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Gracchi V, van den Belt SM, Corpeleijn E, Heerspink HJL, Verkade HJ. Albuminuria and markers for cardiovascular risk in 12-year-olds from the general Dutch population: a cross-sectional study. Eur J Pediatr 2023; 182:4921-4929. [PMID: 37606701 PMCID: PMC10640422 DOI: 10.1007/s00431-023-05152-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/01/2023] [Accepted: 08/06/2023] [Indexed: 08/23/2023]
Abstract
In adults, albuminuria represents a risk factor for cardiovascular disease and is associated with hypertension and obesity. Pediatric data from the general population are inconsistent and largely based on randomly collected urine. A possible association between antenatal programming and albuminuria at school age has still to be investigated. The purpose of this study is to assess albuminuria in first morning void urine samples in a population-based pediatric cohort and to investigate cross-sectionally the association with factors related to cardiovascular risk. Moreover, we investigate the possible association of antenatal factors with albuminuria. A first morning void urine sample was collected in the population-based GECKO (Groningen Expert Center for Kids with Obesity) Drenthe cohort at the age of 12 years. We investigated cross-sectionally associations between albuminuria and body mass index (BMI), waist circumference (WC), blood pressure (BP) and antenatal factors. The prevalence of UACR (urinary albumin-creatinine ratio) ≥ 3 mg/mmol was 3.3% (95%CI 2.3-4.2). In a multivariate linear regression model, UAC was negatively associated with z-BMI (β-0.08, p = 0.013) and positively with z-systolic BP (β 0.09, p = 0.006), model significance p = 0.002. UACR was negatively associated with z-BMI (β - 0.13, p < 0.001) and positively with z-diastolic BP (β 0.09, p = 0.003), model significance p = 0.001. Albuminuria was not significantly associated with antenatal factors such as gestational age and standardized birth weight. CONCLUSIONS Albuminuria in first morning void urine in 12-year-olds has a lower prevalence than previously reported by randomly collected samples. A negative association between albuminuria and BMI is confirmed. A positive association with blood pressure, but no association with antenatal factors was found. WHAT IS KNOWN • While, in adults, albuminuria is a recognized risk factor for cardiovascular disease and is associated with hypertension and obesity, pediatric data are inconsistent and largely based on randomly collected urine. • A possible association between antenatal programming and albuminuria at school age has still to be investigated. WHAT IS NEW • In this population study on first morning void urine samples from 12-year-olds of the general population, albuminuria is negatively associated with body mass index, and positively associated with blood pressure, while there is no association with antenatal factors. • The prevalence of albuminuria at 12 years is lower than previously reported in studies based on randomly collected urine samples, probably due to elimination of orthostatic proteinuria.
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Affiliation(s)
- Valentina Gracchi
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, P.O. Box 30.001 - CA13, 9700RB, Groningen, The Netherlands.
| | - Sophie M van den Belt
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700RB, Groningen, The Netherlands
| | - Eva Corpeleijn
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700RB, Groningen, The Netherlands
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700RB, Groningen, The Netherlands
| | - Henkjan J Verkade
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, P.O. Box 30.001 - CA13, 9700RB, Groningen, The Netherlands
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Powers Carson J, Arora J. Glycated serum proteins and albumin but not glycated albumin show negative correlation with BMI in an overweight/obese, diabetic population from the United States. Clin Biochem 2023; 120:110654. [PMID: 37757966 PMCID: PMC10809425 DOI: 10.1016/j.clinbiochem.2023.110654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/01/2023] [Accepted: 09/24/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND AND AIMS Multiple previously published studies have shown a weak to medium, negative correlation between BMI and glycated albumin (GA). However, many of these studies were in populations with a narrow range of BMI. It is unknown whether this trend exists if a wider BMI range is used. This is an important question for proper interpretation of GA levels in obese populations. MATERIALS AND METHODS A retrospective analysis of clinical trial data (NCT02519309) was performed. After appropriate exclusions, 334 subjects remained. These included 73.7% with type 2 diabetes (T2D) diagnosis and 26.3% with prediabetes. BMI ranged from 24.8-86.9 kg/m2. Laboratory data were measured in a CLIA-certified laboratory using commercially available, automated methods. RESULTS No significant, negative correlation was seen between GA and BMI. However, individual components (glycated serum proteins and albumin) as well as the GA/HbA1c ratio show a weak, negative correlation with BMI for all subjects and those with T2D. The strongest negative correlation was with albumin. Examination by traditional BMI subgroups also showed statistically significant differences for those with T2D, but not for the prediabetic cohort. Correlations between BMI and C-reactive protein were similar in those with diabetes and prediabetes; however, correlation between BMI and insulin was stronger in those with diabetes. CONCLUSION Negative correlations between BMI and albumin or BMI and glycated serum proteins persist in diabetic populations that are obese and overweight, even when a statistically significant negative correlation is not observed between BMI and GA. Inflammation or insulin-mediated changes in protein synthesis could be contributors to these negative correlations, but BMI-related changes to the glomerulus could also affect clearance of albumin or glycated proteins and should be examined.
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Affiliation(s)
- Jennifer Powers Carson
- Division of Endocrinology, Metabolism, and Lipid Research, Department of Medicine, 660 S. Euclid Ave., Washington University School of Medicine, St. Louis, MO 63110, USA.
| | - Jyoti Arora
- Center for Biostatistics and Data Science, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA
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Zhang JW, Lin Y, Liu YM, Wang MM, Gong JG, Shen XG, Shen QQ, Lin B, Su WE, Gao YC, Yuan CY, Pan ZH, Zhu B. Excess selenium intake is associated with microalbuminuria in female but not in male among adults with obesity: Results from NHANES 2009-2018. Front Nutr 2023; 10:1043395. [PMID: 36761214 PMCID: PMC9907462 DOI: 10.3389/fnut.2023.1043395] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/09/2023] [Indexed: 01/27/2023] Open
Abstract
Introduction Selenium is a critical trace element with antioxidant activities that has been related to the preservation of kidney function. Few studies, however, have looked at the effects of excess selenium on kidneys. The purpose of the present study was performed to investigate the relationship between dietary selenium intake and the prevalence of microalbuminuria in American adults with obesity. Methods A total of 8,547 participants with obesity in the National Health and Nutrition Examination Survey (NHANES) with the age of 19 years or older were included in the present study. Multivariable regression and subgroup analyses were performed to examine the association between dietary selenium and microalbuminuria in the two genders, separately. A selenium intake above the median was defined as high selenium intake. Results Dietary selenium intake was significantly higher in men compared to women (139.49 μg/day vs. 101.06 μg/day; P < 0.0001). Among female participants, the prevalence of microalbuminuria was significantly higher in participants with a high selenium intake compared with those without a high selenium intake (13.82 vs. 9.96%; P = 0.008), whereas this difference did not exist in male participants (10.79 vs. 11.97%; P = 0.40). Dietary selenium is not significantly correlated with microalbuminuria (P = 0.68) in the male population, whereas each 1 μg/day of increase in selenium consumption was independently associated with a 6h higher risk of microalbuminuria (OR = 1.006; 95% CI, 1.001-1.011, P = 0.01) in females. Conclusion According to our research, excessive selenium consumption is positively correlated with microalbuminuria in females with obesity, but not in males with obesity.
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Affiliation(s)
- Jia-wei Zhang
- Department of Nephrology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China,Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang Chinese Medical University, Hangzhou, China,The Third College of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yi Lin
- Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Yue-min Liu
- Department of Nephrology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Min-min Wang
- Department of Nephrology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Jian-guang Gong
- Department of Nephrology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Xiao-gang Shen
- Department of Nephrology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Quan-quan Shen
- Department of Nephrology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Bo Lin
- Department of Nephrology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Wei-er Su
- The Third College of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuan-cheng Gao
- Department of Nephrology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China,Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang Chinese Medical University, Hangzhou, China,The Third College of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Chen-yi Yuan
- Department of Nephrology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China,Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang Chinese Medical University, Hangzhou, China,The Third College of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhi-hui Pan
- Department of Nephrology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China,Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine (Guangxing Hospital), Affiliated to Zhejiang Chinese Medical University, Hangzhou, China,The Third College of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Bin Zhu
- Department of Nephrology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China,*Correspondence: Bin Zhu,
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Kang M, Kwon S, Lee J, Shin JI, Kim YC, Park JY, Bae E, Kim EY, Kim DK, Lim CS, Lee JP. Albuminuria within the Normal Range Can Predict All-Cause Mortality and Cardiovascular Mortality. KIDNEY360 2022; 3:74-82. [PMID: 35368577 PMCID: PMC8967601 DOI: 10.34067/kid.0003912021] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/05/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Despite interest in low-grade albuminuria and poor clinical outcomes, evidence from a large-scale population is lacking. Therefore, we identified the association of low-grade albuminuria within the normal range with all-cause and cardiovascular (CV) mortality. METHODS After excluding individuals with urine albumin-creatinine ratio (ACR) ≥30 mg/g (n=6094), this cohort study analyzed 43,396 adults who participated in the National Health and Nutrition Examination Survey (1999-2016). Participants were divided into four quartiles of ACR. The primary outcome was all-cause mortality, and the secondary outcome was CV mortality. Multivariable Cox proportional hazards models were used. RESULTS During a median 7.9 years of follow-up, 3516 (9%) participants died. Compared with the reference group (Q1, ACR <4.171 mg/g), low-grade albuminuria groups were associated with all-cause mortality (Q3, ACR ≥6.211 to <10.010 mg/g, hazard ratio [HR], 1.25 [95% CI, 1.11 to 1.41]; Q4, ACR ≥10.010 mg/g, HR, 1.57 [95% CI, 1.41 to 1.76]) in a multivariable hazards model. A similar pattern was also seen in the association of low-grade albuminuria with CV mortality. Subgroup analyses showed that low-grade albuminuria was also associated with all-cause mortality in the nondiabetic group, nonhypertensive group, and non-CKD group (eGFR ≥60 ml/min per 1.73 m2). CONCLUSIONS Our findings suggest that low-grade albuminuria is associated with all-cause and CV mortality. Low-grade albuminuria should be monitored, even for patients with low CV risk.
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Affiliation(s)
- Minjung Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Soie Kwon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jeonghwan Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jung-Im Shin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Yoon Park
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Eunjin Bae
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
- Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Korea
| | - Eun Young Kim
- Mental Health Center, Seoul National University Health Care Center, Seoul, Korea
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
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Elgendy H, Youssef T, Banjar A, Elmorsy S. Decreased Analgesic Requirements in Super Morbidly Versus Morbidly Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy. Obes Surg 2021; 30:2715-2722. [PMID: 32246413 PMCID: PMC7260144 DOI: 10.1007/s11695-020-04559-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background Scarce data exists about analgesic requirements in super morbidly obese (SMO) patients who underwent sleeve gastrectomy. We attempted to investigate analgesic requirements for SMO, when compared with morbidly obese (MO) individuals who underwent sleeve gastrectomy and its impact on postoperative outcome. Methods We studied 279 consecutive patients (183 MO, 96 SMO) who underwent bariatric surgery. Data analysis included perioperative anaesthetic management, analgesic consumptions, opioids side effects, and ICU admission. Results The SMO group showed higher patients with asthma, epilepsy, obstructive sleep apnoea (OSA), and ASA III percentages (P = 0.014, P = 0.016, P ˂ 0.001, and P ˂ 0.001, respectively). There were no significant differences in the total morphine consumption intraoperatively, or after 24 h. However, reduced consumption of intraoperative fentanyl and morphine in SMO when calculated per total body weight (TBW) (P = 0.004 and P = 0.001, respectively). At PACU, tramadol consumption per TBW and lean body mass (LBM) were significantly reduced in SMO (P = 0.001 and P = 0.025, respectively). Paracetamol consumption was significantly reduced in the SMO group (P = 0.04). They showed higher comorbidities (P ˂ 0.001), longer anaesthesia time (P = 0.033), and greater ICU admissions (P ˂ 0.001). Vomiting was higher in the MO group (P = 0.004). Both groups showed comparable pain scores (P = 0.558) and PACU stay time (P = 0.060). Conclusions Super morbidly obese patients required fewer opioids and analgesics perioperatively. They exhibited higher comorbidities with greater anaesthesia time and ICU admissions. PACU stay time and pain scores were comparable.
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Affiliation(s)
- Hamed Elgendy
- Department of Anaesthesia, Assiut University Hospitals, Assiut, Egypt. .,Anaesthesia Dept., Al Wakrah Hospital, HAMAD Medical Corporation, P.O. Box 82228, Doha, Qatar. .,Qatar University & Weill Cornel Medicine Qatar, Doha, Qatar.
| | - Talha Youssef
- Internal Medicine Department, Prince Mohammad Bin Abdul-Aziz Hospital, Ministry of National Guard, Al Madinah, Saudi Arabia
| | - Ahmad Banjar
- Umm Al Qura University & King Abdullah Medical City, Internship Program, Makkah, Makkah, Saudi Arabia
| | - Soha Elmorsy
- Medical Pharmacology, Faculty of Medicine, Cairo University, Giza, Egypt
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Ren M, You L, Lin D, Feng Q, Huang C, Li F, Qi Y, Feng W, Yang C, Yan L, Sun K. Association of metabolic syndrome with the incidence of low-grade albuminuria: a cohort study in middle-aged and elderly Chinese adults. Aging (Albany NY) 2021; 13:7350-7360. [PMID: 33686966 PMCID: PMC7993658 DOI: 10.18632/aging.202592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/14/2021] [Indexed: 11/30/2022]
Abstract
Background: Individuals with metabolic syndrome have elevated risks of micro- and macro-albuminuria as well as chronic kidney disease (CKD). Objective: To assess the influence of metabolic abnormalities on the presence of low-grade albuminuria (below the threshold for microalbuminuria). Design, participants, and main outcome measures: This community-based cohort study included 3,935 eligible individuals aged 40 years or older. The presence of low-grade albuminuria was detected in those without micro- or macro-albuminuria and analyzed according to the highest quartile of the baseline urinary albumin-to-creatinine ratio (ACR ≥11.13 mg/g). CKD was defined by an estimated glomerular filtration rate <60 mL/min/1.73 m2 or the new presence of albuminuria (ACR ≥30 mg/g). Results: Overall, 577 (14.7%) participants developed low-grade albuminuria and 164 (4.2%) participants developed CKD during a mean follow-up period of 3.6 years. Compared with participants without metabolic syndrome, those with metabolic syndrome had greater risks of low-grade albuminuria [adjusted odd ratio (OR) and 95% confidence interval (95% CI): 1.30 (1.05–1.61)] and CKD [1.71 (1.20–2.44)]. Moreover, the incidence rates of low-grade albuminuria and CKD increased as the number of metabolic syndrome components increased (P for trend <0.0001). Conclusions: The presence of metabolic syndrome is associated with increased incidence rates of low-grade albuminuria and CKD the middle-aged and elderly Chinese populations.
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Affiliation(s)
- Meng Ren
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, People' s Republic of China
| | - Lili You
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, People' s Republic of China
| | - Diaozhu Lin
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, People' s Republic of China
| | - Qiling Feng
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, People' s Republic of China
| | - Chulin Huang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, People' s Republic of China
| | - Feng Li
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, People' s Republic of China
| | - Yiqin Qi
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, People' s Republic of China
| | - Wanting Feng
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, People' s Republic of China
| | - Chuan Yang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, People' s Republic of China
| | - Li Yan
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, People' s Republic of China
| | - Kan Sun
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, People' s Republic of China
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Qin S, Wang A, Gu S, Wang W, Gao Z, Tang X, Yan L, Wan Q, Luo Z, Qin G, Chen L, Ning G, Mu Y. Association between obesity and urinary albumin-creatinine ratio in the middle-aged and elderly population of Southern and Northern China: a cross-sectional study. BMJ Open 2021; 11:e040214. [PMID: 33402405 PMCID: PMC7786798 DOI: 10.1136/bmjopen-2020-040214] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The relationship between obesity and albuminuria has not been clarified. This study aimed to investigate the correlation between obesity and the urinary albumin-creatinine ratio (UACR) in Southern and Northern China. DESIGN A descriptive, cross-sectional study. SETTING Eight regional centres in REACTION (China's Risk Evaluation of cAncers in Chinese diabeTic Individuals, a lONgitudinal study), including Dalian, Lanzhou, Zhengzhou, Guangzhou, Guangxi, Luzhou, Shanghai and Wuhan. PARTICIPANTS A total of 41 085 patients who were not diagnosed with chronic kidney disease (CKD) and had good compliance were selected according to the inclusion criteria. Patients who were diagnosed with CKD, who had other kidney diseases that could lead to increased urinary protein excretion, who were using angiotensin-converting-enzyme inhibitors or angiotensin II receptor blockers and whose important data were missing were excluded. RESULTS Participants with both, central and peripheral obesity, had a higher risk of elevated UACR, even after adjusting for multiple factors (OR: 1.14, 95% CI: 1.07 to 1.12, p<0.001), and the risk of high UACR in the South was more prominent than that in the North (OR South: 1.22, 95% CI: 1.11 to 1.34; OR North: 1.13, 95% CI: 1.04 to 1.22, p<0.001). The risk was also elevated in the male population, hypertensive individuals, glycosylated haemoglobin (HbA1c)≥6.5% and age ≥60 years in the South. Besides the above groups, diabetes was also a risk factor for the Northern population. CONCLUSIONS In China, people with both central and peripheral obesity are prone to a high UACR, and the southern population has a higher risk than northern population. Factors such as male sex, hypertension, HbA1c≥6.5% and an age ≥60 years are also risk factors for CKD.
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Affiliation(s)
- Shan Qin
- Department of Endocrinology, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Anping Wang
- Department of Endocrinology, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Shi Gu
- School of Medicine, Nankai University, Tianjin, China
| | - Weiqing Wang
- Department of Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Zhengnan Gao
- Department of Endocrinology, Dalian Municipal Central Hospital, Dalian, Liaoning, China
| | - Xulei Tang
- Department of Endocrinology, First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Li Yan
- Department of Endocrinology, Sun Yat‑sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qin Wan
- Department of Endocrinology, Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan, China
| | - Zuojie Luo
- Department of Endocrinology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Guijun Qin
- Department of Endocrinology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Lulu Chen
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Guang Ning
- Department of Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Yiming Mu
- Department of Endocrinology, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
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Jian C, Xu Y, Shen Y, Wang Y, Ma X, Bao Y. Association Between Neck Circumference and Microalbuminuria in Community Residents. Diabetes Metab Syndr Obes 2021; 14:2407-2414. [PMID: 34093027 PMCID: PMC8169818 DOI: 10.2147/dmso.s313202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/04/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Neck circumference (NC) represents the subcutaneous fat deposition in the neck and is an effective indicator for evaluating metabolic disorders, such as metabolic syndrome, subclinical atherosclerosis, and non-alcoholic fatty liver disease. Microalbuminuria (MAU) is regarded as a potential sign of systemic endothelial dysfunction and microvascular abnormalities. The aim of this study was to elucidate the association of NC with urine albumin-to-creatinine ratio (UACR) and MAU. METHODS A total of 1882 Shanghai community residents were enrolled (816 men and 1066 women), with age ranging from 40 to 80 years. Anthropometric parameters, including NC, and biochemical indices were measured. MAU was determined if 30 mg/g ≤ UACR < 300 mg/g. An elevated NC was defined as NC ≥ 38.5 cm for men and NC ≥ 34.5 cm for women. RESULTS Individuals with an elevated NC had significantly higher prevalence of MAU and UACR values than those with normal NC in both men and women (all P < 0.05). The logistic regression analysis showed that there were significant and positive associations between elevated NC and the increasing risk of MAU after adjusting for lipid profile and glycemic indices (P = 0.007 for men and P = 0.009 for women). After further adjusting for blood pressure, elevated NC caused an 69.3% additional risk of MAU in men (P = 0.037) and the positive correlation in women disappeared (P = 0.131). CONCLUSION There was an independent and positive association between elevated NC and the risk of MAU in men in the Chinese community population. CHINESE CLINICAL TRIAL REGISTRY WWWCHICTRORGCN REGISTRATION NUMBER ChiCTR1900024011.
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Affiliation(s)
- Chaohui Jian
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Clinical Center for Diabetes; Shanghai Key Clinical Center for Metabolic Disease; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, 200233, People’s Republic of China
| | - Yiting Xu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Clinical Center for Diabetes; Shanghai Key Clinical Center for Metabolic Disease; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, 200233, People’s Republic of China
| | - Yun Shen
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Clinical Center for Diabetes; Shanghai Key Clinical Center for Metabolic Disease; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, 200233, People’s Republic of China
| | - Yufei Wang
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Clinical Center for Diabetes; Shanghai Key Clinical Center for Metabolic Disease; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, 200233, People’s Republic of China
| | - Xiaojing Ma
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Clinical Center for Diabetes; Shanghai Key Clinical Center for Metabolic Disease; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, 200233, People’s Republic of China
- Correspondence: Xiaojing Ma; Yuqian Bao Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Diabetes Institute, 600 Yishan Road, Shanghai, 200233, People’s Republic of ChinaTel +86-21-64369181Fax +86-21-64368031 Email ;
| | - Yuqian Bao
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Clinical Center for Diabetes; Shanghai Key Clinical Center for Metabolic Disease; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, 200233, People’s Republic of China
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9
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Landecho MF, Alegría-Murillo L, López-Fidalgo J, Colina I, Santesteban V, García-Unciti M, Beloqui O, Frühbeck G, Cuervo M. Unravelling gender-specific factors that link obesity to albuminuria. Eur J Clin Invest 2020; 50:e13307. [PMID: 32511747 DOI: 10.1111/eci.13307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Obesity is a major public health problem, which continues to be diagnosed and classified by BMI, excluding the most elemental concepts of the precision medicine approach. Obesity does not equally affect males and females, even with the same BMI. Microalbuminuria is a risk marker of cardiovascular disease closely related to obesity. The aim of this study was to evaluate the gender-dependent differences in the development of early obesity-related disease, focusing on pathologic microalbuminuria (PMA). MATERIAL AND METHODS We developed a single-centre cross-sectional study including 1068 consecutive adults from May 2016 to January 2018, divided into two groups: one including the first 787 patients attended, evaluated as a description population; the second group included 281 subjects analysed as an external validation population. Collected data included medical history, anthropometric measures, abdominal bioimpedance and routine laboratory tests. RESULTS First, we confirmed the lack of accuracy of classic obesity measures in predicting microalbuminuria. Second, we tested the utility of a tailored evaluation to predict PMA, with an area under the ROC curve of 0.78 for females and 0.82 for males. We also confirmed the different physiology of visceral adiposity for males when compared to females, in which small variations of fat mass entail major changes in the clinical repercussion. Third, we performed an external validation of our results, achieving a 77% accuracy rate. CONCLUSIONS Our findings support that there is an individual threshold of fat amount necessary to develop obesity-dependent PMA and that gender plays a major role in the interplay between PMA and adiposity.
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Affiliation(s)
- Manuel F Landecho
- General Health Check-up Unit, Internal Medicine Department, Clinica Universidad de Navarra, Pamplona, Spain
| | | | | | - Inmaculada Colina
- General Health Check-up Unit, Internal Medicine Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Virginia Santesteban
- General Health Check-up Unit, Internal Medicine Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Marisol García-Unciti
- General Health Check-up Unit, Internal Medicine Department, Clinica Universidad de Navarra, Pamplona, Spain.,Department of Nutrition, Food Science and Physiology, Universidad de Navarra, Pamplona, Spain
| | - Oscar Beloqui
- General Health Check-up Unit, Internal Medicine Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Gema Frühbeck
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Madrid, Spain.,Metabolic Research Laboratory, Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, Pamplona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain
| | - Marta Cuervo
- General Health Check-up Unit, Internal Medicine Department, Clinica Universidad de Navarra, Pamplona, Spain.,Department of Nutrition, Food Science and Physiology, Universidad de Navarra, Pamplona, Spain.,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.,Center for Nutrition Research, Universidad de Navarra, Pamplona, Spain
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10
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Effects of low skeletal muscle mass and sarcopenic obesity on albuminuria: a 7-year longitudinal study. Sci Rep 2020; 10:5774. [PMID: 32238873 PMCID: PMC7113302 DOI: 10.1038/s41598-020-62841-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 03/19/2020] [Indexed: 12/25/2022] Open
Abstract
We aimed to identify the association between low skeletal muscle, sarcopenic obesity, and the incidence of albuminuria in the general population using a longitudinal study. Data from 29,942 subjects who underwent two or more routine health examinations from 2006 to 2013 were retrospectively reviewed. Relative skeletal muscle mass was presented using the skeletal muscle mass index (SMI), a measure of body weight-adjusted appendicular skeletal muscle mass estimated by bioelectrical impedance analysis. The cumulative incidence of albuminuria was 981 (3.3%) during the 7-year follow-up period. The hazard ratio of incident albuminuria was 1.44 (95% CI: 1.22–1.71, p for trend <0.001) in the lowest SMI tertile relative to the highest SMI tertile after multivariable adjustment. After additionally adjusting for general and central obesity, the hazard ratio was 1.35 (95% CI: 1.13–1.61, p for trend = 0.001) and 1.30 (95% CI: 1.08–1.56, p for trend = 0.003), respectively. Furthermore, the risk of developing albuminuria was much higher in the sarcopenic obesity group (HR: 1.49, 95% CI: 1.21–1.81, p for trend <0.001) compared to the other groups. Sarcopenic obesity, as well as low skeletal muscle, may lead to albuminuria in general populations.
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11
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Visceral adiposity index is associated with increased urinary albumin excretion: A population-based study. Clin Nutr 2018; 38:1332-1338. [PMID: 29895473 DOI: 10.1016/j.clnu.2018.05.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/19/2018] [Accepted: 05/29/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND The effects of visceral fat accumulation on the renal damage have drawn much attention. We aimed to investigate the possible relationship between visceral adiposity and albuminuria. METHODS We included information from a population-based study in 9473 subjects aged 40 years or older. As a novel and valid indicator for visceral adipose function, visceral adiposity index (VAI) was determined by gender-specific equations and calculated using simple anthropometric and functional parameters. Increased urinary albumin excretion was defined as albumin-to-creatinine ratio (ACR) 30 mg/g or greater. RESULTS The prevalence rate of increased urinary albumin excretion was 6.6% in this population and gradually increased across VAI quartiles. Participants with higher VAI had elevated age, blood pressure, cholesterol, fasting insulin and decreased high density lipoprotein cholesterol and estimated glomerular filtration rate (eGFR) level. In multivariate logistic regression analysis, the adjusted odds ratios (ORs) of increased urinary albumin excretion for increasing VAI quartiles were 1.00 (reference), 1.29 (95% confidence intervals [CI] 0.94-1.76), 1.46 (95% CI 1.08-1.97) and 1.79 (95% CI 1.33-2.41). In subgroup analysis and after multiple adjustments, significant relation between VAI level and prevalent increased urinary albumin excretion was detected in women, younger subjects, non-obesity subjects, those without diabetes and those with eGFR ≥60 ml/min per 1.73 m2. CONCLUSION Visceral fat accumulation evaluating by VAI is independently associated with increased urinary albumin excretion in middle-aged and elderly Chinese.
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12
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Tulmaç ÖB, Dağ ZÖ, Erdoğan F, Sayan CD, Sağsöz N. Association of body mass index and weight gain patterns with albumin excretion in pregnancy. J Obstet Gynaecol Res 2017; 44:384-389. [PMID: 29239056 DOI: 10.1111/jog.13548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 10/01/2017] [Indexed: 11/30/2022]
Abstract
AIM We examined body mass index (BMI) and gestational weight gain (GWG) patterns of pregnant women and investigated the impact of these factors on the urinary albumin-creatinine ratio (ACR) during pregnancy. METHODS The data of 163 women whose basal BMI and ACR were measured during the first trimester were used in this study. Body weight alone between 12-16 weeks and body weight together with ACR after 37 weeks of gestation were measured. RESULTS Overall, 46% of women were overweight or obese, 60.7% had excessive weight gain and 16.6% had inadequate weight gain. Only 22.7% of women gained weight within the recommended range. There was no difference in weight gain patterns with respect to BMI. ACR during the third trimester was significantly higher than during the first trimester (7.08 [0.00-1180.90] mg/g vs 4.73 [0.00-275.00] mg/g, respectively; P = 0.001). The ACR of obese women was higher than in normal weight subjects during the third trimester (16.79 mg/g [0.01-1180.90] vs 8.07 mg/g [0.10-402.14] respectively; adjusted P = 0.015). Both ACR change and third trimester ACR were weakly but significantly correlated with basal BMI (r: 0.228 P: 0.003 and r: 0.301 P < 0.001, respectively) but not with GWG or GWG rate. Basal BMI was not associated with first-trimester ACR. CONCLUSION Obesity is associated with an increase in urinary albumin excretion during the course of pregnancy. Distinction of this relationship during pregnancy offers an opportunity for further research on pathophysiological mechanisms. The alarmingly high rate of non-compliance with IOM guidelines in pregnant women is a concern. Prompt measures for counseling of women before and during pregnancy in order to maintain healthy weight are needed.
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Affiliation(s)
- Özlem B Tulmaç
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Zeynep Ö Dağ
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Funda Erdoğan
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Cemile D Sayan
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Nevin Sağsöz
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
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13
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Cho MH, Kim KS, Chung S. Microalbuminuria Is Associated with Lower Weight and Taller Height in Adolescence. TOHOKU J EXP MED 2017; 243:151-157. [PMID: 29129845 DOI: 10.1620/tjem.243.151] [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] [Indexed: 01/09/2023]
Abstract
Microalbuminuria (MA) is a well-known predictor of cardiovascular disease and mortality in adults. However, these relationships remain unclear in adolescents. A few studies on association between MA and obesity have been conducted in adolescents. However, the association between MA and growth parameters such as height has not been studied, despite the fact that adolescence is a period of rapid physiological change. We, therefore, aimed to evaluate the association between MA and growth parameters, and the association between MA and obesity related cardiovascular risk factors after adjusting for growth. The study included 1,459 adolescents (847 boys and 612 girls) aged 12-18 years who participated in the Korean National Health and Nutrition Examination Survey (2011-2013). A urine albumin/creatinine ratio (UACR) of 30-299 mg/g in a morning urine sample was considered to reflect MA. MA was detected in 53 (3.6%) including 24 girls. Height z-score of adolescents with MA was greater than that of normoalbuminuric adolescents (0.87 vs. 0.38; P < 0.01). Upon multiple regression analysis, UACR was associated with lower weight z-score (β = -0.100, P < 0.01) and higher height z-score (β = 0.069, P < 0.01). In term of cardiovascular risk factors, the UACR was not associated with fasting glucose, high-density-lipoprotein cholesterol, or triglyceride levels. Adolescents with MA tend to be thin and tall. MA is not a useful screening method for obesity-related cardiovascular risk in adolescents, but instead MA is associated with taller height and lower weight, growth-related parameters in adolescence.
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Affiliation(s)
- Myung Hyun Cho
- Department of Pediatrics, Konkuk University Medical Center
| | - Kyo Sun Kim
- Department of Pediatrics, Konkuk University Medical Center.,Department of Pediatrics, Konkuk University School of Medicine
| | - Sochung Chung
- Department of Pediatrics, Konkuk University Medical Center.,Department of Pediatrics, Konkuk University School of Medicine
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14
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Li Y, Shi J, Huang X, Wang R, Gu B, Liang P, Zhao S, Sun Y, Liu W, Deng Y, Xi L, Zhao D, Song D, Cao Y, Zhang Y, Gu W, Hong J. Glycated Hemoglobin is Independently Associated with Albuminuria in Young Nondiabetic People with Obesity: A Cross-Sectional Study. Med Sci Monit 2017; 23:2612-2618. [PMID: 28553987 PMCID: PMC5461886 DOI: 10.12659/msm.902450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The aim of this study was to explore the association between glycated hemoglobin (HbA1c) level and albuminuria in young nondiabetic people with obesity. Material/Methods A total of 537 young nondiabetic people with obesity were enrolled in this cross-sectional study, which was approved by the Rui-jin Hospital Ethics Committee. Albuminuria was defined as a urinary albumin-to-creatinine ratio (ACR) ≥30 mg/g. Multivariate logistic regression was used to analyze the association between HbA1c level and albuminuria. Results Urinary ACR progressively increased across the tertiles of HbA1c level (P for trend <0.05). HbA1c levels were positively associated with the risk of albuminuria in the logistic regression analysis after adjustment for confounding factors. The adjusted odds ratio (OR) for albuminuria was 3.72 (95% confidence interval [CI], 1.25–11.00; P=0.017) when comparing between the highest (≥5.7%) and lowest tertiles of HbA1c level (≤5.3%). Moreover, an increment of 1 SD in HbA1c level increased the risk of albuminuria in a fully adjusted model (OR, 1.73; 95% CI, 1.25–2.46). Conclusions These data suggest that HbA1c level was independently associated with albuminuria in young nondiabetic people with obesity.
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Affiliation(s)
- Yanli Li
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Key Laboratory for Endocrine Tumors, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China (mainland)
| | - Juan Shi
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Key Laboratory for Endocrine Tumors, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China (mainland)
| | - Xiaolin Huang
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Key Laboratory for Endocrine Tumors, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China (mainland)
| | - Rui Wang
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Key Laboratory for Endocrine Tumors, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China (mainland)
| | - Bin Gu
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Key Laboratory for Endocrine Tumors, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China (mainland)
| | - Peiwen Liang
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Key Laboratory for Endocrine Tumors, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China (mainland)
| | - Shaoqian Zhao
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Key Laboratory for Endocrine Tumors, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China (mainland)
| | - Yingkai Sun
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Key Laboratory for Endocrine Tumors, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China (mainland)
| | - Wen Liu
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Key Laboratory for Endocrine Tumors, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China (mainland)
| | - Yuying Deng
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Key Laboratory for Endocrine Tumors, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China (mainland)
| | - Liuqing Xi
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Key Laboratory for Endocrine Tumors, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China (mainland)
| | - Dandan Zhao
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Key Laboratory for Endocrine Tumors, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China (mainland)
| | - Dalong Song
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Key Laboratory for Endocrine Tumors, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China (mainland)
| | - Yanan Cao
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Key Laboratory for Endocrine Tumors, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China (mainland)
| | - Yifei Zhang
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Key Laboratory for Endocrine Tumors, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China (mainland)
| | - Weiqiong Gu
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Key Laboratory for Endocrine Tumors, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China (mainland)
| | - Jie Hong
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Key Laboratory for Endocrine Tumors, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China (mainland)
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