Dietary Advanced Glycation End Products and Risk of Chronic Kidney Disease

Dietary Advanced Glycation End Products and Risk of Overall and Cause-Specific Mortality: Results from the Golestan Cohort Study

Controversy exists regarding the association of dietary advanced glycation end products (dAGEs) with the risk of disease outcomes and mortality. We aimed to examine, prospectively, the association between dAGEs intake and the risk of overall and cause-specific mortality in the Golestan Cohort Study. The cohort was conducted between 2004 and 2008 in Golestan Province (Iran) recruiting 50,045 participants aged 40-75 years. Assessment of dietary intake over the last year was performed at baseline using a 116-item food frequency questionnaire. The dAGEs values for each individual were calculated based on published databases of AGE values of various food items. The main outcome was overall mortality at the time of follow-up (13.5 years). Hazard ratios (HRs) and 95% confidence intervals (CIs) for overall and cause-specific mortality were estimated according to the dAGEs quintiles. During 656, 532 person-years of follow-up, 5406 deaths in men and 4722 deaths in women were reported. Participants at the highest quintile of dAGE had a lower risk of overall mortality (HR: 0.89, 95% CI: 0.84, 0.95), CVD mortality (HR: 0.89, 95% CI: 0.84, 0.95), and death from other causes (HR: 0.89, 95% CI: 0.84, 0.95) compared to those in the first quintile after adjusting for confounders. We found no association of dAGEs with risk of mortality from cancer (all), respiratory and infectious diseases, and injuries. Our findings do not confirm a positive association between dAGEs and the risk of mortality in Iranian adults. There is still no agreement among studies investigating dAGEs and their health-related aspects. So, further high-quality studies are required to clarify this association.

Investigation on the contents of heat-induced hazards in commercial nuts

The purpose was to investigate the contents of heat-induced hazards by liquid chromatography-tandem mass spectrometry (LC-MS/MS) in 44 commercial nuts. Results showed that content ranges of Acrylamide (AA), 5-hydroxymethylfurfural (5-HMF), N^ε-carboxymethyl-lysine (CML), N^ε-carboxyethyl-lysine (CEL), 3-Deoxyglucosone (3-DG), Glyoxal (GO), and Methylglyoxal (MGO) were ND-123.57 µg/kg, 0.57-213.42 mg/kg, 3.18-18.67 mg/kg, 3.98-57.85 mg/kg, 1.5-133.86 mg/kg, 0.45-1.59 mg/kg and 0.29-13.84 mg/kg, respectively. Sunflower seeds contained more heat-induced hazards followed by pistachios, cashews, almonds, walnuts and hazelnuts. The content of 5-HMF was positively correlated with the content of 3-DG. CML exhibited positive correlation with content of GO while no correlation between CEL and MGO. Higher levels of 3-DG and 5-HMF were observed in nuts produced with sugar and honey. Deep processing had a stronger promoting effect on CML and CEL formation. These data could provide a crucial guide for consumers to select nut products which might reduce heat-induced hazards intake.

Accumulation of Advanced Glycation End-Products in the Body and Dietary Habits

The formation of advanced glycation end-products (AGE) in tissues is a physiological process; however, excessive production and storage are pathological and lead to inflammation. A sedentary lifestyle, hypercaloric and high-fructose diet and increased intake of processed food elements contribute to excessive production of compounds, which are created in the non-enzymatic multi-stage glycation process. The AGE’s sources can be endogenous and exogenous, mainly due to processing food at high temperatures and low moisture, including grilling, roasting, and frying. Accumulation of AGE increases oxidative stress and initiates various disorders, leading to the progression of atherosclerosis, cardiovascular disease, diabetes and their complications. Inborn defensive mechanisms, recovery systems, and exogenous antioxidants (including polyphenols) protect from excessive AGE accumulation. Additionally, numerous products have anti-glycation properties, occurring mainly in fruits, vegetables, herbs, and spices. It confirms the role of diet in the prevention of civilization diseases.

Advanced Glycation End Products (AGEs) and Chronic Kidney Disease: Does the Modern Diet AGE the Kidney?

Since the 1980s, chronic kidney disease (CKD) affecting all ages has increased by almost 25%. This increase may be partially attributable to lifestyle changes and increased global consumption of a “western” diet, which is typically energy dense, low in fruits and vegetables, and high in animal protein and ultra-processed foods. These modern food trends have led to an increase in the consumption of advanced glycation end products (AGEs) in conjunction with increased metabolic dysfunction, obesity and diabetes, which facilitates production of endogenous AGEs within the body. When in excess, AGEs can be pathological via both receptor-mediated and non-receptor-mediated pathways. The kidney, as a major site for AGE clearance, is particularly vulnerable to AGE-mediated damage and increases in circulating AGEs align with risk of CKD and all-cause mortality. Furthermore, individuals with significant loss of renal function show increased AGE burden, particularly with uraemia, and there is some evidence that AGE lowering via diet or pharmacological inhibition may be beneficial for CKD. This review discusses the pathways that drive AGE formation and regulation within the body. This includes AGE receptor interactions and pathways of AGE-mediated pathology with a focus on the contribution of diet on endogenous AGE production and dietary AGE consumption to these processes. We then analyse the contribution of AGEs to kidney disease, the evidence for dietary AGEs and endogenously produced AGEs in driving pathogenesis in diabetic and non-diabetic kidney disease and the potential for AGE targeted therapies in kidney disease.

A negative association of dietary advanced glycation end products with obesity and body composition in Iranian adults

Obesity caused by excessive deposited fat is generally classified as BMI ≥ 30 kg/m2. Research regarding the association between dietary advanced glycation end products (dAGE) and obesity is limited. The aim of the present study was to investigate the association between dAGE and obesity and body composition in Iranian adults. This cross-sectional study included 265 adults aged 18-75 years from Tehran, Iran. dAGE were estimated using a validated semi-quantitative FFQ, according to the published food carboxymethyl lysine-AGE database for 549 routinely consumed food items for the Northeastern American multiethnic urban population, and were reported by dividing total energy intake. Dietary intake, sociodemographic data and physical activity status were collected using validated questionnaires, and anthropometric characteristics were measured. Body composition was assessed by bioelectrical impedance analysis, and obesity was defined based on WHO guidelines. The intake of fat and meat was significantly increased in higher tertiles, compared with the first tertile of dAGE (P < 0·001). No association between dAGE and body composition measures and obesity was observed; however, there was a significant negative association between dAGE and BMI (BMI; P = 0·01), waist circumference (P = 0·01), waist:hip ratio (P = 0·03), fat-free mass (P = 0·02) and muscle mass index (P = 0·01) in non-linear models. In conclusion, higher consumption of dAGE was associated with increased intake of fat and meat and was negatively related to changes in body composition measurements. Therefore, dAGE may connect obesity to diet by energy imbalance.

Modifiable Lifestyle Factors for Primary Prevention of CKD: A Systematic Review and Meta-Analysis

BACKGROUND

Despite increasing incidence of CKD, no evidence-based lifestyle recommendations for CKD primary prevention apparently exist.

METHODS

To evaluate the consistency of evidence associating modifiable lifestyle factors and CKD incidence, we searched MEDLINE, Embase, CINAHL, and references from eligible studies from database inception through June 2019. We included cohort studies of adults without CKD at baseline that reported lifestyle exposures (diet, physical activity, alcohol consumption, and tobacco smoking). The primary outcome was incident CKD (eGFR<60 ml/min per 1.73 m²). Secondary outcomes included other CKD surrogate measures (RRT, GFR decline, and albuminuria).

RESULTS

We identified 104 studies of 2,755,719 participants with generally a low risk of bias. Higher dietary potassium intake associated with significantly decreased odds of CKD (odds ratio [OR], 0.78; 95% confidence interval [95% CI], 0.65 to 0.94), as did higher vegetable intake (OR, 0.79; 95% CI, 0.70 to 0.90); higher salt intake associated with significantly increased odds of CKD (OR, 1.21; 95% CI, 1.06 to 1.38). Being physically active versus sedentary associated with lower odds of CKD (OR, 0.82; 95% CI, 0.69 to 0.98). Current and former smokers had significantly increased odds of CKD compared with never smokers (OR, 1.18; 95% CI, 1.10 to 1.27). Compared with no consumption, moderate consumption of alcohol associated with reduced risk of CKD (relative risk, 0.86; 95% CI, 0.79 to 0.93). These associations were consistent, but evidence was predominantly of low to very low certainty. Results for secondary outcomes were consistent with the primary finding.

CONCLUSIONS

These findings identify modifiable lifestyle factors that consistently predict the incidence of CKD in the community and may inform both public health recommendations and clinical practice.

Dietary Intake of Nε-carboxymethyl-lysine, a Major Advanced Glycation End Product, is Not Associated with Increased Risk of Mortality in Japanese Adults in the Takayama Study

BACKGROUND

Although endogenous advanced glycation end products (AGEs) have been implicated in the development of various chronic diseases, whether AGEs in foods represent a risk to human health remains unknown.

OBJECTIVES

We aimed to estimate the intake of Nε-carboxymethyl-lysine (CML), a major AGE product, using a database of CML contents on LC-MS methods, and to examine CML's association with total and cause-specific mortality in Japanese adults.

METHODS

The analysis included 13,355 men and 15,724 women, aged 35 years and older, from the Takayama study. They responded to a self-administered questionnaire in 1992. Their diet, including the CML intake, was assessed using a food-frequency questionnaire at baseline. Mortality was ascertained during 16 years of follow-up. HRs and 95% CIs for mortality were estimated separately for men and women according to CMI quartiles.

RESULTS

We noted 2901 deaths in men and 2438 deaths in women during the follow-up. In men, as compared with the lowest quartile of intake, the highest quartile of CML was inversely associated with the risks of both total and non-cancer, non-cardiovascular disease mortality after controlling for covariates [HR = 0.89 (95% CI, 0.79-1.00; P-trend = 0.047) and HR = 0.74 (95% CI, 0.58-0.94; P-trend = 0.03), respectively]. However, stratified analyses showed both inverse and positive associations between CML intake and cause-specific mortality in women, depending on their characteristics. For example, years of education had a modifying effect on both the CML intake and non-cancer, non-cardiovascular disease mortality in women. In men, the associations of CML intake with mortality depended on food sources.

CONCLUSIONS

Overall, the present study does not support a positive association between CML intake and mortality in Japanese adults. The potential relevance of the food source of CML to the link between dietary CML and mortality warrants further attention.

Healthy eating recommendations: good for reducing dietary contribution to the body's advanced glycation/lipoxidation end products pool?

The present review aims to give dietary recommendations to reduce the occurrence of the Maillard reaction in foods and in vivo to reduce the body's advanced glycation/lipoxidation end products (AGE/ALE) pool. A healthy diet, food reformulation and good culinary practices may be feasible for achieving the goal. A varied diet rich in fresh vegetables and fruits, non-added sugar beverages containing inhibitors of the Maillard reaction, and foods prepared by steaming and poaching as culinary techniques is recommended. Intake of supplements and novel foods with low sugars, low fats, enriched in bioactive compounds from food and waste able to modulate carbohydrate metabolism and reduce body's AGE/ALE pool is also recommended. In conclusion, the recommendations made for healthy eating by the Spanish Society of Community Nutrition (SENC) and Harvard University seem to be adequate to reduce dietary AGE/ALE, the body's AGE/ALE pool and to achieve sustainable nutrition and health.

Dietary advanced glycation end products and the risk of postmenopausal breast cancer in the National Institutes of Health-AARP Diet and Health Study

BACKGROUND

Advanced glycation end products (AGEs) are reactive metabolites produced as a by-product of sugar metabolism and are consumed through the diet in high-fat and highly processed foods. They are associated with chronic inflammatory diseases, and evidence suggests that they play a role in carcinogenesis. The authors evaluated the association of dietary AGE intake and the risk of postmenopausal invasive breast cancer.

METHODS

This was a prospective cohort study of 183,548 postmenopausal women in the National Institutes of Health-AARP Diet and Health Study. The main outcome was incident invasive breast cancer. AGE intake was estimated from food-frequency questionnaires. Incident breast cancer cases were identified through state cancer registries. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals for developing breast cancer according to AGE intake quintiles. Multivariable regression models were adjusted for breast cancer risk factors.

RESULTS

The mean follow-up was 12.8 years, and 9851 breast cancers (1978 advanced stage) were identified. The median AGE daily intake was 5932 kilo units per 100 kilocalories (KU/1000 kcal). Women with higher intake tended to have lower education levels, higher body mass index, less physical activity, were current smokers, and had higher fat and meat intake. The highest quintile of AGE intake (compared with the lowest) was associated with an increased risk of breast cancer (HR, 1.09; 95% CI, 1.02-1.16; P = .03) after adjusting for breast cancer risk factors and particularly was associated with 37% of advanced-stage tumors (HR, 1.37; 95% CI, 1.09-1.74; P < .02) after adjusting for risk factors and fat and meat intake.

CONCLUSIONS

Dietary AGEs may play a role in the development of postmenopausal breast cancer.

Dietary Patterns and Risk of Chronic Kidney Disease Among Tehranian Adults with High Blood Pressure

BACKGROUND

Although high blood pressure is an important risk factor for chronic kidney disease (CKD), it remains unclear whether diet can still influence the risk of CKD in adults with high blood pressure.

OBJECTIVES

This study aimed at investigating the association between major dietary patterns and the incidence of CKD in adults with high blood pressure.

METHODS

In this cross-sectional study, we recruited 1,521 subjects aged ≥ 27 years with high blood pressure and with preserved estimated glomerular filtration rate at baseline, who participated in the fourth examination survey of the Tehran Lipid and Glucose Study. The principal component analysis was performed to derive dietary patterns. High blood pressure was defined as systolic blood pressure ≥ 120, diastolic blood pressure ≥ 80, or the current use of antihypertensive drugs. Multiple logistic regression analysis was applied to investigate the association between the dietary pattern scores and CKD risk.

RESULTS

After 3.6 years of follow-up, the incidence of CKD was 16.8%. Three dietary patterns were produced by using factor analysis, including the Western, the healthy, and the traditional Iranian dietary patterns. The healthy and the traditional Iranian dietary patterns were not related to the risk of CKD, but scoring on the Western dietary pattern was associated with enhanced odds of CKD, after being adjusted for relevant confounders (odds ratio: 2.12; 95% confidence interval: 1.19 - 3.76).

CONCLUSIONS

Results of this study provided evidence that a high score on the Western dietary pattern was associated with an increased risk of CKD in adults with high blood pressure.

Investigation of hallmarks of carbonyl stress and formation of end products in feline chronic kidney disease as markers of uraemic toxins

OBJECTIVES

Cats are commonly affected by chronic kidney disease (CKD). Many reactive carbonyl intermediates and end products originating from the oxidative stress pathways are recognised as uraemic toxins and may play a role in CKD progression. The aim of the present study is to confirm whether carbonyl end-product formation is higher in cats affected by CKD and to assess whether an angiotensin-converting enzyme inhibitor (ACEi) might affect these hallmarks.

METHODS

Twenty-two cats were divided into three groups: a control group (CG), cats with CKD and cats with CKD treated with an ACEi. Serum levels of pentosidine, carboxymethyllysine, advanced oxidation protein products, malondialdehyde, methylglyoxal and hexanoyl-lysine were measured. In addition, biochemical parameters and systolic blood pressure were evaluated. After checking for normality, comparisons between groups were performed followed by multiple comparison tests. P values ⩽0.05 were considered significant. Correlations between concentrations of the considered biomarkers and of the other metabolic parameters were investigated.

RESULTS

Advanced oxidation protein products, malondialdehyde and hexanoyl-lysine concentrations were significantly higher in CKD and ACEi-treated groups compared with the CG ( P <0.05). Carboxymethyllysine increased in the ACEi-treated group when compared with the CG, whereas intermediate values of these biomarkers were found in the CKD group ( P <0.05). The ACEi-treated group showed the highest values of carboxymethyllysine, advanced oxidation protein products and hexanoyl-lysine. By contrast, the CKD group had the highest concentration of malondialdehyde. No statistically significant difference was found in the levels of pentosidine or methylglyoxal. End products correlated with creatinine and urea and with each other.

CONCLUSIONS AND RELEVANCE

Significantly high concentrations of both intermediate and end products of carbonyl/oxidative stress were detected in CKD cats. This is the first study to have concurrently taken into account several uraemic toxins and biochemical parameters in cats affected by CKD.

Nutrition and Diabetes, Cardiovascular and Chronic Kidney Diseases: Findings from 20 Years of the Tehran Lipid and Glucose Study

CONTEXT

The high prevalence of chronic diseases can be prevented or managed by specific changes in lifestyle patterns of individuals of which dietary factors is emphasized. The objective of this study was to review all findings of the Tehran Lipid and Glucose Study regarding validity and reliability of food frequency questionnaire (FFQ), evaluating dietary quality and association of dietary factors in relation to diabetes, dysglycemia, cardiovascular (CVD) and chronic kidney disease (CKD).

EVIDENCE ACQUISITION

Related documents were searched through PubMed and Scopus databases, in English language from 2000 to 2017. Finally, 52 relevant documents were eligible for inclusion in this review.

RESULTS

The FFQ proved to be an acceptable tool for assessing nutrient and food group intakes and rank individuals accurately according to the levels of their dietary intakes. After 8 years of follow-up, the western dietary pattern (DP) was fairly stable but there was instability of traditional Iranian DP. DPs of over two-thirds of Tehranian populations were not in accordance with the dietary recommendations. Higher dietary scores of variety and healthy DPs were also associated with reduced odds of dysglycemia. The main dietary factor related to increased risk of CVD in our population was western DP. Patterns of amino acid intakes may contribute to the development of CVD. Higher intakes of several micronutrients and macronutrients, DPs and some vegetables decrease the risk of CKD. In conclusion DPs of most Tehranian adults need improvement.

CONCLUSIONS

This review showed that higher adherence to healthy food choices was associated with reduced odds of dysglycemia and CVD. Dietary sources of renal-protective nutrients should be encouraged among the general population.

"Biocompatible" Neutral pH Low-GDP Peritoneal Dialysis Solutions: Much Ado About Nothing?

Adverse outcomes in peritoneal dialysis (PD), including PD related infections, the loss of residual kidney function (RKF), and longitudinal, deleterious changes in peritoneal membrane function continue to limit the long-term success of PD therapy. The observation that these deleterious changes occur upon exposure to conventional glucose-based PD solutions fuels the search for a more biocompatible PD solution. The development of a novel PD solution with a neutral pH, and lower in glucose degradation products (GDPs) compared to its conventional predecessors has been labeled a "biocompatible" solution. While considerable evidence in support of these novel solutions' biocompatibility has emerged from cell culture and animal studies, the clinical benefits as compared to conventional PD solutions are less clear. Neutral pH low GDP (NpHLGDP) PD solutions appear to be effective in reducing infusion pain, but their effects on other clinical endpoints including peritoneal membrane function, preservation of RKF, PD-related infections, and technique and patient survival are less clear. The literature is limited by studies characterized by relatively few patients, short follow-up time, heterogeneity with regards to the novel PD solution type under study, and the different patient populations under study. Nonetheless, the search for a more biocompatible PD solution continues with emerging data on promising non glucose-based solutions.

Iridoid glycoside from Cornus officinalis ameliorated diabetes mellitus-induced testicular damage in male rats: Involvement of suppression of the AGEs/RAGE/p38 MAPK signaling pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Cornus officinalis (CO) has been widely used as a traditional Chinese medicine for treating diabetes mellitus (DM) and its complications. Iridoid glycoside from C. officinalis (IGCO) can resist apoptosis, hyperglycemia, oxidation and so on. The aim of this study was to investigate the therapeutic effects of IGCO on DM-induced testicular damage through inhibition of the AGEs/RAGE/p38 MAPK signaling pathway.

MATERIALS AND METHODS

A DM model of male Wistar rats was induced with streptozotocin injection (30mg/kg, i.p.) and high-fat diet. The DM rats were administrated with IGCO at low and high doses (15 and 30mg/kg, p.o.) for 12 weeks. Testicular damage was evaluated by estimating relative testicular weights, testicular pathohistology, sperm count, live sperm rate, endogenous sex hormone level and activity of testicular marker enzymes. Besides, general diabetic symptoms, renal function, oxidative stress parameters and testicular apoptosis marker were also determined. Finally, the mechanism was explored based on the AGEs/RAGE/p38 MAPK pathway.

RESULTS

IGCO effectively mitigated the general symptoms of DM rats including weight loss, polydipsia, polyphagia, polyuria, elevated blood glucose level and low serum insulin level. Nourishing the kidney evidently, IGCO reduced serum creatinine, urea nitrogen and urine protein excretion, and also markedly protected against DM-induced testicular damage by increasing testis/body weight ratio and live sperm rate, improving the histomorphology of testes, upregulating testosterone, LH, FSH and GnRH levels and preventing the decrease of testicular marker enzymes LDH, ACP and γ-GT. Moreover, IGCO showed considerable anti-oxidative and anti-apoptotic effects, which downregulated the increase of ROS and MDA levels, restored SOD and CAT activities, and decreased spermatogenic cell apoptosis and Bax/Bcl-2 ratio. In the end, the increased AGEs, RAGE and p-p38 MAPK protein levels in DM rats were also reversed by IGCO significantly.

CONCLUSIONS

The kidney tonic IGCO well protected DM rats from testicular damage, which may be related to suppression of the AGEs-RAGE-p38 MAPK pathway.

The effects of advanced glycation end products (AGEs) on dermal wound healing and scar formation: a systematic review

Introduction:

With ageing, the skin gradually loses its youthful appearance and functions like wound healing and scar formation. The pathophysiological theory of Advanced Glycation End products (AGEs) has gained traction during the last decade. This review aims to document the influence of AGEs on the mechanical and physiologic properties of the skin, how they affect dermal wound healing and scar formation in high-AGE populations like elderly patients and diabetics, and potential therapeutic strategies.

Methods:

This systematic literature study involved a structured search in Pubmed and Web of Science with qualitative analysis of 14 articles after a three-staged selection process with the use of in- and exclusion criteria.

Results:

Overall, AGEs cause shortened, thinned, and disorganized collagen fibrils, consequently reducing elasticity and skin/scar thickness with increased contraction and delayed wound closure. Documented therapeutic strategies include dietary AGE restriction, sRAGE decoy receptors, aminoguanidine, RAGE-blocking antibodies, targeted therapy, thymosin β4, anti-oxidant agents and gold nanoparticles, ethyl pyruvate, Gal-3 manipulation and metformin.

Discussion:

With lack of evidence concerning scars, no definitive conclusions can yet be made about the role of AGEs on possible appearance or function of scar tissue. However, all results suggest that scars tend to be more rigid and contractile with persistent redness and reduced tendency towards hypertrophy as AGEs accumulate.

Conclusion:

Abundant evidence supports the pathologic role of AGEs in ageing and dermal wound healing and the effectiveness of possible therapeutic agents. More research is required to conclude its role in scar formation and scar therapy.

Our skin is the body’s first line of defense. It is the barrier that protects us from chemical and biological threats such as viruses, bacteria or corrosive liquids. It is the sensor that allows us to detect physical threats like extreme temperatures, pressure and pain. And when these preventative measures fail, the skin has yet another property: the ability to heal.

Skin changes visibly with age, most notably with the appearance of wrinkles. However, there is more to ageing than meets the eye; invisible alterations cause the decline of various functions of the skin, such as wound healing and scar formation. An array of non-conclusive research has been done in this field. One theory that has gained traction during the last decade is the Advanced Glycation End products (AGEs) theory. The theory states that AGEs play an important role in skin aging, wound healing and the effectiveness of different therapeutic options. Their presence supposedly indicates a diminished ability for wound healing and scar formation.

AGEs are proteins to which sugar molecule is bound. The sugar molecule inhibits the original protein from functioning properly. As skin contains many proteins like collagen, the formation of these AGEs could be a viable explanation for the diminished functioning with ageing. In this review, we investigated whether the accumulation of AGEs affects wound healing and scar formation.

Normal scar formation results in a thin scar. However, it may happen that scarring results in thick, large, painful and itchy scars. We investigated whether people with a high AGE content in their skin, like diabetics and elderly, have difficulties forming aesthetically pleasing scars. Secondly, we investigated which therapies reduce the AGE content and, if so, whether these therapies can improve wound healing and scarring. This literature study involved research in scientific databases with qualitative analysis of 14 articles after a three-staged selection process with the use of set criteria.

We found the different ways in which AGEs affect skin properties and wound healing. Collagen, one of the most important proteins in the skin, is affected by these AGEs. Once a sugar binds to it, the collagen strings becomes thinner and shorter, and the different collagen proteins cross-link with each other in an unstructured way. The result of these alterations is a reduced elasticity, i.e. the skin becomes stiffer. The scar will be thinner and the time for wounds to close is longer. We also found strategies to diminish the AGE content, including dietary AGE restriction and Metformin, a drug used in diabetes.

We can conclude that there is proof of AGEs playing an important role in skin ageing, wound healing and the effectiveness of different therapeutic options. However, more research is required to conclude the exact role of AGEs in scar formation and scar therapy.