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Chen G, Lin T, Wu M, Cai G, Wu C, Ding Q, Xu J, Chen H, Li W, Xu G, Lan Y. Causal Association of Cytokines and Growth Factors with Stroke and Its Subtypes: a Mendelian Randomization Study. Mol Neurobiol 2024; 61:3212-3222. [PMID: 37979035 DOI: 10.1007/s12035-023-03752-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/28/2023] [Indexed: 11/19/2023]
Abstract
Cytokines and growth factors contribute to nerve growth and angiogenesis and are associated with the development of vascular disease. This Mendelian randomization (MR) study was designed to examine the causal relationship between factors associated with stem cell paracrine mechanisms and with stroke and its subtypes. We used pooled statistics on cytokine levels from three studies (INTERIAL, Olink Proseek CVD array, and KORA) encompassing 7795 participants in Europe. Data for stroke and its subtypes were pooled from these European populations (40,585 cases and 406,111 controls) in a multiprogenitor genome-wide association study (GWAS). MR was performed using established analytical methods, including inverse variance weighting (IVW), weighted median (WM), and MR-Egger. Genetically determined high IGF-1 levels were found to associate negatively with risk of stroke, ischemic stroke (large-artery atherosclerosis), and ischemic stroke (cardiogenic embolism). Meanwhile, high IL-13 levels had a positive causal relationship with ischemic stroke (large-artery atherosclerosis). An additional 27 cytokines were found to have a causal association with stroke or its subtypes. However, these results should be interpreted with caution given that the power efficacy was <80%. This MR study supports the concept of a causal relationship of 29 cytokines with stroke or its subtypes. Our genetic analysis provides new insights into stroke prevention and treatment by demonstrating an association of stem cell paracrine-related cytokines with stroke risk.
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Affiliation(s)
- Gengbin Chen
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
- Postgraduate Research Institute, Guangzhou Sport University, Guangzhou, China
| | - Tuo Lin
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Manfeng Wu
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Guiyuan Cai
- Department of Rehabilitation Medicine, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Cheng Wu
- Department of Rehabilitation Medicine, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, China
- Department of Rehabilitation Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan Road II, Guangzhou, 510080, China
| | - Qian Ding
- Department of Rehabilitation Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan Road II, Guangzhou, 510080, China
| | - Jiayue Xu
- Department of Rehabilitation Medicine, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Hongying Chen
- Department of Rehabilitation Medicine, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Wanqi Li
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Guangqing Xu
- Department of Rehabilitation Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan Road II, Guangzhou, 510080, China.
| | - Yue Lan
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China.
- Guangzhou Key Laboratory of Aging Frailty and Neurorehabilitation, Guangzhou, China.
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Bergman M, Manco M, Satman I, Chan J, Schmidt MI, Sesti G, Vanessa Fiorentino T, Abdul-Ghani M, Jagannathan R, Kumar Thyparambil Aravindakshan P, Gabriel R, Mohan V, Buysschaert M, Bennakhi A, Pascal Kengne A, Dorcely B, Nilsson PM, Tuomi T, Battelino T, Hussain A, Ceriello A, Tuomilehto J. International Diabetes Federation Position Statement on the 1-hour post-load plasma glucose for the diagnosis of intermediate hyperglycaemia and type 2 diabetes. Diabetes Res Clin Pract 2024; 209:111589. [PMID: 38458916 DOI: 10.1016/j.diabres.2024.111589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
Many individuals with intermediate hyperglycaemia (IH), including impaired fasting glycaemia (IFG) and impaired glucose tolerance (IGT), as presently defined, will progress to type 2 diabetes (T2D). There is confirmatory evidence that T2D can be prevented by lifestyle modification and/or medications, in people with IGT diagnosed by 2-h plasma glucose (PG) during a 75-gram oral glucose tolerance test (OGTT). Over the last 40 years, a wealth of epidemiological data has confirmed the superior value of 1-h plasma glucose (PG) over fasting PG (FPG), glycated haemoglobin (HbA1c) and 2-h PG in populations of different ethnicity, sex and age in predicting diabetes and associated complications including death. Given the relentlessly rising prevalence of diabetes, a more sensitive, practical method is needed to detect people with IH and T2D for early prevention or treatment in the often lengthy trajectory to T2D and its complications. The International Diabetes Federation (IDF) Position Statement reviews findings that the 1-h post-load PG ≥ 155 mg/dL (8.6 mmol/L) in people with normal glucose tolerance (NGT) during an OGTT is highly predictive for detecting progression to T2D, micro- and macrovascular complications, obstructive sleep apnoea, cystic fibrosis-related diabetes mellitus, metabolic dysfunction-associated steatotic liver disease, and mortality in individuals with risk factors. The 1-h PG of 209 mg/dL (11.6 mmol/L) is also diagnostic of T2D. Importantly, the 1-h PG cut points for diagnosing IH and T2D can be detected earlier than the recommended 2-h PG thresholds. Taken together, the 1-h PG provides an opportunity to avoid misclassification of glycaemic status if FPG or HbA1c alone are used. The 1-h PG also allows early detection of high-risk people for intervention to prevent progression to T2D which will benefit the sizeable and growing population of individuals at increased risk of T2D. Using a 1-h OGTT, subsequent to screening with a non-laboratory diabetes risk tool, and intervening early will favourably impact the global diabetes epidemic. Health services should consider developing a policy for screening for IH based on local human and technical resources. People with a 1-h PG ≥ 155 mg/dL (8.6 mmol/L) are considered to have IH and should be prescribed lifestyle intervention and referred to a diabetes prevention program. People with a 1-h PG ≥ 209 mg/dL (11.6 mmol/L) are considered to have T2D and should have a repeat test to confirm the diagnosis of T2D and then referred for further evaluation and treatment. The substantive data presented in the Position Statement provides strong evidence for redefining current diagnostic criteria for IH and T2D by adding the 1-h PG.
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Affiliation(s)
- Michael Bergman
- NYU Grossman School of Medicine, Departments of Medicine and of Population Health, Division of Endocrinology, Diabetes and Metabolism, VA New York Harbor Healthcare System, New York, NY, USA.
| | - Melania Manco
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Ilhan Satman
- Istanbul University Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey
| | - Juliana Chan
- The Chinese University of Hong Kong, Faculty of Medicine, Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, Hong Kong, China
| | - Maria Inês Schmidt
- Postgraduate Program in Epidemiology, School of Medicine and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, University of Rome-Sapienza, 00189 Rome, Italy
| | - Teresa Vanessa Fiorentino
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Muhammad Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio Texas, USA
| | - Ram Jagannathan
- Hubert Department of Global Health Rollins, School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Rafael Gabriel
- Department of International Health, National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Viswanathan Mohan
- Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, India
| | - Martin Buysschaert
- Department of Endocrinology and Diabetology, Université Catholique de Louvain, University, Clinic Saint-Luc, Brussels, Belgium
| | - Abdullah Bennakhi
- Dasman Diabetes Institute Office of Regulatory Affairs, Ethics Review Committee, Kuwait
| | - Andre Pascal Kengne
- South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa
| | - Brenda Dorcely
- NYU Grossman School of Medicine, Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, New York, NY, USA
| | - Peter M Nilsson
- Department of Clinical Sciences and Lund University Diabetes Centre, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Tiinamaija Tuomi
- Folkhälsan Research Center, Helsinki, Finland; Abdominal Center, Endocrinology, Helsinki University Central Hospital, Research Program for Diabetes and Obesity, Center of Helsinki, Helsinki, Finland
| | | | - Akhtar Hussain
- Faculty of Health Sciences, Nord University, Bodø, Norway; Faculty of Medicine, Federal University of Ceará (FAMED-UFC), Brazil; International Diabetes Federation (IDF), Brussels, Belgium; Diabetes in Asia Study Group, Post Box: 752, Doha-Qatar; Centre for Global Health Research, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Jaakko Tuomilehto
- Department of International Health, National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain; Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland; Saudi Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
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Li Y, Yang W, Li J, Zhang Y, Zhang L, Chen S, He L, Zhang Y. Relationship between serum insulin-like growth factor 1 levels and ischaemic stroke: a systematic review and meta-analysis. BMJ Open 2022; 12:e045776. [PMID: 35705353 PMCID: PMC9204407 DOI: 10.1136/bmjopen-2020-045776] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To assess the association of insulin-like growth factor 1 (IGF-1) with the risk of incident ischaemic stroke and outcome after ischaemic stroke. DESIGN A systematic review of primary studies. SETTING Hospitals in Western Sweden, Italy, China and Denmark. METHODS A search was carried out in eligible studies in electronic databases (PubMed, Scopus, Embase, China National Knowledge Infrastructure and Web of Science) updated to 29 December 2020. The relevant data were extracted in order to conduct the meta-analysis. Review Manager V.5.2 was used to pool data and calculate the mean difference (MD) and its 95% CI. Heterogeneity, subgroup analysis, sensitivity analysis and publication bias were also performed in this meta-analysis. RESULTS A total of 2277 patients were included in 17 studies. This meta-analysis indicated that higher serum IGF-1 levels were significantly correlated with less risk of ischaemic stroke (MD=-45.32 95% CI -63.70 to -26.94], p < 0.00001, I2=99%) and better improvement of outcome after ischaemic stroke (MD=27.52, 95% CI 3.89 to 51.14, p=0.02, I2=96%). According to subgroup analysis, heterogeneity comes from country, sample size, male and the time from symptom onset to blood collection. Sensitivity analysis showed that there was no significant influence of any individual study on the pooled MD. The effect of high heterogeneity on result credibility was eliminated when four included studies were merged (MD=-30.32, 95% CI -36.52 to -24.11, p< 0.00001, I2=0%). Moreover, no potential publication bias was discovered in this meta-analysis. CONCLUSION Higher serum IGF-1 was significantly correlated with a lower risk of ischaemic stroke. In view of the high degree of heterogeneity, it may need more studies to confirm the prognostic value of serum IGF-1 levels in ischaemic stroke and explore the sources of heterogeneity.
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Affiliation(s)
- Yangni Li
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Weinan Yang
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Jinhui Li
- Department of Rehabilitation and Traditional Chinese Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yishu Zhang
- Zhejiang Chinese Medical University, Hangzhou, China
| | | | - Simiao Chen
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Lan He
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuyan Zhang
- Zhejiang Chinese Medical University, Hangzhou, China
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Bergman M, Manco M, Sesti G, Dankner R, Pareek M, Jagannathan R, Chetrit A, Abdul-Ghani M, Buysschaert M, Olsen MH, Nilsson PM, Medina JL, Roth J, Groop L, Del Prato S, Raz I, Ceriello A. Petition to replace current OGTT criteria for diagnosing prediabetes with the 1-hour post-load plasma glucose ≥ 155 mg/dl (8.6 mmol/L). Diabetes Res Clin Pract 2018; 146:18-33. [PMID: 30273707 DOI: 10.1016/j.diabres.2018.09.017] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 02/08/2023]
Abstract
Many individuals with prediabetes, as presently defined, will progress to diabetes (T2D) despite the considerable benefit of lifestyle modification. Therefore, it is paramount to screen individuals at increased risk with a more sensitive method capable of identifying prediabetes at an even earlier time point in the lengthy trajectory to T2D. This petition reviews findings demonstrating that the 1-hour (1-h) postload plasma glucose (PG) ≥ 155 mg/dl (8.6 mmol/L) in those with normal glucose tolerance (NGT) during an oral glucose tolerance test (OGTT) is highly predictive for detecting progression to T2D, micro- and macrovascular complications and mortality in individuals at increased risk. Furthermore, the STOP DIABETES Study documented effective interventions that reduce the future risk of T2D in those with NGT and a 1-h PG ≥ 155 mg/dl (8·6 mmol/L). The 1-h OGTT represents a valuable opportunity to extend the proven benefit of diabetes prevention to the sizeable and growing population of individuals at increased risk of progression to T2D. The substantial evidence provided in this petition strongly supports redefining current diagnostic criteria for prediabetes with the elevated 1-h PG level. The authors therefore advocate a 1-h OGTT to detect prediabetes and hence, thwart the global diabetes epidemic.
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Affiliation(s)
- Michael Bergman
- NYU School of Medicine, Department of Medicine and of Population Health, Division of Endocrinology and Metabolism, NYU Langone Diabetes Prevention Program, New York, NY, USA.
| | - Melania Manco
- Research Unit for Multifactorial Diseases and Complex Phenotypes, Bambino Gesù Children Hospital, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy
| | - Giorgio Sesti
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Rachel Dankner
- The Feinstein Institute for Medical Research, Manhasset, North Shore, NY, USA; Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, School of Public Health, Department of Epidemiology and Preventive Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Manan Pareek
- Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, University of Southern Denmark, Denmark; Cardiology Section, Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark
| | - Ram Jagannathan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 18, Atlanta, GA, USA
| | - Angela Chetrit
- Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Muhammad Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Martin Buysschaert
- Department of Endocrinology and Diabetology, Université Catholique de Louvain, University, Clinic Saint-Luc, Brussels, Belgium
| | - Michael H Olsen
- Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, University of Southern Denmark, Denmark; Cardiology Section, Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark
| | - Peter M Nilsson
- Department of Clinical Sciences and Lund University Diabetes Centre, Lund University, Skåne University Hospital, Malmö, Sweden
| | | | - Jesse Roth
- The Feinstein Institute for Medical Research, Manhasset, North Shore, NY, USA
| | - Leif Groop
- Lund University, Lund University Diabetes Centre, Malmö, Sweden
| | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Itamar Raz
- Diabetes Unit at Hadassah University Hospital, Hadassah Center for the Prevention of Diabetes, Diabetes Clinical Research Center, Jerusalem, Israel
| | - Antonio Ceriello
- Institut d'Investigacions Biomèdiques August Pi I Sunyer and Centro de Investigación Biomedica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Barcelona, Spain; Department of Cardiovascular and Metabolic Diseases, Istituto Ricerca Cura Carattere Scientifico Multimedica, Sesto, San Giovanni, MI, Italy
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Fiorentino TV, Marini MA, Succurro E, Andreozzi F, Perticone M, Hribal ML, Sciacqua A, Perticone F, Sesti G. One-Hour Postload Hyperglycemia: Implications for Prediction and Prevention of Type 2 Diabetes. J Clin Endocrinol Metab 2018; 103:3131-3143. [PMID: 30020454 DOI: 10.1210/jc.2018-00468] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/12/2018] [Indexed: 12/18/2022]
Abstract
CONTEXT Recently, a value of 1-hour postload glucose concentration (1-h-PG) ≥155 mg/dL (8.6 mmol/L) in individuals with normal glucose tolerance (NGT) has been found to be associated with an increased risk for future type 2 diabetes mellitus (T2DM). In this review, we analyze the implication of 1-h-PG determination in prediction of T2DM and cardiovascular disease. DESIGN A literature search was performed using MEDLINE. We included all English studies published up to February 2018 in peer-reviewed journals that examined the relationship between 1-h-PG and diabetes, cardiometabolic alterations, organ damage, and cardiovascular disease. RESULTS Several longitudinal studies have consistently shown that 1-h-PG ≥155 mg/dL can recognize individuals at increased risk for future T2DM among subjects with NGT. Additionally, we describe the pathophysiological abnormalities associated with 1-h-PG ≥155 mg/dL including impaired insulin sensitivity, β-cell dysfunction, and increased glucose intestinal absorption, which are known to be involved in T2DM pathogenesis. Importantly, numerous studies have demonstrated that a value of 1-h-PG ≥155 mg/dL in individuals with NGT is not only linked to an increased risk for future T2DM, but also able to identify those having a worse cardiovascular phenotype and an increased risk of adverse cardiovascular outcomes. CONCLUSIONS Although 1-h-PG determination is not currently recommended by the American Diabetes Association for identifying high-risk individuals, the available evidence indicates that a value of 1-h-PG ≥155 mg/dL may be a useful tool to recognize, among subjects with NGT, those at increased risk of T2DM and cardiovascular disease.
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Affiliation(s)
- Teresa Vanessa Fiorentino
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Viale Europa, Catanzaro, Italy
| | | | - Elena Succurro
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Viale Europa, Catanzaro, Italy
| | - Francesco Andreozzi
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Viale Europa, Catanzaro, Italy
| | - Maria Perticone
- Department of Experimental and Clinical Medicine, University Magna Græcia of Catanzaro, Viale Europa, Catanzaro, Italy
| | - Marta Letizia Hribal
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Viale Europa, Catanzaro, Italy
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Viale Europa, Catanzaro, Italy
| | - Francesco Perticone
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Viale Europa, Catanzaro, Italy
| | - Giorgio Sesti
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Viale Europa, Catanzaro, Italy
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Saber H, Himali JJ, Beiser AS, Shoamanesh A, Pikula A, Roubenoff R, Romero JR, Kase CS, Vasan RS, Seshadri S. Serum Insulin-Like Growth Factor 1 and the Risk of Ischemic Stroke: The Framingham Study. Stroke 2017; 48:1760-1765. [PMID: 28596451 PMCID: PMC5505338 DOI: 10.1161/strokeaha.116.016563] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 04/04/2017] [Accepted: 05/04/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Low insulin-like growth factor 1 (IGF-1) has been associated with increased risk of atherosclerosis and atrial fibrillation in cross-sectional studies. Yet, prospective data linking IGF-1 levels to the development of ischemic stroke remain inconclusive. We examined prospectively the association between serum IGF-1 levels and incident ischemic stroke. METHODS We measured serum IGF-1 levels in 757 elderly individuals (mean age 79±5, 62% women), free of prevalent stroke, from the Framingham original cohort participants at the 22nd examination cycle (1990-1994) and were followed up for the development of ischemic stroke. Cox models were used to relate IGF-1 levels to the risk for incident ischemic stroke, adjusted for potential confounders. RESULTS During a mean follow-up of 10.2 years, 99 individuals developed ischemic stroke. After adjustment for age, sex, and potential confounders, higher IGF-1 levels were associated with a lower risk of incident ischemic stroke, with subjects in the lowest quintile of IGF-1 levels having a 2.3-fold higher risk of incident ischemic stroke (95% confidence interval, 1.09-5.06; P=0.03) as compared with those in the top quintile. We observed an effect modification by diabetes mellitus and waist-hip ratio for the association between IGF-1 and ischemic stroke (P<0.1). In subgroup analyses, the effects were restricted to subjects with diabetics and those in top waist-hip ratio quartile, in whom each standard deviation increase in IGF-1 was associated with a 61% (hazard ratio, 0.39; 95% confidence interval, 0.20-0.78; P=0.007) and 41% (hazard ratio, 0.59; 95% confidence interval, 0.37-0.95; P=0.031) lower risk of incident ischemic stroke, respectively. CONCLUSIONS IGF-1 levels were inversely associated with ischemic stroke, especially among persons with insulin resistance.
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Affiliation(s)
- Hamidreza Saber
- From the Framingham Heart Study, MA (H.S., J.J.H., A.S.B., J.R.R., C.S.K., R.S.V., S.S.); Boston University School of Public Health, MA (J.J.H., A.S.B.); McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada (A.S.); Department of Neurology, University of Toronto, Ontario, Canada (A.P.); Department of Medicine, Tufts University School of Medicine, Boston, MA (R.R.); Department of Neurology, Boston University School of Medicine, MA (J.J.H., A.S.B., J.R.R., C.S.K., R.S.V., S.S.); and Department of Neurology, Wayne State University School of Medicine, Detroit, MI (H.S.)
| | - Jayandra J Himali
- From the Framingham Heart Study, MA (H.S., J.J.H., A.S.B., J.R.R., C.S.K., R.S.V., S.S.); Boston University School of Public Health, MA (J.J.H., A.S.B.); McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada (A.S.); Department of Neurology, University of Toronto, Ontario, Canada (A.P.); Department of Medicine, Tufts University School of Medicine, Boston, MA (R.R.); Department of Neurology, Boston University School of Medicine, MA (J.J.H., A.S.B., J.R.R., C.S.K., R.S.V., S.S.); and Department of Neurology, Wayne State University School of Medicine, Detroit, MI (H.S.)
| | - Alexa S Beiser
- From the Framingham Heart Study, MA (H.S., J.J.H., A.S.B., J.R.R., C.S.K., R.S.V., S.S.); Boston University School of Public Health, MA (J.J.H., A.S.B.); McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada (A.S.); Department of Neurology, University of Toronto, Ontario, Canada (A.P.); Department of Medicine, Tufts University School of Medicine, Boston, MA (R.R.); Department of Neurology, Boston University School of Medicine, MA (J.J.H., A.S.B., J.R.R., C.S.K., R.S.V., S.S.); and Department of Neurology, Wayne State University School of Medicine, Detroit, MI (H.S.)
| | - Ashkan Shoamanesh
- From the Framingham Heart Study, MA (H.S., J.J.H., A.S.B., J.R.R., C.S.K., R.S.V., S.S.); Boston University School of Public Health, MA (J.J.H., A.S.B.); McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada (A.S.); Department of Neurology, University of Toronto, Ontario, Canada (A.P.); Department of Medicine, Tufts University School of Medicine, Boston, MA (R.R.); Department of Neurology, Boston University School of Medicine, MA (J.J.H., A.S.B., J.R.R., C.S.K., R.S.V., S.S.); and Department of Neurology, Wayne State University School of Medicine, Detroit, MI (H.S.)
| | - Aleksandra Pikula
- From the Framingham Heart Study, MA (H.S., J.J.H., A.S.B., J.R.R., C.S.K., R.S.V., S.S.); Boston University School of Public Health, MA (J.J.H., A.S.B.); McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada (A.S.); Department of Neurology, University of Toronto, Ontario, Canada (A.P.); Department of Medicine, Tufts University School of Medicine, Boston, MA (R.R.); Department of Neurology, Boston University School of Medicine, MA (J.J.H., A.S.B., J.R.R., C.S.K., R.S.V., S.S.); and Department of Neurology, Wayne State University School of Medicine, Detroit, MI (H.S.)
| | - Ronenn Roubenoff
- From the Framingham Heart Study, MA (H.S., J.J.H., A.S.B., J.R.R., C.S.K., R.S.V., S.S.); Boston University School of Public Health, MA (J.J.H., A.S.B.); McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada (A.S.); Department of Neurology, University of Toronto, Ontario, Canada (A.P.); Department of Medicine, Tufts University School of Medicine, Boston, MA (R.R.); Department of Neurology, Boston University School of Medicine, MA (J.J.H., A.S.B., J.R.R., C.S.K., R.S.V., S.S.); and Department of Neurology, Wayne State University School of Medicine, Detroit, MI (H.S.)
| | - Jose R Romero
- From the Framingham Heart Study, MA (H.S., J.J.H., A.S.B., J.R.R., C.S.K., R.S.V., S.S.); Boston University School of Public Health, MA (J.J.H., A.S.B.); McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada (A.S.); Department of Neurology, University of Toronto, Ontario, Canada (A.P.); Department of Medicine, Tufts University School of Medicine, Boston, MA (R.R.); Department of Neurology, Boston University School of Medicine, MA (J.J.H., A.S.B., J.R.R., C.S.K., R.S.V., S.S.); and Department of Neurology, Wayne State University School of Medicine, Detroit, MI (H.S.)
| | - Carlos S Kase
- From the Framingham Heart Study, MA (H.S., J.J.H., A.S.B., J.R.R., C.S.K., R.S.V., S.S.); Boston University School of Public Health, MA (J.J.H., A.S.B.); McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada (A.S.); Department of Neurology, University of Toronto, Ontario, Canada (A.P.); Department of Medicine, Tufts University School of Medicine, Boston, MA (R.R.); Department of Neurology, Boston University School of Medicine, MA (J.J.H., A.S.B., J.R.R., C.S.K., R.S.V., S.S.); and Department of Neurology, Wayne State University School of Medicine, Detroit, MI (H.S.)
| | - Ramachandran S Vasan
- From the Framingham Heart Study, MA (H.S., J.J.H., A.S.B., J.R.R., C.S.K., R.S.V., S.S.); Boston University School of Public Health, MA (J.J.H., A.S.B.); McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada (A.S.); Department of Neurology, University of Toronto, Ontario, Canada (A.P.); Department of Medicine, Tufts University School of Medicine, Boston, MA (R.R.); Department of Neurology, Boston University School of Medicine, MA (J.J.H., A.S.B., J.R.R., C.S.K., R.S.V., S.S.); and Department of Neurology, Wayne State University School of Medicine, Detroit, MI (H.S.)
| | - Sudha Seshadri
- From the Framingham Heart Study, MA (H.S., J.J.H., A.S.B., J.R.R., C.S.K., R.S.V., S.S.); Boston University School of Public Health, MA (J.J.H., A.S.B.); McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada (A.S.); Department of Neurology, University of Toronto, Ontario, Canada (A.P.); Department of Medicine, Tufts University School of Medicine, Boston, MA (R.R.); Department of Neurology, Boston University School of Medicine, MA (J.J.H., A.S.B., J.R.R., C.S.K., R.S.V., S.S.); and Department of Neurology, Wayne State University School of Medicine, Detroit, MI (H.S.).
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Andreozzi F, Mannino GC, Perticone M, Perticone F, Sesti G. Elevated 1-h post-load plasma glucose levels in subjects with normal glucose tolerance are associated with a pro-atherogenic lipid profile. Atherosclerosis 2017; 256:15-20. [DOI: 10.1016/j.atherosclerosis.2016.11.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 10/25/2016] [Accepted: 11/16/2016] [Indexed: 12/11/2022]
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Sesti G, Fiorentino TV, Succurro E, Perticone M, Arturi F, Sciacqua A, Perticone F. Elevated 1-h post-load plasma glucose levels in subjects with normal glucose tolerance are associated with unfavorable inflammatory profile. Acta Diabetol 2014; 51:927-32. [PMID: 24619654 DOI: 10.1007/s00592-013-0539-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 11/28/2013] [Indexed: 02/06/2023]
Abstract
Glucose tolerant subjects with 1-h post-load glucose ≥155 mg/dl (NGT-1 h-high) are at increased risk for type 2 diabetes (T2DM). Prospective studies showed that chronic subclinical inflammation is a predictor of T2DM. In this study, we aimed to evaluate the inflammatory profile in NGT-1 h-high subjects as compared with individuals with 1-h post-load glucose <155 mg/dl (NGT-1 h-low). To this end, an oral glucose tolerance tests (OGTT) were performed in 1,099 nondiabetic whites. Cardio-metabolic risk factors including high-sensitivity C-reactive protein (hsCRP), erythrocyte sedimentation rate (ESR), fibrinogen, and complement C3 (C3) were determined. Of the 1,099 subjects examined, 497 had NGT-1 h-low, 154 had NGT-1 h-high, 158 had isolated impaired fasting glucose (IFG), and 290 had impaired glucose tolerance (IGT). As compared with NGT-1 h-low, NGT-1 h-high and IGT subjects exhibited significantly higher hsCRP, ESR, fibrinogen, and C3 levels. Notably, hsCRP, ESR, and C3 were also significantly higher as compared with IFG individuals. In a logistic regression analysis adjusted for age and gender, NGT-1 h-high and IGT subjects had a 1.8-fold increased risk of having the highest value of the Inflammatory Score. These data suggest that a value of a 1-h OGTT glucose ≥155 mg/dl may be helpful to identify a subset of normal glucose tolerance individuals at risk for chronic subclinical inflammation, a predictor of T2DM, and cardiovascular diseases.
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Affiliation(s)
- Giorgio Sesti
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, 88100, Viale Europa, Catanzaro, Italy,
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Sesti G, Hribal ML, Procopio T, Fiorentino TV, Sciacqua A, Andreozzi F, Marini MA, Perticone F. Low circulating insulin-like growth factor-1 levels are associated with high serum uric acid in nondiabetic adult subjects. Nutr Metab Cardiovasc Dis 2014; 24:1365-1372. [PMID: 25149895 DOI: 10.1016/j.numecd.2014.06.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 06/07/2014] [Accepted: 06/23/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND AIMS Low insulin-like growth factor-1 (IGF-1) levels and high uric acid concentrations are associated with cardio-metabolic disorders. Acute IGF-1 infusion decreases uric acid concentration in healthy individuals. In this study, we aimed to examine the relationship between IGF-1 and uric acid levels. METHODS AND RESULTS 1430 adult non diabetic subjects were stratified into quartiles according to their circulating IGF-1 values. Significant differences in uric acid concentration, measured by the URICASE/POD method were observed between low (quartile 1), intermediate (quartile 2 and 3), and high (quartile 4) IGF-1 levels groups after adjusting for age, gender, and body mass index (P = 0.02). These differences remained significant after adjustment for blood pressure, total cholesterol, high density lipoprotein, triglycerides, fasting and 2 h post-load glucose levels, HOMA-IR index (P = 0.005), liver enzymes (P = 0.03), glucose tolerance status (P = 0.02), growth hormone levels (GH) (P = 0.05), anti-hypertensive treatments (P = 0.04) or diuretics use (P = 0.04)). To clarify the molecular links between IGF-1 and uric acid, we performed an in vitro study, incubating human hepatoma cells with uric acid for 24 or 48 h in the presence of GH and observed a 21% and 26% decrease, respectively, in GH-stimulated IGF-1 mRNA expression (P = 0.02 and P = 0.012, respectively). This effect appears to be mediated by uric acid ability to down regulate GH intracellular signaling; in fact we observed a significant decrease of GH activated JAK2 and Stat5 phosphorylation. CONCLUSIONS These data demonstrate an inverse relationship between IGF-1 and uric acid levels in adults and suggest that uric acid might affect hepatic IGF-1 synthesis.
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Affiliation(s)
- G Sesti
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Italy.
| | - M L Hribal
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Italy
| | - T Procopio
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Italy
| | - T V Fiorentino
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Italy
| | - A Sciacqua
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Italy
| | - F Andreozzi
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Italy
| | - M A Marini
- Department of Systems Medicine, University of Rome-Tor Vergata, Italy
| | - F Perticone
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Italy
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Sesti G, Hribal ML, Fiorentino TV, Sciacqua A, Perticone F. Elevated 1 h postload plasma glucose levels identify adults with normal glucose tolerance but increased risk of non-alcoholic fatty liver disease. BMJ Open Diabetes Res Care 2014; 2:e000016. [PMID: 25452862 PMCID: PMC4212569 DOI: 10.1136/bmjdrc-2014-000016] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 07/21/2014] [Accepted: 07/23/2014] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To determine the ability of the proposed diagnostic value of a 1-h OGTT glucose ≥155mg/dL to identify individuals with non-alcoholic fatty liver disease (NAFLD) diagnosed by ultrasonography in a cohort of adult white individuals. DESIGN The study group comprised 710 white individuals participating to the CATAnzaro MEtabolic RIsk factors (CATAMERI) Study, a cross-sectional study assessing cardio-metabolic risk factors in individuals carrying at least one risk factor including dysglycemia, overweight/obesity, hypertension, dyslipidemia. a 75 g oral Oral Glucose Tolerance Test (OGTT) was performed with 0, 30, 60, 90 and 120 min sampling for plasma glucose and insulin measurements. Cardio-metabolic risk factors including alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase (GGT) were assessed in the whole cohort. RESULTS Of the 710 participants examined, 295 had normal glucose tolerance (NGT) with 1-hour post-load plasma glucose <155 mg/dL (NGT 1h-low), 109 individuals had NGT 1h-high, 104 had isolated impaired fasting glucose (IFG), and 202 had impaired glucose tolerance (IGT). As compared with NGT 1h-low, NGT 1h-high and IGT subjects exhibited significantly higher body mass index (BMI), triglycerides, high sensitivity C reactive protein, ALT, GGT, and hepatic insulin resistance (IR), assessed by the liver IR index, as well as lower high density lipoprotein, and insulin-like growth factor-1 (IGF-1) levels. In a logistic regression analysis adjusted for age, gender, and BMI, NGT 1h-high participants had a 1.5-fold increased risk of having NAFLD and an even increased risk was observed in subjects with IGT (1.8-fold), but not in the isolated IFG group (1.01-fold). CONCLUSIONS These data suggest that the value of a 1-hour OGTT glucose ≥155 mg/dL may be helpful to identify a subset of NGT individuals at risk for NAFLD.
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Affiliation(s)
- Giorgio Sesti
- Department of Medical and Surgical Sciences , Viale Europa, University Magna-Græcia of Catanzaro , Catanzaro , Italy
| | - Marta Letizia Hribal
- Department of Medical and Surgical Sciences , Viale Europa, University Magna-Græcia of Catanzaro , Catanzaro , Italy
| | - Teresa Vanessa Fiorentino
- Department of Medical and Surgical Sciences , Viale Europa, University Magna-Græcia of Catanzaro , Catanzaro , Italy
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences , Viale Europa, University Magna-Græcia of Catanzaro , Catanzaro , Italy
| | - Francesco Perticone
- Department of Medical and Surgical Sciences , Viale Europa, University Magna-Græcia of Catanzaro , Catanzaro , Italy
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Sesti G, Mannino GC, Andreozzi F, Greco A, Perticone M, Sciacqua A, Marini MA, Perticone F. A polymorphism at IGF1 locus is associated with carotid intima media thickness and endothelium-dependent vasodilatation. Atherosclerosis 2013; 232:25-30. [PMID: 24401213 DOI: 10.1016/j.atherosclerosis.2013.10.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 10/04/2013] [Accepted: 10/17/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Whether IGF-1 has a protective or a detrimental role in vascular homeostasis remains unsettled. There is evidence that the C/T polymorphism rs35767 near the promoter region of the IGF1 gene located in chromosome 12 is associated with plasma IGF-1 levels. We investigated the effects of this polymorphism on circulating IGF-1 levels, carotid intima media thickness (cIMT) and endothelial-dependent vasodilation. METHODS Two samples of adult nondiabetic Whites were studied. Sample 1 comprised 1124 individuals in whom cIMT was measured by ultrasonography. Sample 2 included 162 drug-naïve hypertensive individuals in whom endothelium-dependent and endothelium-independent vasodilation were assessed by intra-arterial infusion of acetylcholine (ACh), and sodium nitroprusside (SNP), respectively. IGF-1 was determined by chemiluminescent immunoassay. rs35767 polymorphism was screened using a TaqMan allelic discrimination assay. RESULTS In sample 1, IGF-1 levels were higher in subjects carrying the T allele compared with CC carriers (178 ± 78 vs. 166 ± 60 ng/mL, respectively; P = 0.007 adjusted for age, gender, and BMI). cIMT was lower in subjects carrying the T allele compared with CC carriers (0.71 ± 0.20 vs. 0.76 ± 0.22 mm, respectively; P < 0.0001 adjusted for age, gender, and BMI). In sample 2, maximally ACh-stimulated forearm blood flow was higher in subjects carrying the T allele compared with CC carriers (343 ± 191 vs. 281 ± 125%, respectively; P = 0.02 adjusted for age, gender, and BMI). CONCLUSION Subjects carrying the T allele exhibited significantly higher levels of circulating IGF-1, lower values of cIMT, and higher endothelium-dependent vasodilatation compared with CC carriers. These findings support the idea that IGF-1 plays a role in the pathogenesis of atherosclerosis.
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Affiliation(s)
- Giorgio Sesti
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Viale Europa, Catanzaro 88100, Italy.
| | - Gaia Chiara Mannino
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Viale Europa, Catanzaro 88100, Italy
| | - Francesco Andreozzi
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Viale Europa, Catanzaro 88100, Italy
| | - Annalisa Greco
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Viale Europa, Catanzaro 88100, Italy
| | - Maria Perticone
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Viale Europa, Catanzaro 88100, Italy
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Viale Europa, Catanzaro 88100, Italy
| | - Maria A Marini
- Department of Systems Medicine, University of Rome-Tor Vergata, Italy
| | - Francesco Perticone
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Viale Europa, Catanzaro 88100, Italy
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Marini MA, Frontoni S, Succurro E, Arturi F, Fiorentino TV, Sciacqua A, Hribal ML, Perticone F, Sesti G. Decreased insulin clearance in individuals with elevated 1-h post-load plasma glucose levels. PLoS One 2013; 8:e77440. [PMID: 24194886 PMCID: PMC3806727 DOI: 10.1371/journal.pone.0077440] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 09/09/2013] [Indexed: 12/16/2022] Open
Abstract
Reduced insulin clearance has been shown to predict the development of type 2 diabetes. Recently, it has been suggested that plasma glucose concentrations ≥8.6 mmol/l (155 mg/dl) at 1 h during an oral glucose tolerance test (OGTT) can identify individuals at high risk for type 2 diabetes among those who have normal glucose tolerance (NGT 1 h-high). The aim of this study was to examine whether NGT 1 h-high have a decrease in insulin clearance, as compared with NGT individuals with 1-h post-load glucose <8.6 mmol/l (l (155 mg/dl, NGT 1 h-low). To this end, 438 non-diabetic White individuals were subjected to OGTT and euglycemic-hyperinsulinemic clamp to evaluate insulin clearance and insulin sensitivity. As compared with NGT 1 h-low individuals, NGT 1 h-high had significantly higher 1-h and 2-h post-load plasma glucose and 2-h insulin levels as well as higher fasting glucose and insulin levels. NGT 1 h-high exhibited also a significant decrease in both insulin sensitivity (P<0.0001) and insulin clearance (P = 0.006) after adjusting for age, gender, adiposity measures, and insulin sensitivity. The differences in insulin clearance remained significant after adjustment for fasting glucose (P = 0.02) in addition to gender, age, and BMI. In univariate analyses adjusted for gender and age, insulin clearance was inversely correlated with body weight, body mass index, waist, fat mass, 1-h and 2-h post-load glucose levels, fasting, 1-h and 2-h post-load insulin levels, and insulin-stimulated glucose disposal. In conclusion, our data show that NGT 1 h-high have a reduction in insulin clearance as compared with NGT 1 h-low individuals; this suggests that impaired insulin clearance may contribute to sustained fasting and post-meal hyperinsulinemia.
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Affiliation(s)
| | - Simona Frontoni
- Department of Systems Medicine, University of Rome-Tor Vergata, Rome, Italy
| | - Elena Succurro
- Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Franco Arturi
- Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Teresa Vanessa Fiorentino
- Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Marta Letizia Hribal
- Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Francesco Perticone
- Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Giorgio Sesti
- Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
- * E-mail:
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