistic regression modeling was used to identify postoperative AKD risk factors. RESULTS Overall incidence of postoperative AKD was 6.8% (n = 61). Use of perioperative angiotensin receptor blocker (ARBs) or angiotensin-converting enzyme inhibitors (ACEi) (odds ratio [OR] = 2.09; P = .030), increasing body mass index (BMI) (OR = 1.58 per 10 kg/m2; P = .014), and use of vancomycin perioperatively (OR = 1.91; P = .021) were associated with increased odds of development of postoperative AKD. CONCLUSION A 6.8% incidence rate of postoperative AKD was noted in patients undergoing TKA or THA. Perioperative use of ARBs/ACEi, perioperative vancomycin use, and increased BMI were associated with increased odds of postoperative AKD.
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Affiliation(s)
- Eric X Jiang
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Hrishikesh C Gogineni
- Department of Orthopaedics, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Joel L Mayerson
- Department of Orthopaedics, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Andrew H Glassman
- Department of Orthopaedics, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Robert A Magnussen
- Department of Orthopaedics, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Thomas J Scharschmidt
- Department of Orthopaedics, Wexner Medical Center, The Ohio State University, Columbus, Ohio
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Mazidi M, Rezaie P, Jangjoo A, Tavassoli A, Rajabi MT, Kengne AP, Nematy M. Effect of bariatric surgery on adiposity and metabolic profiles: A prospective cohort study in Middle-Eastern patients. World J Diabetes 2017; 8:374-380. [PMID: 28751961 PMCID: PMC5507835 DOI: 10.4239/wjd.v8.i7.374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/05/2017] [Accepted: 06/06/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To investigate changes in adiposity and cardio-metabolic risk profile following Roux-en-Y gastric bypass in patients of Middle Eastern ethnicity with severe obesity. METHODS This prospective cohort study involved 92 patients who met the indications of bariatric surgery. Post-procedure markers of obesity and cardiometabolic profile were monitored regularly for a year. RESULTS Mean body mass index decreased by 29.5% from 41.9 to 29.5 kg/m2 between baseline and 12-mo follow-up, while mean fat mass decreased by 45.9% from 64.2 kg to 34.7 kg. An improvement was also observed in the gluco-metabolic profile with both fasting glucose and HbA1c substantially decreasing (P < 0.001). CONCLUSION The present study shows the short to medium term (1 year) health benefits of bariatric surgery for patients of Middle Eastern ethnicity.
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237
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Eo H, Park JE, Jeon YJ, Lim Y. Ameliorative Effect of Ecklonia cava Polyphenol Extract on Renal Inflammation Associated with Aberrant Energy Metabolism and Oxidative Stress in High Fat Diet-Induced Obese Mice. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2017; 65:3811-3818. [PMID: 28459555 DOI: 10.1021/acs.jafc.7b00357] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Immoderate fat accumulation causes both oxidative stress and inflammation, which can induce kidney damage in obesity. Previously, Ecklonia cava has shown anti-inflammatory and antioxidative effects. Our group aimed to investigate whether E. cava polyphenol extract (ECPE) improves renal damage in high fat diet (HFD)-induced obese mice through regulation of not only energy metabolism but also oxidative stress and inflammation. After obesity induction by HFD, the mice were treated with different dosages of ECPE (100 or 500 mg/kg/day) by gavage for 12 weeks. ECPE treatment lowered the protein levels related to lipid accumulation (SREBP1c, ACC & FAS), inflammation (NLRP3 inflammasome, NFκB, MCP-1, TNF-α & CRP), and oxidative stress (Nrf2, HO-1, MnSOD, NQO1, GPx, 4-HNE and protein carbonyls) in HFD induced obese mice. Moreover, ECPE supplementation significantly up-regulated renal SIRT1, PGC-1α, and AMPK, which are associated with renal energy metabolism. Consequently, the results provide novel insights into the anti-inflammatory roles of ECPE in obesity-induced renal inflammation.
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Affiliation(s)
- Hyeyoon Eo
- Department of Food and Nutrition, Kyung Hee University , 26 Kyunghee-daero, Dongdaemun-gu, Seoul 02447, Republic of Korea
| | - Ji Eun Park
- Department of Food and Nutrition, Kyung Hee University , 26 Kyunghee-daero, Dongdaemun-gu, Seoul 02447, Republic of Korea
| | - You-Jin Jeon
- Department of Marine Life Sciences, Jeju National University , Jeju 63243, Republic of Korea
| | - Yunsook Lim
- Department of Food and Nutrition, Kyung Hee University , 26 Kyunghee-daero, Dongdaemun-gu, Seoul 02447, Republic of Korea
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Zhang X, Lerman LO. The metabolic syndrome and chronic kidney disease. Transl Res 2017; 183:14-25. [PMID: 28025032 PMCID: PMC5393937 DOI: 10.1016/j.trsl.2016.12.004] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/22/2016] [Accepted: 12/02/2016] [Indexed: 02/07/2023]
Abstract
The metabolic syndrome (MetS) is a cluster of cardiovascular risk factors including insulin resistance (IR), dyslipidemia, and hypertension, which may also foster development of chronic kidney disease. The mechanisms of MetS-induced kidney disease are not fully understood. The purpose of this review is to summarize recent discoveries regarding the impact of MetS on the kidney, particularly on the renal microvasculature and cellular mitochondria. Fundamental manifestations of MetS include IR and adipose tissue expansion, the latter promoting chronic inflammation and oxidative stress that exacerbate IR. Those in turn can elicit various kidney injurious events through endothelial dysfunction, activation of the renin-angiotensin-aldosterone system, and adipokine imbalance. Inflammation and IR are also major contributors to microvascular remodeling and podocyte injury. Hence, these events may result in hypertension, albuminuria, and parenchymal damage. In addition, dyslipidemia and excessive nutrient availability may impair mitochondrial function and thereby promote progression of kidney cell damage. Elucidation of the link between MetS and kidney injury may help develop preventative measures and possibly novel therapeutic targets to alleviate and avert development of renal manifestations.
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Affiliation(s)
- Xin Zhang
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minn
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minn.
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239
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Möhner M, Pohrt A, Gellissen J. Occupational exposure to respirable crystalline silica and chronic non-malignant renal disease: systematic review and meta-analysis. Int Arch Occup Environ Health 2017; 90:555-574. [PMID: 28409224 PMCID: PMC5583269 DOI: 10.1007/s00420-017-1219-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 04/05/2017] [Indexed: 12/12/2022]
Abstract
Background While occupational exposure to respirable silica is known to lead to lung disease, most notably silicosis, its association with chronic kidney disease is unclear. Objectives This review explores the association between occupational exposure to respirable silica and chronic non-malignant renal disease such as glomerulonephritis. The evidence has been collected and compiled. Possible sources of bias are thoroughly discussed. Methods Cohort studies with silica exposure and case–control studies of renal disease were searched in PubMed until January 2015. Two authors independently abstracted data; any disagreement was resolved by consulting a third reviewer. A meta-analysis was performed to evaluate the association to silica exposure. Results A total of 23 cohort and four case–control studies were included in the analysis. The meta-analysis of cohort studies yielded elevated overall SMRs for renal disease. Some studies, however, included dose–response analyses, most of which did not show a positive trend. The approaches and results of the case–control studies were very heterogeneous. Conclusions While the studies of cohorts exposed to silica found elevated SMRs for renal disease, no clear evidence of a dose–response relationship emerged. The elevated risk may be attributed to diagnostic and methodological issues. In order to permit a reliable estimation of a possible causal link, exposed cohorts should be monitored for renal disease, as the information from mortality studies is hardly reliable in this field. Electronic supplementary material The online version of this article (doi:10.1007/s00420-017-1219-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matthias Möhner
- Division of Work and Health, Federal Institute for Occupational Safety and Health, Nöldnerstr. 40/42, 10317, Berlin, Germany.
| | - Anne Pohrt
- Division of Work and Health, Federal Institute for Occupational Safety and Health, Nöldnerstr. 40/42, 10317, Berlin, Germany
| | - Johannes Gellissen
- Division of Work and Health, Federal Institute for Occupational Safety and Health, Nöldnerstr. 40/42, 10317, Berlin, Germany
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240
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Affiliation(s)
- Alejandro R Chade
- From the Department of Physiology and Biophysics, Center for Excellence in Cardiovascular-Renal Research, Department of Medicine, and Department of Radiology, University of Mississippi Medical Center, Jackson.
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241
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Zhong F, Zhuang L, Wang Y, Ma Y. Homocysteine levels and risk of essential hypertension: A meta-analysis of published epidemiological studies. Clin Exp Hypertens 2017; 39:160-167. [PMID: 28287885 DOI: 10.1080/10641963.2016.1226888] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Plasma homocysteine (Hcy) levels may be associated with essential hypertension (EH). However, the results of previous studies on this association are inconsistent. METHODS In this meta-analysis, we performed a systematic literature search of the Embase, PubMed, Cochrane Library, and Web of Science for the relevant articles dated up to March 2016. Pooled odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were used to evaluate the estimates. RESULTS We included 11 studies with a total of 16,571 participants (4,830 EH cases). We found that elevated Hcy levels were associated with the risk of EH (pooled OR: 1.36, 95% CI: 1.02-1.80 in the random-effects model). However, subsequent subgroup analyses showed that elevated Hcy levels increased the EH risk in retrospective studies (OR: 1.82, 95% CI: 1.53-2.16; p < 0.001) and unadjusted studies (OR: 1.72, 95% CI: 1.43-2.07; p < 0.001), but not in perspective studies (OR: 0.99, 95% CI: 0.73-1.28; p = 0.939) and adjusted studies (OR: 1.21, 95% CI: 0.85-1.72; p = 0.297). No significant publication bias was found (p = 0.876 for Begg's test, p = 0.144 for Egger's test). CONCLUSION Plasma Hcy levels are associated with EH risk. However, our findings do not support a causal association between Hcy levels and EH.
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Affiliation(s)
- Fade Zhong
- a Ningbo Municipal Blood Center , Ningbo , Zhejiang , China
| | - Li Zhuang
- a Ningbo Municipal Blood Center , Ningbo , Zhejiang , China
| | - Ying Wang
- b Ningbo Municipal Medical Center Eastern Lihuili Hospital , Ningbo , Zhejiang , China
| | - Youli Ma
- c Ningbo Municipal Medical Center Lihuili Hospital , Ningbo , Zhejiang , China
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242
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Glastras SJ, Chen H, Tsang M, Teh R, McGrath RT, Zaky A, Chen J, Wong MG, Pollock CA, Saad S. The renal consequences of maternal obesity in offspring are overwhelmed by postnatal high fat diet. PLoS One 2017; 12:e0172644. [PMID: 28225809 PMCID: PMC5321436 DOI: 10.1371/journal.pone.0172644] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 02/07/2017] [Indexed: 12/26/2022] Open
Abstract
AIMS/HYPOTHESIS Developmental programming induced by maternal obesity influences the development of chronic disease in offspring. In the present study, we aimed to determine whether maternal obesity exaggerates obesity-related kidney disease. METHODS Female C57BL/6 mice were fed high-fat diet (HFD) for six weeks prior to mating, during gestation and lactation. Male offspring were weaned to normal chow or HFD. At postnatal Week 8, HFD-fed offspring were administered one dose streptozotocin (STZ, 100 mg/kg i.p.) or vehicle control. Metabolic parameters and renal functional and structural changes were observed at postnatal Week 32. RESULTS HFD-fed offspring had increased adiposity, glucose intolerance and hyperlipidaemia, associated with increased albuminuria and serum creatinine levels. Their kidneys displayed structural changes with increased levels of fibrotic, inflammatory and oxidative stress markers. STZ administration did not potentiate the renal effects of HFD. Though maternal obesity had a sustained effect on serum creatinine and oxidative stress markers in lean offspring, the renal consequences of maternal obesity were overwhelmed by the powerful effect of diet-induced obesity. CONCLUSION Maternal obesity portends significant risks for metabolic and renal health in adult offspring. However, diet-induced obesity is an overwhelming and potent stimulus for the development of CKD that is not potentiated by maternal obesity.
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Affiliation(s)
- Sarah J. Glastras
- Department of Medicine, Kolling Institute, University of Sydney, Sydney, Australia
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Hui Chen
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, Australia
| | - Michael Tsang
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, Australia
| | - Rachel Teh
- Department of Medicine, Kolling Institute, University of Sydney, Sydney, Australia
| | - Rachel T. McGrath
- Department of Medicine, Kolling Institute, University of Sydney, Sydney, Australia
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Amgad Zaky
- Department of Medicine, Kolling Institute, University of Sydney, Sydney, Australia
| | - Jason Chen
- Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Muh Geot Wong
- Department of Medicine, Kolling Institute, University of Sydney, Sydney, Australia
| | - Carol A. Pollock
- Department of Medicine, Kolling Institute, University of Sydney, Sydney, Australia
| | - Sonia Saad
- Department of Medicine, Kolling Institute, University of Sydney, Sydney, Australia
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Murphy MO, Herald JB, Wills CT, Unfried SG, Cohn DM, Loria AS. Postnatal treatment with metyrapone attenuates the effects of diet-induced obesity in female rats exposed to early-life stress. Am J Physiol Endocrinol Metab 2017; 312:E98-E108. [PMID: 27965205 PMCID: PMC5336565 DOI: 10.1152/ajpendo.00308.2016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 12/02/2016] [Accepted: 12/06/2016] [Indexed: 12/30/2022]
Abstract
Experimental studies in rodents have shown that females are more susceptible to exhibiting fat expansion and metabolic disease compared with males in several models of fetal programming. This study tested the hypothesis that female rat pups exposed to maternal separation (MatSep), a model of early-life stress, display an exacerbated response to diet-induced obesity compared with male rats. Also, we tested whether the postnatal treatment with metyrapone (MTP), a corticosterone synthase inhibitor, would attenuate this phenotype. MatSep was performed in WKY offspring by separation from the dam (3 h/day, postnatal days 2-14). Upon weaning, male and female rats were placed on a normal (ND; 18% kcal fat) or high-fat diet (HFD; 60% kcal fat). Nondisturbed littermates served as controls. In male rats, no diet-induced differences in body weight (BW), glucose tolerance, and fat tissue weight and morphology were found between MatSep and control male rats. However, female MatSep rats displayed increased BW gain, fat pad weights, and glucose intolerance compared with control rats (P < 0.05). Also, HFD increased plasma corticosterone (196 ± 51 vs. 79 ± 18 pg/ml, P < 0.05) and leptin levels (1.8 ± 0.4 vs. 1.3 ± 0.1 ng/ml, P < 0.05) in female MatSep compared with control rats, whereas insulin and adiponectin levels were similar between groups. Female control and MatSep offspring were treated with MTP (50 µg/g ip) 30 min before the daily separation. MTP treatment significantly attenuated diet-induced obesity risk factors, including elevated adiposity, hyperleptinemia, and glucose intolerance. These findings show that exposure to stress hormones during early life could be a key event to enhance diet-induced obesity and metabolic disease in female rats. Thus, pharmacological and/or behavioral inflection of the stress levels is a potential therapeutic approach for prevention of early life stress-enhanced obesity and metabolic disease.
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Affiliation(s)
- Margaret O Murphy
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky
| | - Joseph B Herald
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky
| | - Caleb T Wills
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky
| | - Stanley G Unfried
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky
| | - Dianne M Cohn
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky
| | - Analia S Loria
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky
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244
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Tonneijck L, Muskiet MHA, Smits MM, van Bommel EJ, Heerspink HJL, van Raalte DH, Joles JA. Glomerular Hyperfiltration in Diabetes: Mechanisms, Clinical Significance, and Treatment. J Am Soc Nephrol 2017; 28:1023-1039. [PMID: 28143897 DOI: 10.1681/asn.2016060666] [Citation(s) in RCA: 476] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
An absolute, supraphysiologic elevation in GFR is observed early in the natural history in 10%-67% and 6%-73% of patients with type 1 and type 2 diabetes, respectively. Moreover, at the single-nephron level, diabetes-related renal hemodynamic alterations-as an adaptation to reduction in functional nephron mass and/or in response to prevailing metabolic and (neuro)hormonal stimuli-increase glomerular hydraulic pressure and transcapillary convective flux of ultrafiltrate and macromolecules. This phenomenon, known as glomerular hyperfiltration, classically has been hypothesized to predispose to irreversible nephron damage, thereby contributing to initiation and progression of kidney disease in diabetes. However, dedicated studies with appropriate diagnostic measures and clinically relevant end points are warranted to confirm this assumption. In this review, we summarize the hitherto proposed mechanisms involved in diabetic hyperfiltration, focusing on ultrastructural, vascular, and tubular factors. Furthermore, we review available evidence on the clinical significance of hyperfiltration in diabetes and discuss currently available and emerging interventions that may attenuate this renal hemodynamic abnormality. The revived interest in glomerular hyperfiltration as a prognostic and pathophysiologic factor in diabetes may lead to improved and timely detection of (progressive) kidney disease, and could provide new therapeutic opportunities in alleviating the renal burden in this population.
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Affiliation(s)
- Lennart Tonneijck
- Diabetes Center, Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands;
| | - Marcel H A Muskiet
- Diabetes Center, Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Mark M Smits
- Diabetes Center, Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Erik J van Bommel
- Diabetes Center, Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacology, University Medical Center Groningen, Groningen, The Netherlands; and
| | - Daniël H van Raalte
- Diabetes Center, Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Jaap A Joles
- Department of Nephrology and Hypertension, University Medical Center, Utrecht, The Netherlands
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245
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Bie P, Evans RG. Normotension, hypertension and body fluid regulation: brain and kidney. Acta Physiol (Oxf) 2017; 219:288-304. [PMID: 27214656 DOI: 10.1111/apha.12718] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 01/13/2016] [Accepted: 05/17/2016] [Indexed: 01/11/2023]
Abstract
The fraction of hypertensive patients with essential hypertension (EH) is decreasing as the knowledge of mechanisms of secondary hypertension increases, but in most new cases of hypertension the pathophysiology remains unknown. Separate neurocentric and renocentric concepts of aetiology have prevailed without much interaction. In this regard, several questions regarding the relationships between body fluid and blood pressure regulation are pertinent. Are all forms of EH associated with sympathetic overdrive or a shift in the pressure-natriuresis curve? Is body fluid homoeostasis normally driven by the influence of arterial blood pressure directly on the kidney? Does plasma renin activity, driven by renal nerve activity and renal arterial pressure, provide a key to stratification of EH? Our review indicates that (i) a narrow definition of EH is useful; (ii) in EH, indices of cardiovascular sympathetic activity are elevated in about 50% of cases; (iii) in EH as in normal conditions, mediators other than arterial blood pressure are the major determinants of renal sodium excretion; (iv) chronic hypertension is always associated with a shift in the pressure-natriuresis curve, but this may be an epiphenomenon; (v) plasma renin levels are useful in the analysis of EH only after metabolic standardization and then determination of the renin function line (plasma renin as a function of sodium intake); and (vi) angiotensin II-mediated hypertension is not a model of EH. Recent studies of baroreceptors and renal nerves as well as sodium intake and renin secretion help bridge the gap between the neurocentric and renocentric concepts.
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Affiliation(s)
- P. Bie
- Department of Cardiovascular and Renal Research; Institute of Molecular Medicine; University of Southern Denmark; Odense Denmark
- Cardiovascular Disease Program; Biomedicine Discovery Institute and Department of Physiology; Monash University; Melbourne Vic. Australia
| | - R. G. Evans
- Cardiovascular Disease Program; Biomedicine Discovery Institute and Department of Physiology; Monash University; Melbourne Vic. Australia
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Khidir N, Al Dhaheri M, El Ansari W, Al Kuwari M, Sargsyan D, Bashah M. Outcomes of Laparoscopic Gastric Greater Curvature Plication in Morbidly Obese Patients. J Obes 2017; 2017:7989714. [PMID: 28900545 PMCID: PMC5576404 DOI: 10.1155/2017/7989714] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 05/14/2017] [Accepted: 07/16/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Laparoscopic gastric greater curvature plication (LGGCP) is a restrictive bariatric procedure without gastrectomy. However, limited literature on effectiveness of gastric plication exists. OBJECTIVES We assessed LGGCP's efficacy, effects on associated comorbidities, safety and the rate of complications, and patient satisfaction with LGGCP's outcomes among morbidly obese patients. METHOD Analysis of retrospectively data collected from medical records of 26 patients who had undergone LGGCP at Hamad General Hospital, Qatar, during 2011-2012. RESULTS Most patients (92%) were Qatari nationals. The sample's mean age was 35.1 years. Mean duration of hospital stay was 3.9 ± 1.2 days. Mean preoperative BMI was 40.7 kg/m2 that decreased at 2 years to 34.6 kg/m2. LGGCP's effects on comorbidities were such that 7.6% of patients experienced resolutions of their comorbidities. There were no mortality or postoperative complications that required reoperation. Six patients (23%) were satisfied with the LGGCP's outcomes while 10 patients (38.5%) underwent sleeve gastrectomy subsequently. CONCLUSION LGGCP had acceptable short term weight loss results, exhibited almost no postoperative complications, and improved patients' comorbidities. Despite the durability of the gastric fold, some patients regained weight. Future research may assess the possibility of an increase in the gastric pouch size postplication associated with weight regain.
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Affiliation(s)
- N. Khidir
- Department of Metabolic & Bariatric Surgery, Hamad General Hospital, Doha, Qatar
- *N. Khidir:
| | - M. Al Dhaheri
- Department of Metabolic & Bariatric Surgery, Hamad General Hospital, Doha, Qatar
| | - W. El Ansari
- Department of Surgery, Hamad General Hospital, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- School of Health and Education, University of Skövde, Skövde, Sweden
| | - M. Al Kuwari
- Department of Metabolic & Bariatric Surgery, Hamad General Hospital, Doha, Qatar
| | - D. Sargsyan
- Department of Metabolic & Bariatric Surgery, Hamad General Hospital, Doha, Qatar
| | - M. Bashah
- Department of Metabolic & Bariatric Surgery, Hamad General Hospital, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
- Qatar Metabolic Institute, Doha, Qatar
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Abstract
The prevalence of obesity-related hypertension is high worldwide and has become a major health issue. The mechanisms by which obesity relates to hypertensive disease are still under intense research scrutiny, and include altered hemodynamics, impaired sodium homeostasis, renal dysfunction, autonomic nervous system imbalance, endocrine alterations, oxidative stress and inflammation, and vascular injury. Most of these contributing factors interact with each other at multiple levels. Thus, as a multifactorial and complex disease, obesity-related hypertension should be recognized as a distinctive form of hypertension, and specific considerations should apply in planning therapeutic approaches to treat obese individuals with high blood pressure.
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Affiliation(s)
- Dinko Susic
- Hypertension Research Laboratory, Ochsner Clinic Foundation, 1514 Jefferson Highway New Orleans, Louisiana 70121, USA
| | - Jasmina Varagic
- Hypertension & Vascular Research, Department of Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157, USA; Department of Physiology and Pharmacology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157, USA.
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248
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Mlodawska E, Tomaszuk-Kazberuk A, Lopatowska P, Waszkiewicz E, Bachorzewska-Gajewska H, Malyszko J, Michniewicz E, Dobrzycki S, Musial WJ. Matrix Metalloproteinase Neutrophil Gelatinase-Associated Lipocalin Complex Predicts Atrial Fibrillation Recurrence after Electrical Cardioversion in Obese Patients. Cardiorenal Med 2016; 7:11-20. [PMID: 27994598 DOI: 10.1159/000448225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 07/03/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There is not much data on matrix metalloproteinase neutrophil gelatinase-associated lipocalin (MMP-NGAL) complex in patients with atrial fibrillation (AF). AIM The aim of the study was to assess the value of MMP-NGAL complex in predicting AF recurrence after electrical cardioversion. METHODS The serum levels of NGAL, cystatin C, interleukin-6, high-sensitivity C-reactive protein, copeptin, MMP-NGAL complex, matrix metalloproteinase 2, tissue inhibitor of metalloproteinase 1, Von Willebrand factor, B-type natriuretic peptide and the urinary level of NGAL were evaluated before cardioversion. RESULTS A total of 83 patients with persistent AF were enrolled in the study. Left atrial diameter (LA) ≥4.5 cm was significantly associated with AF recurrence at follow-up (p = 0.009). In selected 39 obese patients, MMP-NGAL complex was associated with AF recurrence (p = 0.03). If the concentration of MMP-NGAL complex increased by 1 ng/ml, the odds of AF recurrence increased by 4% (OR 1.04; CI: 1.00-1.08; p = 0.03). MMP-NGAL complex did not correlate with AF recurrence in patients with a first episode of AF, in patients ≥65 years of age and in patients with a LA ≥4.5 cm or with chronic kidney disease. CONCLUSIONS It is known that the greater the BMI at baseline, the higher the likelihood of progression from paroxysmal to permanent AF. However, European Society of Cardiology (ESC) guidelines do not consider obese patients a population with a low likelihood of success of cardioversion. That is why we need a sensitive marker to predict sinus rhythm maintenance in such a population. We found that MMP-NGAL complex may predict AF recurrence after successful cardioversion in obese patients.
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Affiliation(s)
- Elzbieta Mlodawska
- Department of Cardiology, Medical University of Bialystok, Bialystok, Poland
| | | | - Paulina Lopatowska
- Department of Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Ewa Waszkiewicz
- Department of Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Hanna Bachorzewska-Gajewska
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland; Department of Clinical Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Jolanta Malyszko
- Department of Nephrology, Medical University of Bialystok, Bialystok, Poland
| | - Ewelina Michniewicz
- Department of Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Slawomir Dobrzycki
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
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Parto P, Lavie CJ, Arena R, Bond S, Popovic D, Ventura HO. Body habitus in heart failure: understanding the mechanisms and clinical significance of the obesity paradox. Future Cardiol 2016; 12:639-653. [DOI: 10.2217/fca-2016-0029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The prevalence of obesity among adults and children worldwide has reached epic proportions and has become a major independent risk factor for the development of heart failure (HF), in addition to a contributor of hypertension and cardiovascular disease. The implications of obesity in the development of HF involve adverse effects on cardiac structure and function. Despite all of this, in the setting of chronic HF, excess body mass is associated with improved clinical outcomes, demonstrating the presence of an obesity paradox. In this review, we will discuss the gender differences, global application, potential mechanisms and role of interventions based on fitness and purposeful weight loss as potential therapeutic strategies.
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Affiliation(s)
- Parham Parto
- Department of Cardiovascular Diseases, John Ochsner Heart & Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA 70121, USA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart & Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA 70121, USA
| | - Ross Arena
- Department of Physical Therapy, Department of Kinesiology & Nutrition & Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Samantha Bond
- Department of Biomedical & Health Information Sciences, College of Applied Science, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Dejana Popovic
- Clinic for Cardiology, University Clinical Center Serbia, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Hector O Ventura
- Department of Cardiovascular Diseases, John Ochsner Heart & Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA 70121, USA
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250
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Chade AR, Hall JE. Role of the Renal Microcirculation in Progression of Chronic Kidney Injury in Obesity. Am J Nephrol 2016; 44:354-367. [PMID: 27771702 DOI: 10.1159/000452365] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Obesity is largely responsible for the growing incidence and prevalence of diabetes, cardiovascular and renal diseases. Current strategies to prevent and treat obesity and its consequences have been insufficient to reverse the ongoing trends. Lifestyle modification or pharmacological therapies often produce modest weight loss which is not sustained and recurrence of obesity is frequently observed, leading to progression of target organ damage in many obese subjects. Therefore, research efforts have focused not only on the factors that regulate energy balance, but also on understanding mechanisms of target organ injury in obesity. Summary and Key Message: Microvascular (MV) disease plays a pivotal role in progressive kidney injury from different etiologies such as hypertension, diabetes, and atherosclerosis, which are all important consequences of chronic obesity. The MV networks are anatomical units that are closely adapted to specific functions of nutrition and removal of waste in every organ. Damage of the small vessels in several tissues and organs has been reported in obesity and may increase cardio-renal risk. However, the mechanisms by which obesity and its attendant cardiovascular and metabolic consequences interact to cause renal MV injury and chronic kidney disease are still unclear, although substantial progress has been made in recent years. This review addresses potential mechanisms and consequences of obesity-induced renal MV injury as well as current treatments that may provide protection of the renal microcirculation and slow progressive kidney injury in obesity.
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Affiliation(s)
- Alejandro R Chade
- Department of Physiology and Biophysics, Center for Excellence in Cardiovascular-Renal Research, University of Mississippi Medical Center, Jackson, Miss., USA
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