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Wu P, Li ST, Shu TT, Mao ZH, Fu WJ, Yang YY, Pan SK, Liu DW, Liu ZS, Gao ZX. Impaired distal renal potassium handling in streptozotocin-induced diabetic mice. Am J Physiol Renal Physiol 2024; 327:F158-F170. [PMID: 38779755 DOI: 10.1152/ajprenal.00240.2023] [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: 08/14/2023] [Revised: 05/13/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
Diabetes is closely associated with K+ disturbances during disease progression and treatment. However, it remains unclear whether K+ imbalance occurs in diabetes with normal kidney function. In this study, we examined the effects of dietary K+ intake on systemic K+ balance and renal K+ handling in streptozotocin (STZ)-induced diabetic mice. The control and STZ mice were fed low or high K+ diet for 7 days to investigate the role of dietary K+ intake in renal K+ excretion and K+ homeostasis and to explore the underlying mechanism by evaluating K+ secretion-related transport proteins in distal nephrons. K+-deficient diet caused excessive urinary K+ loss, decreased daily K+ balance, and led to severe hypokalemia in STZ mice compared with control mice. In contrast, STZ mice showed an increased daily K+ balance and elevated plasma K+ level under K+-loading conditions. Dysregulation of the NaCl cotransporter (NCC), epithelial Na+ channel (ENaC), and renal outer medullary K+ channel (ROMK) was observed in diabetic mice fed either low or high K+ diet. Moreover, amiloride treatment reduced urinary K+ excretion and corrected hypokalemia in K+-restricted STZ mice. On the other hand, inhibition of SGLT2 by dapagliflozin promoted urinary K+ excretion and normalized plasma K+ levels in K+-supplemented STZ mice, at least partly by increasing ENaC activity. We conclude that STZ mice exhibited abnormal K+ balance and impaired renal K+ handling under either low or high K+ diet, which could be primarily attributed to the dysfunction of ENaC-dependent renal K+ excretion pathway, despite the possible role of NCC.NEW & NOTEWORTHY Neither low dietary K+ intake nor high dietary K+ intake effectively modulates renal K+ excretion and K+ homeostasis in STZ mice, which is closely related to the abnormality of ENaC expression and activity. SGLT2 inhibitor increases urinary K+ excretion and reduces plasma K+ level in STZ mice under high dietary K+ intake, an effect that may be partly due to the upregulation of ENaC activity.
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Affiliation(s)
- Peng Wu
- Traditional Chinese Medicine Integrated Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
- Institute of Nephrology, Zhengzhou University, Zhengzhou, People's Republic of China
- Henan Province Research Center for Kidney Disease, Zhengzhou, People's Republic of China
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, People's Republic of China
| | - Shu-Ting Li
- Traditional Chinese Medicine Integrated Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
- Institute of Nephrology, Zhengzhou University, Zhengzhou, People's Republic of China
- Henan Province Research Center for Kidney Disease, Zhengzhou, People's Republic of China
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, People's Republic of China
| | - Ting-Ting Shu
- Traditional Chinese Medicine Integrated Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
- Institute of Nephrology, Zhengzhou University, Zhengzhou, People's Republic of China
- Henan Province Research Center for Kidney Disease, Zhengzhou, People's Republic of China
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, People's Republic of China
| | - Zi-Hui Mao
- Traditional Chinese Medicine Integrated Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
- Institute of Nephrology, Zhengzhou University, Zhengzhou, People's Republic of China
- Henan Province Research Center for Kidney Disease, Zhengzhou, People's Republic of China
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, People's Republic of China
| | - Wen-Jia Fu
- Traditional Chinese Medicine Integrated Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
- Institute of Nephrology, Zhengzhou University, Zhengzhou, People's Republic of China
- Henan Province Research Center for Kidney Disease, Zhengzhou, People's Republic of China
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, People's Republic of China
| | - Yuan-Yuan Yang
- Traditional Chinese Medicine Integrated Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
- Institute of Nephrology, Zhengzhou University, Zhengzhou, People's Republic of China
- Henan Province Research Center for Kidney Disease, Zhengzhou, People's Republic of China
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, People's Republic of China
| | - Shao-Kang Pan
- Traditional Chinese Medicine Integrated Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
- Institute of Nephrology, Zhengzhou University, Zhengzhou, People's Republic of China
- Henan Province Research Center for Kidney Disease, Zhengzhou, People's Republic of China
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, People's Republic of China
| | - Dong-Wei Liu
- Traditional Chinese Medicine Integrated Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
- Institute of Nephrology, Zhengzhou University, Zhengzhou, People's Republic of China
- Henan Province Research Center for Kidney Disease, Zhengzhou, People's Republic of China
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, People's Republic of China
| | - Zhang-Suo Liu
- Traditional Chinese Medicine Integrated Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
- Institute of Nephrology, Zhengzhou University, Zhengzhou, People's Republic of China
- Henan Province Research Center for Kidney Disease, Zhengzhou, People's Republic of China
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, People's Republic of China
| | - Zhong-Xiuzi Gao
- Traditional Chinese Medicine Integrated Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
- Institute of Nephrology, Zhengzhou University, Zhengzhou, People's Republic of China
- Henan Province Research Center for Kidney Disease, Zhengzhou, People's Republic of China
- Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, People's Republic of China
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Sang M, Liu Y, Wu T, Zhou X, Wang D, Sun Z, Qiu S. Association of a novel electrolyte index, SUSPPUP, based on the measurement of fasting serum and spot urinary sodium and potassium, with prediabetes and diabetes in Chinese population. Clin Chim Acta 2022; 531:426-433. [PMID: 35525267 DOI: 10.1016/j.cca.2022.04.1005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/18/2022] [Accepted: 04/28/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND SUSPPUP, calculated as serum sodium [Na+] to urinary Na+ divided by (serum potassium [K+]) 2 to urinary K+, is a composite electrolyte index that reflects renal Na+ retention and K+ excretion. It remains unclear whether SUSPPUP and its components including serum or urinary Na+ or K+, are associated with glucose metabolism. This study aimed to address their associations. METHODS We conducted a cross-sectional study enrolling 5,581 Chinese adults (1,269 with prediabetes, 1,044 with diabetes, and 3,268 with normoglycemia). Fasting serum and morning spot urine were used to measure electrolytes that included Na+ and K+. RESULTS SUSPPUP was higher in prediabetes and diabetes than normoglycemia. The odds of prediabetes and diabetes were increased by 21% and 39% for every 1-standard deviation increment of SUSPPUP after multivariable-adjustment. Multiple linear regression analysis showed that SUSPPUP correlated positively with fasting plasma glucose, 2 h plasma glucose after OGTT, and glycated hemoglobin A1c. Higher spot urinary Na+ was associated with lower odds of prediabetes and diabetes, while spot urinary K+ showed the opposite. CONCLUSION Increases in Na+ retention and K+ excretion in the kidney, as reflected by an elevated SUSPPUP, are associated with increased prevalence of prediabetes and diabetes in Chinese community-dwellers.
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Affiliation(s)
- Miaomiao Sang
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Yu Liu
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Tongzhi Wu
- Adelaide Medical School and Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Xiaoying Zhou
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Duolao Wang
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Zilin Sun
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China.
| | - Shanhu Qiu
- Department of General Practice, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China.
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Chekka LMS, Chapman AB, Gums JG, Cooper-DeHoff RM, Johnson JA. Race-Specific Comparisons of Antihypertensive and Metabolic Effects of Hydrochlorothiazide and Chlorthalidone. Am J Med 2021; 134:918-925.e2. [PMID: 33434556 PMCID: PMC8243781 DOI: 10.1016/j.amjmed.2020.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/07/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Chlorthalidone is recommended over hydrochlorothiazide (HCTZ) as the preferred thiazide, but the supporting evidence is not robust at routinely used doses, or in whites vs blacks, in whom differences in response to thiazides are well known. We compare the efficacy and safety of HCTZ and chlorthalidone as first-line therapies for white and black hypertensive patients. METHODS We compared treatment-related outcomes between the HCTZ arm (12.5 mg for 2-3 weeks; 25 mg for additional 6 weeks) of the Pharmacogenomic Evaluation of Antihypertensive Responses (PEAR, n = 376) and chlorthalidone arm (15 mg for 2 weeks; 25 mg for additional 6 weeks) of PEAR-2 (n = 326) clinical trials, in 17-65-year-old mild-moderate uncomplicated hypertensive whites and blacks. RESULTS Mean systolic/diastolic blood pressure (SBP/DBP) reduction with HCTZ vs chlorthalidone: 8 ± 8/4 ± 5 vs 12 ± 9/7 ± 5 mm Hg in whites (P < 10-6 SBP and DBP); 12 ± 10/7 ± 6 vs 15 ± 10/9 ± 6 in blacks (P = .008 SBP, P = .054 DBP). Treatment with HCTZ vs chlorthalidone in whites resulted in significantly fewer patients achieving target BP (<140/90 mm Hg) (44% vs 57%, P = .018) and clinical response rate (≥10 mm Hg DBP reduction); and significantly higher nonresponse rate (<6 mm Hg DBP reduction); but no significant differences in rates among blacks (eg, target-BP rate: 56% vs 63%, P = .31). HCTZ treatment led to significantly lower rates of hypokalemia and hyperuricemia in whites and blacks, vs chlorthalidone, and significantly lower odds of requiring potassium supplementation among blacks (odds ratio 0.16; 95% confidence interval, 0.07-0.37; P = 3.4e-7). CONCLUSION Compared with HCTZ, chlorthalidone showed greater blood pressure lowering and adverse metabolic effects in whites, but similar blood pressure lowering and greater adverse effects in blacks; suggesting that the recent guideline recommendations to choose chlorthalidone over HCTZ may not be warranted in blacks.
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Affiliation(s)
- Lakshmi Manasa S Chekka
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida, Gainesville, Florida
| | | | - John G Gums
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida, Gainesville, Florida
| | - Rhonda M Cooper-DeHoff
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida, Gainesville, Florida; Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, Florida
| | - Julie A Johnson
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida, Gainesville, Florida; Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, Florida.
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Pillay P, Pillay S, Mchunu N. The spectrum of electrolyte abnormalities in black African people living with human immunodeficiency virus and diabetes mellitus at Edendale Hospital, Pietermaritzburg, South Africa. South Afr J HIV Med 2020; 21:1095. [PMID: 32832115 PMCID: PMC7433308 DOI: 10.4102/sajhivmed.v21i1.1095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/07/2020] [Indexed: 11/16/2022] Open
Abstract
Background Serum electrolyte abnormalities in black African people living with human immunodeficiency virus (HIV) and diabetes mellitus (PLWH/DM) is unknown. Objectives The aim of this study was to analyse serum electrolytes (sodium, potassium, calcium and phosphate) and factors associated with electrolyte abnormalities in black African PLWH/DM versus HIV-uninfected patients with DM. Methods We conducted a retrospective case-control study in 96 black African PLWH/DM (cases) and 192 HIV-uninfected patients with DM (controls), who were visiting the Edendale Hospital DM clinic, from 01 January 2016 to 31 December 2016. Pearson’s correlation, multivariate linear and logistic regression analyses were utilised. Results Hypocalcaemia was the most frequent electrolyte abnormality in PLWH/DM and HIV-uninfected patients with DM (31.25% vs. 22.91%), followed by hyponatraemia (18.75% vs. 13.54%). Median (IQR) corrected serum calcium levels were significantly lower in PLWH/DM compared with HIV-uninfected patients with DM (2.24 [2.18–2.30] mmol/L vs. 2.29 [2.20–2.36] mmol/L; p = 0.001). For every per cent increase in glycated haemoglobin, the odds of hyponatraemia significantly increased in both PLWH/DM (odds ratio [OR]: 1.55; 95% confidence interval [CI]: 1.19 –2.02; p = 0.003) and HIV-uninfected patients with DM (OR: 1.26; 95% CI: 1.04 –1.54; p = 0.009). Conclusion Hypocalcaemia and hyponatraemia were the most frequent electrolyte abnormalities and occurred more frequently in PLWH/DM compared with HIV-uninfected patients with DM. People living with HIV and DM have significantly lower corrected serum calcium levels compared with HIV-uninfected patients with DM. Furthermore, hyponatraemia is a marker of impaired glycaemic control.
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Affiliation(s)
- Preyanka Pillay
- Department of Internal Medicine, Greys Hospital, Pietermaritzburg, South Africa.,School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Somasundram Pillay
- Department of Internal Medicine, Edendale Hospital, Pietermaritzburg, South Africa.,Department of Internal Medicine, King Edward Hospital, Durban, South Africa
| | - Nobuhle Mchunu
- Department of Biostatistics, Faculty of Statistics, South African Medical Research Council, Durban, South Africa.,Department of Statistics, School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
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He G, Gang X, Sun Z, Wang P, Wang G, Guo W. Type 2 diabetes mellitus caused by Gitelman syndrome-related hypokalemia: A case report. Medicine (Baltimore) 2020; 99:e21123. [PMID: 32702863 PMCID: PMC7373581 DOI: 10.1097/md.0000000000021123] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Gitelman syndrome (GS) is an autosomal-recessive disease caused by SLC12A3 gene mutations. It is characterized by hypokalemic metabolic alkalosis in combination with hypomagnesemia and hypocalciuria. Recently, patients with GS are found at an increased risk for developing type 2 diabetes mellitus (T2DM). However, diagnosis of hyperglycemia in GS patients has not been thoroughly investigated, and family studies on SLC12A3 mutations and glucose metabolism are rare. Whether treatment including potassium and magnesium supplements, and spironolactone can ameliorate impaired glucose tolerance in GS patients, also needs to be investigated. PATIENT CONCERNS We examined a 55-year-old Chinese male with intermittent fatigue and persistent hypokalemia for 17 years. DIAGNOSES Based on the results of the clinical data, including electrolytes, oral glucose tolerance test (OGTT), and genetic analysis of the SLC12A3 gene, GS and T2DM were newly diagnosed in the patient. Two mutations of the SLC12A3 gene were found in the patient, one was a missense mutation p.N359K in exon 8, and the other was a novel insert mutation p.I262delinsIIGVVSV in exon 6. SLC12A3 genetic analysis and OGTT of 9 other family members within 3 generations were also performed. Older brother, youngest sister, and son of the patient carried the p.N359K mutation in exon 8. The older brother and the youngest sister were diagnosed with T2DM and impaired glucose tolerance by OGTT, respectively. INTERVENTIONS The patient was prescribed potassium and magnesium (potassium magnesium aspartate, potassium chloride) oral supplements and spironolactone. The patient was also suggested to maintain a high potassium diet. Acarbose was used to maintain the blood glucose levels. OUTCOMES The electrolyte imbalance including hypokalemia and hypomagnesemia, and hyperglycemia were improved with a remission of the clinical manifestations. CONCLUSION GS is one of the causes for manifestation of hypokalemia. SLC12A3 genetic analysis plays an important role in diagnosis of GS. Chinese male GS patients characterized with heterozygous SLC12A3 mutation should be careful toward occurrence of T2DM. Moreover, the patients with only 1 SLC12A3 mutant allele should pay regular attention to blood potassium and glucose levels. GS treatment with potassium and magnesium supplements, and spironolactone can improve impaired glucose metabolism.
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Affiliation(s)
- Guangyu He
- Department of Endocrinology and Metabolism
| | | | | | - Ping Wang
- Department of Otolaryngology-Head and Neck Surgery, The First Hospital of Jilin University, Changchun, Jilin, P.R. China
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Va P, Dodd KW, Zhao L, Thompson-Paul AM, Mercado CI, Terry AL, Jackson SL, Wang CY, Loria CM, Moshfegh AJ, Rhodes DG, Cogswell ME. Evaluation of measurement error in 24-hour dietary recall for assessing sodium and potassium intake among US adults - National Health and Nutrition Examination Survey (NHANES), 2014. Am J Clin Nutr 2019; 109:1672-1682. [PMID: 31136657 PMCID: PMC6537943 DOI: 10.1093/ajcn/nqz044] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 03/04/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Understanding measurement error in sodium and potassium intake is essential for assessing population intake and studying associations with health outcomes. OBJECTIVE The aim of this study was to compare sodium and potassium intake derived from 24-h dietary recall (24HDR) with intake derived from 24-h urinary excretion (24HUE). DESIGN Data were analyzed from 776 nonpregnant, noninstitutionalized US adults aged 20-69 y who completed 1-to-2 24HUE and 24HDR measures in the 2014 NHANES. A total of 1190 urine specimens and 1414 dietary recalls were analyzed. Mean bias was estimated as mean of the differences between individual mean 24HDR and 24HUE measurements. Correlations and attenuation factors were estimated using the Kipnis joint-mixed effects model accounting for within-person day-to-day variability in sodium excretion. The attenuation factor reflects the degree to which true associations between long-term intake (estimated using 24HUEs) and a hypothetical health outcome would be approximated using a single 24HDR: values near 1 indicate close approximation and near 0 indicate bias toward null. Estimates are reported for sodium, potassium, and the sodium: potassium (Na/K) ratio. Model parameters can be used to estimate correlations/attenuation factors when multiple 24HDRs are available. RESULTS Overall, mean bias for sodium was -452 mg (95% CI: -646, -259), for potassium -315 mg (CI: -450, -179), and for the Na/K ratio -0.04 (CI: -0.15, 0.07, NS). Using 1 24HDR, the attenuation factor for sodium was 0.16 (CI: 0.09, 0.21), for potassium 0.25 (CI:0.16, 0.36), and for the Na/K ratio 0.20 (CI: 0.10, 0.25). The correlation for sodium was 0.27 (CI: 0.16, 0.37), for potassium 0.35 (CI: 0.26, 0.55), and for the Na/K ratio 0.27 (CI: 0.13, 0.32). CONCLUSIONS Compared with 24HUE, using 24HDR underestimates mean sodium and potassium intake but is unbiased for the Na/K ratio. Additionally, using 24HDR as a measure of exposure in observational studies attenuates the true associations of sodium and potassium intake with health outcomes.
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Affiliation(s)
- Puthiery Va
- Epidemic Intelligence Service,Division for Heart Disease and Stroke Prevention,Address correspondence to PV (e-mail: )
| | | | - Lixia Zhao
- Division for Heart Disease and Stroke Prevention,IHRC, Inc., Atlanta, GA
| | | | | | - Ana L Terry
- National Center for Health Statistics, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Chia-Yih Wang
- National Center for Health Statistics, Centers for Disease Control and Prevention, Atlanta, Georgia
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Emami S, Saraf-Bank S, Rouhani MH, Azadbakht L. Diet Quality and Total Daily Price of Foods Consumed among Iranian Diabetic Patients. Int J Prev Med 2019; 10:50. [PMID: 31143424 PMCID: PMC6528422 DOI: 10.4103/ijpvm.ijpvm_334_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 08/26/2017] [Indexed: 12/31/2022] Open
Abstract
Background: The aim is to investigate the association between diet quality and daily price of foods consumed among Iranian diabetic patients. Methods: This cross-sectional study was conducted among 200 patients with type 2 diabetes mellitus (T2DM) aged 30–70 years. General information, socioeconomic status, anthropometric and biochemical characteristics, and food prices were collected by pretested questionnaires. Dietary intakes were assessed using a semi-quantitative reliable and valid food frequency questionnaire. Modified nutritionist IV and SPSS software were used for analyses. Results: The results of the present study indicated a direct relationship between total daily price of diet and nutrient adequacy ratio of Vitamin D, Vitamin B1, selenium, zinc, magnesium, potassium, and mean adequacy ratio of 11 micronutrients (Vitamin C, Vitamin E, Vitamin D, Vitamin B1, Vitamin B6, Vitamin B12, selenium, zinc, calcium, magnesium, and potassium) (P < 0.05). Furthermore, the total daily price of diet had a positive association with dietary intakes of protein, Vitamin D, Vitamin B1, selenium, zinc, magnesium and potassium among type 2 diabetic patients (P < 0.05). However, no significant relationship was observed between the total daily price of diet and anthropometric indices, biochemical characteristics, and socioeconomic status of participants in the present study (P > 0.05). Conclusions: This study showed that dietary quality and dietary intakes of energy, protein, and micronutrients were directly associated with the total daily price of foods among Iranian patients with type 2 diabetes.
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Affiliation(s)
- Shaghayegh Emami
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.,School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada, USA
| | - Sahar Saraf-Bank
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Hossein Rouhani
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Leila Azadbakht
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.,School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada, USA.,Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
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8
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Brey CW, Akbari-Alavijeh S, Ling J, Sheagley J, Shaikh B, Al-Mohanna F, Wang Y, Gaugler R, Hashmi S. Salts and energy balance: A special role for dietary salts in metabolic syndrome. Clin Nutr 2018; 38:1971-1985. [PMID: 30446179 DOI: 10.1016/j.clnu.2018.10.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/20/2018] [Accepted: 10/28/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Dietary salts sodium (Na+), potassium (K+), magnesium (Mg2+), and calcium (Ca2+) are important in metabolic diseases. Yet, we do not have sufficient understanding on the salts global molecular network in these diseases. In this systematic review we have pooled information to identify the general effect of salts on obesity, insulin resistance and hypertension. AIMS To assess the roles of salts in metabolic disorders by focusing on their individual effect and the network effect among these salts. METHODS We searched articles in PubMed, EMBASE and Google Scholar. We selected original laboratory research, systematic reviews, clinical trials, observational studies and epidemiological data that focused on dietary salts and followed the preferred reporting items for systematic review in designing the present systematic review. RESULTS From the initial search of 2898 studies we selected a total of 199 articles that met our inclusion criteria and data extraction. Alterations in metabolic pathways associated with the sensitivity of sodium, potassium, magnesium and calcium may lead to obesity, hypertension, and insulin resistance. We found that the results of most laboratory research, animal studies and clinical trials are coherent but some research outcome are either inconsistent or inconclusive. CONCLUSION Important of salts in metabolic disorder is evident. In order to assess the effects of dietary salts in metablic diseases, environmental factors, dietary habits, physical activity, and the microbiome, should be considered in any study. Although interest in this area of research continues to grow, the challenge is to integrate the action of these salts in metabolic syndrom.
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Affiliation(s)
| | - Safoura Akbari-Alavijeh
- Laboratory of Developmental Biology, Center for Vector Biology, Rutgers University, 180 Jones Avenue, New Brunswick, NJ, 08901, USA
| | - Jun Ling
- Department of Basic Sciences, Geisinger Commonwealth School of Medicine, 525 Pine Street, Scranton, PA, 18509, USA
| | - Jordan Sheagley
- Department of Basic Sciences, Geisinger Commonwealth School of Medicine, 525 Pine Street, Scranton, PA, 18509, USA
| | - Bilal Shaikh
- Laboratory of Developmental Biology, Center for Vector Biology, Rutgers University, 180 Jones Avenue, New Brunswick, NJ, 08901, USA
| | | | - Yi Wang
- Laboratory of Developmental Biology, Center for Vector Biology, Rutgers University, 180 Jones Avenue, New Brunswick, NJ, 08901, USA
| | - Randy Gaugler
- Laboratory of Developmental Biology, Center for Vector Biology, Rutgers University, 180 Jones Avenue, New Brunswick, NJ, 08901, USA
| | - Sarwar Hashmi
- Laboratory of Developmental Biology, Center for Vector Biology, Rutgers University, 180 Jones Avenue, New Brunswick, NJ, 08901, USA; Rutgers Center for Lipid Research, New Jersey Institute for Food, Nutrition, & Health, Rutgers University, USA.
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9
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Chatterjee R, Davenport CA, Raffield LM, Maruthur N, Lange L, Selvin E, Butler K, Yeh HC, Wilson JG, Correa A, Edelman D, Hauser E. KCNJ11 variants and their effect on the association between serum potassium and diabetes risk in the Atherosclerosis Risk in Communities (ARIC) Study and Jackson Heart Study (JHS) cohorts. PLoS One 2018; 13:e0203213. [PMID: 30169531 PMCID: PMC6118367 DOI: 10.1371/journal.pone.0203213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 08/16/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND In the Atherosclerosis Risk in Communities (ARIC) Study and Jackson Heart Study (JHS) cohorts, serum potassium (K) is an independent predictor of diabetes risk, particularly among African-American participants. Experimental studies show that serum K levels affects insulin secretion. The KCNJ11 gene encodes for a K channel that regulates insulin secretion and whose function is affected by serum K levels. Variants in KCNJ11 are associated with increased diabetes risk. We hypothesized that there could be a gene-by-environment interaction between KCNJ11 variation and serum K on diabetes risk. METHODS Evaluating a combined cohort of ARIC and JHS participants, we sought to determine if KCNJ11 variants are risk factors for diabetes; and if KCNJ11 variants modify the association between serum K and diabetes risk. Among participants without diabetes at baseline, we performed multivariable logistic regression to determine the effect of serum K, KCNJ11 variants, and their interactions on the odds of incident diabetes mellitus over 8-9 years in the entire cohort and by race. RESULTS Of 11,812 participants, 3220 (27%) participants developed diabetes. 48% and 47% had 1 or 2 diabetes risk alleles of rs5215 and rs5219, respectively. Caucasians had higher proportions of these risk alleles compared to African Americans (60% vs 17% for rs5215 and 60% vs 13% for rs5219, p<0.01). Serum K was a significant independent predictor of incident diabetes. Neither rs5215 nor rs5219 was associated with incident diabetes. In multivariable models, we found no statistically significant interactions between race and either rs5215 or rs5219 (P-values 0.493 and 0.496, respectively); nor between serum K and either rs5215 or rs5219 on odds of incident diabetes (P-values 0.534 and 0.687, respectively). CONCLUSION In this cohort, rs5215 and rs5219 of KCNJ11 were not significant predictors of incident diabetes nor effect modifiers of the association between serum K and incident diabetes.
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Affiliation(s)
| | | | - Laura M. Raffield
- University of North Carolina, Chapel Hill, NC, United States of America
| | - Nisa Maruthur
- Johns Hopkins University,Baltimore, MD, United States of America
| | - Leslie Lange
- University of Colorado, Denver,CO, United States of America
| | - Elizabeth Selvin
- Johns Hopkins University,Baltimore, MD, United States of America
| | - Kenneth Butler
- University of Mississippi Medical Center, Jackson, MS, United States of America
| | - Hsin-Chieh Yeh
- Johns Hopkins University,Baltimore, MD, United States of America
| | - James G. Wilson
- University of Mississippi Medical Center, Jackson, MS, United States of America
| | - Adolfo Correa
- University of Mississippi Medical Center, Jackson, MS, United States of America
| | - David Edelman
- Duke University, Durham, NC, United States of America
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10
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Bellavia A, Zota AR, Valeri L, James-Todd T. Multiple mediators approach to study environmental chemicals as determinants of health disparities. Environ Epidemiol 2018; 2:e015. [PMID: 31531412 PMCID: PMC6748334 DOI: 10.1097/ee9.0000000000000015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/17/2018] [Indexed: 11/26/2022] Open
Abstract
A major goal of health disparities research is to identify and intervene upon modifiable risk factors that help explain the observed associations between social factors and adverse health outcomes. To this end, statistical methods incorporating mediation analysis have shown promise, as they quantify the contribution of an intermediate variable in an exposure-outcome association. A growing body of literature suggests that environmental chemicals can contribute to health disparities. However, evaluating environmental chemicals as an important component of health disparities introduces methodological complexities that may make standard mediation approaches inadequate. Specific to environmental health is the issue of evaluating both the source and biomarker of the environmental toxicant in order to calculate the proportion of the disparity that would remain had we intervened on the modifiable factors. Recent methodological developments on multiple mediators can improve efforts to integrate both source and biomarker of exposure into epidemiological studies of health disparities. We illustrate a conceptual framework and present how mediation techniques can be used to address environmental health disparities questions. With this, we provide a methodological tool that has the potential to advance this growing field, while simultaneously informing public health prevention and policy surrounding the impact of environmental factors on health disparities.
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Affiliation(s)
- Andrea Bellavia
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Ami R. Zota
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Linda Valeri
- Psychiatric Biostatistics Laboratory, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Tamarra James-Todd
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of Women’s Health, Department of Medicine, Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
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11
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Chatterjee R, Slentz C, Davenport CA, Johnson J, Lin PH, Muehlbauer M, D’Alessio D, Svetkey LP, Edelman D. Effects of potassium supplements on glucose metabolism in African Americans with prediabetes: a pilot trial. Am J Clin Nutr 2017; 106:1431-1438. [PMID: 29092881 PMCID: PMC5698842 DOI: 10.3945/ajcn.117.161570] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 10/10/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Low potassium has been identified both as a risk factor for type 2 diabetes and as a mediator of the racial disparity in diabetes risk. Low potassium could be a potentially modifiable risk factor, particularly for African Americans.Objective: We sought to determine the effects of potassium chloride (KCl) supplements, at a commonly prescribed dose, on measures of potassium and glucose metabolism.Design: Among African-American adults with prediabetes, we conducted a double-blinded pilot randomized controlled trial that compared the effects of 40 mEq K/d as KCl supplements with a matching placebo, taken for 3 mo, on measures of potassium and glucose metabolism, with measures collected from frequently sampled oral-glucose-tolerance tests (OGTTs).Results: Twenty-seven of 29 recruited participants completed the trial. Participants had high adherence to the study medication (92% by pill count). Participants in both groups gained weight, with an overall mean ± SD weight gain of 1.24 ± 2.03 kg. In comparison with participants who received placebo, urine potassium but not serum potassium increased significantly among participants randomly assigned to receive KCl (P = 0.005 and 0.258, respectively). At the end of the study, participants taking KCl had stable or improved fasting glucose, with a mean ± SD change in fasting glucose of -1.1 ± 8.4 mg/dL compared with an increase of 6.1 ± 7.6 mg/dL in those who received placebo (P = 0.03 for comparison between arms). There were no significant differences in glucose or insulin measures during the OGTT between the 2 groups, but there was a trend for improved insulin sensitivity in potassium-treated participants.Conclusions: In this pilot trial, KCl at a dose of 40 mEq/d did not increase serum potassium significantly. However, despite weight gain, KCl prevented worsening of fasting glucose. Further studies in larger sample sizes, as well as with interventions to increase serum potassium more than was achieved with our intervention, are indicated to definitively test this potentially safe and inexpensive approach to reducing diabetes risk. This trial was registered at clinicaltrials.gov as NCT02236598.
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Affiliation(s)
| | - Cris Slentz
- Departments of Medicine and,Duke Molecular Physiology Institute, Duke University, Durham, NC
| | | | - Johanna Johnson
- Departments of Medicine and,Duke Molecular Physiology Institute, Duke University, Durham, NC
| | | | - Michael Muehlbauer
- Departments of Medicine and,Duke Molecular Physiology Institute, Duke University, Durham, NC
| | - David D’Alessio
- Departments of Medicine and,Duke Molecular Physiology Institute, Duke University, Durham, NC
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12
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Plasma potassium, diuretic use and risk of developing chronic kidney disease in a predominantly White population. PLoS One 2017; 12:e0174686. [PMID: 28346526 PMCID: PMC5367826 DOI: 10.1371/journal.pone.0174686] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 03/12/2017] [Indexed: 02/08/2023] Open
Abstract
Objective Both hypokalemia and hyperkalemia are associated with disease progression in patients with chronic kidney disease (CKD). It is unclear whether similar associations are present in the general population. Our aim was to examine the association of plasma potassium with risk of developing CKD and the role of diuretics in this association in a population-based cohort. Research design and methods We studied 5,130 subjects free of CKD at baseline of the Prevention of Renal and Vascular End-Stage Disease (PREVEND) study, a prospective, population-based cohort of Dutch men and women aged 28–75 years. Hypokalemia was defined as plasma potassium <3.5 mmol/L, and hyperkalemia as plasma potassium ≥5.0 mmol/L. Risk of CKD was defined as de novo development of eGFR <60 ml/min/1.73m2 and/or albuminuria >30 mg/24h. Results Mean baseline plasma potassium was 4.4±0.3 mmol/L. The prevalences of hypokalemia and hyperkalemia were 0.5% and 3.8%, respectively; 3.0% of the subjects used diuretics. During a median follow-up of 10.3 years (interquartile range: 6.3–11.4 years), 753 subjects developed CKD. The potassium-CKD association was modified by diuretic use (Pinteraction = 0.02). Both hypokalemia without (HR, 7.74, 95% CI, 3.43–17.48) or with diuretic use (HR, 4.32, 95% CI, 1.77–10.51) were associated with an increased CKD risk as compared to plasma potassium 4.0–4.4 mmol/L without diuretic use. Plasma potassium concentrations ≥3.5 mmol/L were associated with an increased CKD risk among subjects using diuretics (Ptrend = 0.01) but not among subjects not using diuretics (Ptrend = 0.74). Conclusion In this population-based cohort, hypokalemia was associated with an increased CKD risk, regardless of diuretic use. In the absence of hypokalemia, plasma potassium was not associated with an increased CKD risk, except among subjects using diuretics.
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13
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Chatterjee R, Davenport CA, Svetkey LP, Batch BC, Lin PH, Ramachandran VS, Fox ER, Harman J, Yeh HC, Selvin E, Correa A, Butler K, Edelman D. Serum potassium is a predictor of incident diabetes in African Americans with normal aldosterone: the Jackson Heart Study. Am J Clin Nutr 2017; 105:442-449. [PMID: 27974310 PMCID: PMC5267306 DOI: 10.3945/ajcn.116.143255] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/14/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Low-normal potassium is a risk factor for diabetes and may account for some of the racial disparity in diabetes risk. Aldosterone affects serum potassium and is associated with insulin resistance. OBJECTIVES We sought to confirm the association between potassium and incident diabetes in an African-American cohort, and to determine the effect of aldosterone on this association. DESIGN We studied participants from the Jackson Heart Study, an African-American adult cohort, who were without diabetes at baseline. With the use of logistic regression, we characterized the associations of serum, dietary, and urinary potassium with incident diabetes. In addition, we evaluated aldosterone as a potential effect modifier of these associations. RESULTS Of 2157 participants, 398 developed diabetes over 8 y. In a minimally adjusted model, serum potassium was a significant predictor of incident diabetes (OR: 0.83; 95% CI: 0.74, 0.92 per SD increment in serum potassium). In multivariable models, we found a significant interaction between serum potassium and aldosterone (P = 0.046). In stratified multivariable models, in those with normal aldosterone (<9 ng/dL, n = 1163), participants in the highest 2 potassium quartiles had significantly lower odds of incident diabetes than did those in the lowest potassium quartile [OR (95% CI): 0.61 (0.39, 0.97) and 0.54 (0.33, 0.90), respectively]. Among those with high-normal aldosterone (≥9 ng/dL, n = 202), we found no significant association between serum potassium and incident diabetes. In these stratified models, serum aldosterone was not a significant predictor of incident diabetes. We found no statistically significant associations between dietary or urinary potassium and incident diabetes. CONCLUSIONS In this African-American cohort, we found that aldosterone may modify the association between serum potassium and incident diabetes. In participants with normal aldosterone, high-normal serum potassium was associated with a lower risk of diabetes than was low-normal serum potassium. Additional studies are warranted to determine whether serum potassium is a modifiable risk factor that could be a target for diabetes prevention. This trial was registered at clinicaltrials.gov as NCT00415415.
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Affiliation(s)
| | | | | | | | - Pao-Hwa Lin
- Department of Medicine, Duke University, Durham, NC
| | | | - Ervin R Fox
- Department of Medicine, University of Mississippi Medical Center, Jackson, MI
| | - Jane Harman
- National Heart, Lung, and Blood Institute, NIH, Bethesda, MD; and
| | - Hsin-Chieh Yeh
- Department of Medicine, Johns Hopkins University, Baltimore, MD
| | | | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson, MI
| | - Kenneth Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MI
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14
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Naimi AI, Schnitzer ME, Moodie EEM, Bodnar LM. Mediation Analysis for Health Disparities Research. Am J Epidemiol 2016; 184:315-24. [PMID: 27489089 DOI: 10.1093/aje/kwv329] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 11/19/2015] [Indexed: 12/21/2022] Open
Abstract
Social epidemiologists often seek to determine the mechanisms that underlie health disparities. This work is typically based on mediation procedures that may not be justified with exposures of common interest in social epidemiology. In this analysis, we explored the consequences of using standard approaches, referred to as the difference and generalized product methods, when mediator-outcome confounders are associated with the exposure. We compared these with inverse probability-weighted marginal structural models, the structural transformation method, doubly robust g-estimation of a structural nested model, and doubly robust targeted minimum loss-based estimation. We used data on 900,726 births from 2003 to 2007 in the Penn Moms study, conducted in Pennsylvania, to assess the extent to which breastfeeding prior to hospital discharge explained the racial disparity in infant mortality. Overall, for every 1,000 births, 3.36 more infant deaths occurred among non-Hispanic black women relative to all other women (95% confidence interval: 2.78, 3.93). Using the difference and generalized product methods to assess the disparity that would remain if everyone breastfed prior to discharge suggested a complete elimination of the disparity (risk difference = -0.87 per 1,000 births; 95% confidence interval: -1.39, -0.35). In contrast, doubly robust methods suggested a reduction in the disparity to 2.45 (95% confidence interval: 2.20, 2.71) more infant deaths per 1,000 births among non-Hispanic black women. Standard approaches for mediation analysis in health disparities research can yield misleading results.
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15
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Zhong VW, Lamichhane AP, Crandell JL, Couch SC, Liese AD, The NS, Tzeel BA, Dabelea D, Lawrence JM, Marcovina SM, Kim G, Mayer-Davis EJ. Association of adherence to a Mediterranean diet with glycemic control and cardiovascular risk factors in youth with type I diabetes: the SEARCH Nutrition Ancillary Study. Eur J Clin Nutr 2016; 70:802-7. [PMID: 26908421 PMCID: PMC4935596 DOI: 10.1038/ejcn.2016.8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 12/20/2015] [Accepted: 01/17/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES This study aimed to determine the association between a Mediterranean diet and glycemic control and other cardiovascular risk factors among youth with type I diabetes (TID). SUBJECTS/METHODS Incident TID cases aged <20 years at diagnosis between 2002 and 2005 were included. Participants were seen at baseline (N=793), 1-year (N=512) and 5-year follow-up visits (N=501). Mediterranean diet score was assessed using a modified KIDMED index (mKIDMED). Multivariate linear regression and longitudinal mixed model were applied to determine the association between mKIDMED score and log-HbA1c, lipids, blood pressure (BP) and obesity. RESULTS In cross-sectional analyses using baseline data, for individuals with the hemoglobin A1c (HbA1c) of 7.5%, a two-point higher mKIDMED score (1 s.d.) was associated with 0.15% lower HbA1c (P=0.02). A two-point higher mKIDMED score was associated with 4.0 mg/dl lower total cholesterol (TC) (P=0.006), 3.4 mg/dl lower low-density lipoprotein cholesterol (LDL-C) (P=0.004), 3.9 mg/dl lower non-high-density lipoprotein cholesterol (non-HDL-C) (P=0.004) and 0.07 lower LDL-C/HDL-C ratio (P=0.02). Using longitudinal data, a two-point increase in mKIDMED score was associated with 0.01% lower log-HbA1c (P=0.07), 1.8 mg/dl lower TC (P=0.05), 1.6 mg/dl lower LDL-C (P=0.03) and 1.8 mg/dl lower non-HDL-C (P=0.03) than would otherwise have been expected. HbA1c mediated ∼20% of the association for lipids in both cross-sectional and longitudinal models. An unexpected positive association between mKIDMED score and systolic BP was found among non-Hispanic white youth in cross-sectional analyses (P=0.009). Mediterranean diet was not associated with obesity. CONCLUSIONS Mediterranean diet may improve glycemic control and cardiovascular health in TID youth.
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Affiliation(s)
- Victor W. Zhong
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA
| | | | - Jamie L. Crandell
- School of Nursing and Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Sarah C. Couch
- Department of Nutritional Sciences, University of Cincinnati, OH, USA
| | - Angela D. Liese
- Department of Epidemiology and Biostatistics, University of South Carolina, SC, USA
| | - Natalie S. The
- Department of Health Sciences, Furman University, SC, USA
| | - Benjamin A. Tzeel
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA
| | - Dana Dabelea
- Department of Epidemiology, University of Colorado, Denver, CO, USA
| | - Jean M. Lawrence
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | | | - Grace Kim
- Seattle Children’s Hospital, Seattle, WA, USA
| | - Elizabeth J. Mayer-Davis
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
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16
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Potassium Measures and Their Associations with Glucose and Diabetes Risk: The Multi-Ethnic Study of Atherosclerosis (MESA). PLoS One 2016; 11:e0157252. [PMID: 27280455 PMCID: PMC4900670 DOI: 10.1371/journal.pone.0157252] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/26/2016] [Indexed: 11/19/2022] Open
Abstract
Background Recent studies have found low-normal potassium (K) to be associated with increased diabetes risk. We sought to verify these associations in a multi-ethnic US cohort; and to determine if these associations extend to US Hispanics and Asian-Americans. Methods We analyzed data from Multi-Ethnic Study of Atherosclerosis (MESA) participants who were free-of-diabetes at baseline. We examined cross-sectional associations between measures of K—serum, dietary, and urine—with fasting glucose and HOMA-IR. We examined longitudinal associations between K and diabetes risk over 8 years. Findings In multivariable models, compared to those with higher serum K (≥4.5mmol/L), those with lower serum K (<4.0mmol/L) had significantly higher fasting glucose [1.3 mg/dL (95%CI 0.2, 2.4), P-value = 0.03]. Incident diabetes developed in 1281 of 5415 at-risk participants. In minimally-adjusted models, we found inverse associations between serum and dietary K and diabetes risk. Compared to those with higher serum K, those with lower serum K had an HR (95% CI) of incident diabetes of 1.23 (1.04, 1.47), P-value = 0.02. However, these associations were attenuated in fully-adjusted models. We found no significant interaction between potassium and ethnicity. Conclusions In this multi-ethnic cohort, we found a significant inverse association between serum K and fasting glucose but no significant association with longer-term diabetes risk. This inverse association between potassium and glucose must be studied further to understand the physiology and its potential impact on chronic health.
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17
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Joseph JJ, Echouffo-Tcheugui JB, Kalyani RR, Yeh HC, Bertoni AG, Effoe VS, Casanova R, Sims M, Correa A, Wu WC, Wand GS, Golden SH. Aldosterone, Renin, and Diabetes Mellitus in African Americans: The Jackson Heart Study. J Clin Endocrinol Metab 2016; 101:1770-8. [PMID: 26908112 PMCID: PMC4880170 DOI: 10.1210/jc.2016-1002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT Previous research has suggested that activation of the renin-angiotensin-aldosterone system may promote insulin resistance and β-cell dysfunction, but the association with incident diabetes in African Americans is unknown. OBJECTIVE We examined the association of aldosterone and renin with insulin resistance, β-cell function, and incident diabetes in a large African American cohort. DESIGN The Jackson Heart Study is a prospective study of the development and progression of cardiovascular disease in African Americans. SETTING Participants were recruited from the tricounty area of metropolitan Jackson, Mississippi. PARTICIPANTS A total of 5301 African American adults, aged 21–94 years, were assessed at baseline and through 12 years of follow-up. Data on aldosterone, renin, and risk factors were collected at baseline (2000–2004). Diabetes (fasting glucose ≥ 126 mg/dL, physician diagnosis, use of diabetes drugs, or glycated hemoglobin ≥ 6.5%) was assessed at baseline and through 12 years of follow-up. Participants were excluded for missing data on baseline covariates or diabetes follow-up. Cox regression was used to estimate hazard ratios (HR) for incident diabetes using sequential modeling adjusting for age, sex, education, occupation, systolic blood pressure, current smoking, physical activity, dietary intake, and body mass index. EXPOSURES Aldosterone, renin, and diabetes risk factors were measured. OUTCOME Outcomes included the homeostatic model assessment of insulin resistance (HOMA-IR) and incident diabetes. RESULTS Among 3234 participants over a median of 8.0 years of follow-up, there were 554 cases of incident diabetes. Every 1% increase in log-transformed aldosterone was associated with a 0.18% higher log-transformed HOMA-IR in cross-sectional analyses of nondiabetic participants (P < .001). Log-transformed aldosterone and renin levels in the fifth vs first quintile were associated with a 78% (HR 1.78, 95% confidence interval 1.35–2.34) and 35% (HR 1.35, 95% confidence interval 1.06–1.72) increase in diabetes risk, respectively, in fully adjusted models. CONCLUSIONS Activation of the renin-angiotensin-aldosterone system may play a significant role in the development of insulin resistance and diabetes in African Americans.
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Affiliation(s)
- Joshua J Joseph
- Division of Endocrinology, Diabetes, and Metabolism (J.J.J., R.R.K., H.-C.Y., G.S.W., S.H.G.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Division of Endocrinology, Diabetes, and Hypertension (J.B.E.-T.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Rollins School of Public Health (J.B.E.-T.), Emory University, Atlanta, Georgia 30322; Division of Public Health Sciences (A.G.B., V.S.E., R.C.), Wake Forest University Health Sciences, Winston-Salem, North Carolina 27157; Department of Medicine (M.S., A.C.), University of Mississippi Medical Center, Jackson, Mississippi 39216; and Department of Medicine (W.-C.W.), Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903
| | - Justin B Echouffo-Tcheugui
- Division of Endocrinology, Diabetes, and Metabolism (J.J.J., R.R.K., H.-C.Y., G.S.W., S.H.G.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Division of Endocrinology, Diabetes, and Hypertension (J.B.E.-T.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Rollins School of Public Health (J.B.E.-T.), Emory University, Atlanta, Georgia 30322; Division of Public Health Sciences (A.G.B., V.S.E., R.C.), Wake Forest University Health Sciences, Winston-Salem, North Carolina 27157; Department of Medicine (M.S., A.C.), University of Mississippi Medical Center, Jackson, Mississippi 39216; and Department of Medicine (W.-C.W.), Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903
| | - Rita R Kalyani
- Division of Endocrinology, Diabetes, and Metabolism (J.J.J., R.R.K., H.-C.Y., G.S.W., S.H.G.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Division of Endocrinology, Diabetes, and Hypertension (J.B.E.-T.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Rollins School of Public Health (J.B.E.-T.), Emory University, Atlanta, Georgia 30322; Division of Public Health Sciences (A.G.B., V.S.E., R.C.), Wake Forest University Health Sciences, Winston-Salem, North Carolina 27157; Department of Medicine (M.S., A.C.), University of Mississippi Medical Center, Jackson, Mississippi 39216; and Department of Medicine (W.-C.W.), Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903
| | - Hsin-Chieh Yeh
- Division of Endocrinology, Diabetes, and Metabolism (J.J.J., R.R.K., H.-C.Y., G.S.W., S.H.G.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Division of Endocrinology, Diabetes, and Hypertension (J.B.E.-T.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Rollins School of Public Health (J.B.E.-T.), Emory University, Atlanta, Georgia 30322; Division of Public Health Sciences (A.G.B., V.S.E., R.C.), Wake Forest University Health Sciences, Winston-Salem, North Carolina 27157; Department of Medicine (M.S., A.C.), University of Mississippi Medical Center, Jackson, Mississippi 39216; and Department of Medicine (W.-C.W.), Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903
| | - Alain G Bertoni
- Division of Endocrinology, Diabetes, and Metabolism (J.J.J., R.R.K., H.-C.Y., G.S.W., S.H.G.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Division of Endocrinology, Diabetes, and Hypertension (J.B.E.-T.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Rollins School of Public Health (J.B.E.-T.), Emory University, Atlanta, Georgia 30322; Division of Public Health Sciences (A.G.B., V.S.E., R.C.), Wake Forest University Health Sciences, Winston-Salem, North Carolina 27157; Department of Medicine (M.S., A.C.), University of Mississippi Medical Center, Jackson, Mississippi 39216; and Department of Medicine (W.-C.W.), Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903
| | - Valery S Effoe
- Division of Endocrinology, Diabetes, and Metabolism (J.J.J., R.R.K., H.-C.Y., G.S.W., S.H.G.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Division of Endocrinology, Diabetes, and Hypertension (J.B.E.-T.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Rollins School of Public Health (J.B.E.-T.), Emory University, Atlanta, Georgia 30322; Division of Public Health Sciences (A.G.B., V.S.E., R.C.), Wake Forest University Health Sciences, Winston-Salem, North Carolina 27157; Department of Medicine (M.S., A.C.), University of Mississippi Medical Center, Jackson, Mississippi 39216; and Department of Medicine (W.-C.W.), Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903
| | - Ramon Casanova
- Division of Endocrinology, Diabetes, and Metabolism (J.J.J., R.R.K., H.-C.Y., G.S.W., S.H.G.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Division of Endocrinology, Diabetes, and Hypertension (J.B.E.-T.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Rollins School of Public Health (J.B.E.-T.), Emory University, Atlanta, Georgia 30322; Division of Public Health Sciences (A.G.B., V.S.E., R.C.), Wake Forest University Health Sciences, Winston-Salem, North Carolina 27157; Department of Medicine (M.S., A.C.), University of Mississippi Medical Center, Jackson, Mississippi 39216; and Department of Medicine (W.-C.W.), Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903
| | - Mario Sims
- Division of Endocrinology, Diabetes, and Metabolism (J.J.J., R.R.K., H.-C.Y., G.S.W., S.H.G.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Division of Endocrinology, Diabetes, and Hypertension (J.B.E.-T.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Rollins School of Public Health (J.B.E.-T.), Emory University, Atlanta, Georgia 30322; Division of Public Health Sciences (A.G.B., V.S.E., R.C.), Wake Forest University Health Sciences, Winston-Salem, North Carolina 27157; Department of Medicine (M.S., A.C.), University of Mississippi Medical Center, Jackson, Mississippi 39216; and Department of Medicine (W.-C.W.), Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903
| | - Adolfo Correa
- Division of Endocrinology, Diabetes, and Metabolism (J.J.J., R.R.K., H.-C.Y., G.S.W., S.H.G.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Division of Endocrinology, Diabetes, and Hypertension (J.B.E.-T.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Rollins School of Public Health (J.B.E.-T.), Emory University, Atlanta, Georgia 30322; Division of Public Health Sciences (A.G.B., V.S.E., R.C.), Wake Forest University Health Sciences, Winston-Salem, North Carolina 27157; Department of Medicine (M.S., A.C.), University of Mississippi Medical Center, Jackson, Mississippi 39216; and Department of Medicine (W.-C.W.), Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903
| | - Wen-Chih Wu
- Division of Endocrinology, Diabetes, and Metabolism (J.J.J., R.R.K., H.-C.Y., G.S.W., S.H.G.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Division of Endocrinology, Diabetes, and Hypertension (J.B.E.-T.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Rollins School of Public Health (J.B.E.-T.), Emory University, Atlanta, Georgia 30322; Division of Public Health Sciences (A.G.B., V.S.E., R.C.), Wake Forest University Health Sciences, Winston-Salem, North Carolina 27157; Department of Medicine (M.S., A.C.), University of Mississippi Medical Center, Jackson, Mississippi 39216; and Department of Medicine (W.-C.W.), Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903
| | - Gary S Wand
- Division of Endocrinology, Diabetes, and Metabolism (J.J.J., R.R.K., H.-C.Y., G.S.W., S.H.G.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Division of Endocrinology, Diabetes, and Hypertension (J.B.E.-T.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Rollins School of Public Health (J.B.E.-T.), Emory University, Atlanta, Georgia 30322; Division of Public Health Sciences (A.G.B., V.S.E., R.C.), Wake Forest University Health Sciences, Winston-Salem, North Carolina 27157; Department of Medicine (M.S., A.C.), University of Mississippi Medical Center, Jackson, Mississippi 39216; and Department of Medicine (W.-C.W.), Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903
| | - Sherita H Golden
- Division of Endocrinology, Diabetes, and Metabolism (J.J.J., R.R.K., H.-C.Y., G.S.W., S.H.G.), Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; Division of Endocrinology, Diabetes, and Hypertension (J.B.E.-T.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Rollins School of Public Health (J.B.E.-T.), Emory University, Atlanta, Georgia 30322; Division of Public Health Sciences (A.G.B., V.S.E., R.C.), Wake Forest University Health Sciences, Winston-Salem, North Carolina 27157; Department of Medicine (M.S., A.C.), University of Mississippi Medical Center, Jackson, Mississippi 39216; and Department of Medicine (W.-C.W.), Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903
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Miller ER, Cooper LA, Carson KA, Wang NY, Appel LJ, Gayles D, Charleston J, White K, You N, Weng Y, Martin-Daniels M, Bates-Hopkins B, Robb I, Franz WK, Brown EL, Halbert JP, Albert MC, Dalcin AT, Yeh HC. A Dietary Intervention in Urban African Americans: Results of the "Five Plus Nuts and Beans" Randomized Trial. Am J Prev Med 2016; 50:87-95. [PMID: 26321012 PMCID: PMC4691550 DOI: 10.1016/j.amepre.2015.06.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/13/2015] [Accepted: 06/16/2015] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Unhealthy diets, often low in potassium, likely contribute to racial disparities in blood pressure. We tested the effectiveness of providing weekly dietary advice, assistance with selection of higher potassium grocery items, and a $30 per week food allowance on blood pressure and other outcomes in African American adults with hypertension. DESIGN We conducted an 8-week RCT with two parallel arms between May 2012 and November 2013. SETTING/PARTICIPANTS We randomized 123 African Americans with controlled hypertension from an urban primary care clinic in Baltimore, Maryland, and implemented the trial in partnership with a community supermarket and the Baltimore City Health Department. Mean (SD) age was 58.6 (9.5) years; 71% were female; blood pressure was 131.3 (14.7)/77.2 (10.5) mmHg; BMI was 34.5 (8.2); and 28% had diabetes. INTERVENTION Participants randomized to the active intervention group (Dietary Approaches to Stop Hypertension [DASH]-Plus) received coach-directed dietary advice and assistance with weekly online ordering and purchasing of high-potassium foods ($30/week) delivered by a community supermarket to a neighborhood library. Participants in the control group received a printed DASH diet brochure along with a debit account of equivalent value to that of the DASH-Plus group. MAIN OUTCOME MEASURES The primary outcome was blood pressure change. Analyses were conducted in January to October 2014. RESULTS Compared with the control group, the DASH-Plus group increased self-reported consumption of fruits and vegetables (mean=1.4, 95% CI=0.7, 2.1 servings/day); estimated intake of potassium (mean=0.4, 95% CI=0.1, 0.7 grams/day); and urine potassium excretion (mean=19%, 95% CI=1%, 38%). There was no significant effect on blood pressure. CONCLUSIONS A program providing dietary advice, assistance with grocery ordering, and $30/week of high-potassium foods in African American patients with controlled hypertension in a community-based clinic did not reduce BP. However, the intervention increased consumption of fruits, vegetables, and urinary excretion of potassium.
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Affiliation(s)
- Edgar R Miller
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Johns Hopkins School of Medicine, Baltimore, Maryland; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland.
| | - Lisa A Cooper
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Johns Hopkins School of Medicine, Baltimore, Maryland; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Kathryn A Carson
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Johns Hopkins School of Medicine, Baltimore, Maryland; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Nae-Yuh Wang
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Johns Hopkins School of Medicine, Baltimore, Maryland; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Lawrence J Appel
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Johns Hopkins School of Medicine, Baltimore, Maryland; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Debra Gayles
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jeanne Charleston
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Karen White
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Na You
- School of Mathematics and Computational Science, Sun Yat-sen University, Guangzhou, China
| | - Yingjie Weng
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Michelle Martin-Daniels
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Barbara Bates-Hopkins
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Inez Robb
- Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Whitney K Franz
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Emily L Brown
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jennifer P Halbert
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Michael C Albert
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; Johns Hopkins Community Physicians, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Arlene T Dalcin
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Hsin-Chieh Yeh
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Johns Hopkins School of Medicine, Baltimore, Maryland; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Abstract
In the USA, compared to whites, African-Americans are disproportionately impacted by the diabetes epidemic. Traditional diabetes risk factors, such as obesity, are more common among African-Americans, but these traditional risk factors do not explain all of the disparity in diabetes risk. Recent research has identified novel environmental, lifestyle, physiologic, and genetic risk factors for diabetes, some of which appear to impact African-Americans more than whites. This manuscript reviews the recent literature to highlight some of these novel risk factors that may be contributing to the racial disparity in diabetes risk. Further study is needed of the modifiable risk factors for development of interventions to reduce the risk of diabetes in African-Americans, as well as other high-risk populations.
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Affiliation(s)
- Ranee Chatterjee
- Division of General Internal Medicine, Duke University, 411 West Chapel Hill Street, Suite 500, Durham, NC, 27701, USA.
| | - Nisa M Maruthur
- Division of General Internal Medicine, Johns Hopkins University, 2024 E Monument St., Baltimore, MD, 21287, USA.
| | - David Edelman
- Division of General Internal Medicine, Duke University, 411 West Chapel Hill Street, Suite 500, Durham, NC, 27701, USA.
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20
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Abstract
Hypokalemia is a common electrolyte disturbance, observed in > 20% of hospitalized patients. Hypokalemia, although not formally defined, is generally considered to be when serum potassium levels fall below the normal value of 3.6 mmol/L. In contrast to other electrolytes, potassium is primarily an intracellular ion: only 2% of all potassium in the body is present in the extracellular fluid, so a small decrease in serum potassium may represent a significant decrease in intracellular potassium. Individuals with mildly decreased potassium levels (3.0-3.5 mmol/L) may be asymptomatic, but patients with more pronounced decreases may report symptoms including muscle weakness, fatigue, and constipation. Very low serum potassium levels (≤ 2.5 mmol/L) can lead to muscle necrosis, paralysis, cardiac arrhythmias, and impaired respiration, which can be life-threatening. Absent comprehensive and robust treatment guidelines, strategies for the prevention or treatment of hypokalemia, such as how to diagnose hypokalemia, when to treat patients, what dosage regimen of potassium supplementation to use and for how long, are often based on the experience of the physician and empirical evidence. However, proper evaluation and treatment of hypokalemia in patients is essential because of associated morbidities. Because small potassium deficits in serum represent large body losses, potassium repletion requires substantial and prolonged supplementation. For patients with known risk factors for hypokalemia (e.g. hypertension, heart failure, or diabetes), careful monitoring is crucial to avoid the adverse sequelae associated with potassium deficits and to ensure that adequate and timely preventive measures can be taken. In this review, we provide practical insights into the etiology, differential diagnosis, and treatment of hypokalemia, including treatment strategies for patients with known risk factors.
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Affiliation(s)
- Matthew R Weir
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine , Baltimore, MD , USA
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21
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Wang G, Divall S, Radovick S, Paige D, Ning Y, Chen Z, Ji Y, Hong X, Walker SO, Caruso D, Pearson C, Wang MC, Zuckerman B, Cheng TL, Wang X. Preterm birth and random plasma insulin levels at birth and in early childhood. JAMA 2014; 311:587-96. [PMID: 24519298 PMCID: PMC4392841 DOI: 10.1001/jama.2014.1] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE Although previous reports have linked preterm birth with insulin resistance in children and adults, it is not known whether altered insulin homeostasis is detectable at birth and tracks from birth through childhood. OBJECTIVE To investigate whether preterm birth is associated with elevated plasma insulin levels at birth and whether this association persists into early childhood. DESIGN, SETTING, AND PARTICIPANTS A prospective birth cohort of 1358 children recruited at birth from 1998 to 2010 and followed-up with prospectively from 2005 to 2012 at the Boston Medical Center in Massachusetts. MAIN OUTCOMES AND MEASURES Random plasma insulin levels were measured at 2 time points: at birth (cord blood) and in early childhood (venous blood). The median age was 1.4 years (interquartile range [IQR], 0.8-3.3) among 4 gestational age groups: full term (≥39 wk), early term (37-38 wk), late preterm (34-36 wk), and early preterm (<34 wk). RESULTS The geometric mean of insulin levels at birth were 9.2 µIU/mL (95% CI, 8.4-10.0) for full term; 10.3 µIU/mL (95% CI, 9.3-11.5) for early term; 13.2 µIU/mL (95% CI, 11.8-14.8) for late preterm; and 18.9 µIU/mL (95% CI, 16.6-21.4) for early preterm. In early childhood, these levels were 11.2 µIU/mL (95% CI, 10.3-12.0) for full term; 12.4 µIU/mL (95% CI, 11.3-13.6) for early term; 13.3 µIU/mL (95% CI, 11.9-14.8) for late preterm; and 14.6 µIU/mL (95% CI, 12.6-16.9) for early preterm. Insulin levels at birth were higher by 1.13-fold (95% CI, 0.97-1.28) for early term, 1.45-fold (95% CI, 1.25-1.65) for late preterm, and 2.05-fold (95% CI, 1.69-2.42) for early preterm than for those born full term. In early childhood, random plasma insulin levels were 1.12-fold (95% CI, 0.99-1.25) higher for early term, 1.19-fold (95% CI, 1.02-1.35) for late preterm, and 1.31-fold (95% CI, 1.10-1.52) for early preterm than those born full term. The association was attenuated after adjustment for postnatal weight gain and was not significant after adjustment for insulin levels at birth. Infants ranked in the top insulin tertile at birth were more likely to remain in the top tertile (41.2%) compared with children ranked in the lowest tertile (28.6%) in early childhood. CONCLUSIONS AND RELEVANCE There was an inverse association between gestational age and elevated plasma insulin levels at birth and in early childhood. The implications for future development of insulin resistance and type 2 diabetes warrant further investigation.
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Affiliation(s)
- Guoying Wang
- Department of Population, Family and Reproductive Health, Center on Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sara Divall
- Division of Endocrinology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sally Radovick
- Division of Endocrinology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David Paige
- Department of Population, Family and Reproductive Health, Center on Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yi Ning
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Zhu Chen
- Department of Population, Family and Reproductive Health, Center on Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yuelong Ji
- Department of Population, Family and Reproductive Health, Center on Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xiumei Hong
- Department of Population, Family and Reproductive Health, Center on Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sheila O. Walker
- Department of Population, Family and Reproductive Health, Center on Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Deanna Caruso
- Department of Population, Family and Reproductive Health, Center on Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Colleen Pearson
- Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Mei-Cheng Wang
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Barry Zuckerman
- Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Tina L. Cheng
- Division of General Pediatrics & Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Center on Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Division of General Pediatrics & Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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22
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Sun K, Su T, Li M, Xu B, Xu M, Lu J, Liu J, Bi Y, Ning G. Serum potassium level is associated with metabolic syndrome: a population-based study. Clin Nutr 2013; 33:521-7. [PMID: 23910935 DOI: 10.1016/j.clnu.2013.07.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 06/28/2013] [Accepted: 07/02/2013] [Indexed: 01/14/2023]
Abstract
BACKGROUND & AIMS Evidence has suggested that low serum potassium concentration or low dietary potassium intake can result in many metabolic disorders. Our objective was to evaluate the association between serum potassium level and risk of prevalent metabolic syndrome. METHODS We conducted a cross-sectional study in 10,341 participants aged 40 years or older. Metabolic syndrome was defined according to guidelines from the National Cholesterol Education Program with modification. RESULTS The prevalence rate of metabolic syndrome was 51.7% in participants with hypokalemia and 37.7% in those with normokalemia. With the reduction of serum potassium quartiles, participants were tended to have higher level of triglycerides and uric acid, lower level of high-density lipoprotein cholesterol (HDL-C), larger waist circumference and more severe insulin resistance. Serum potassium level significantly decreased with the increasing number of metabolic syndrome components. Compared with subjects in the highest quartile of serum potassium level, multivariate adjusted odds ratios for prevalent metabolic syndrome in the lowest quartile was 1.48 (95% confidence interval, 1.16-1.87). Moreover, compared with subjects without central obesity, hypertriglyceridemia, low HDL-C and elevated fasting plasma glucose, those with each of these metabolic syndrome components have lower level of serum potassium after adjusted for age and sex. CONCLUSIONS Low serum potassium level significantly associated with prevalence of metabolic syndrome in middle-aged and elderly Chinese.
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Affiliation(s)
- Kan Sun
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, E-Institute of Shanghai Universities, Shanghai 200025, China; Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrinology and Metabolism, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Tingwei Su
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, E-Institute of Shanghai Universities, Shanghai 200025, China; Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrinology and Metabolism, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Mian Li
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, E-Institute of Shanghai Universities, Shanghai 200025, China; Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrinology and Metabolism, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Baihui Xu
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, E-Institute of Shanghai Universities, Shanghai 200025, China; Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrinology and Metabolism, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Min Xu
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, E-Institute of Shanghai Universities, Shanghai 200025, China; Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrinology and Metabolism, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jieli Lu
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, E-Institute of Shanghai Universities, Shanghai 200025, China; Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrinology and Metabolism, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jianmin Liu
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, E-Institute of Shanghai Universities, Shanghai 200025, China; Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrinology and Metabolism, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yufang Bi
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, E-Institute of Shanghai Universities, Shanghai 200025, China; Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrinology and Metabolism, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Guang Ning
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, E-Institute of Shanghai Universities, Shanghai 200025, China; Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrinology and Metabolism, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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Meisinger C, Stöckl D, Rückert IM, Döring A, Thorand B, Heier M, Huth C, Belcredi P, Kowall B, Rathmann W. Serum potassium is associated with prediabetes and newly diagnosed diabetes in hypertensive adults from the general population: the KORA F4-study. Diabetologia 2013. [PMID: 23183943 DOI: 10.1007/s00125-012-2786-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIMS/HYPOTHESIS Evidence suggests that low serum potassium concentrations or hypokalaemia induced by the intake of diuretics are associated with incident diabetes and increased risk for diabetes in persons with hypertension. We examined a possible association between serum potassium and prediabetes (defined as isolated impaired fasting glucose [i-IFG], isolated impaired glucose tolerance [i-IGT] or combined IFG/IGT), as well as known and newly diagnosed diabetes (NDD), in 32- to 81-year-old men and women with and without hypertension. METHODS This cross-sectional analysis was based on 2,948 participants in the Cooperative Health Research in the Region of Augsburg (KORA) F4 study conducted in 2006-2008 in southern Germany. Serum concentrations of potassium were measured by indirect potentiometry. RESULTS In the total sample there was no association between serum potassium concentrations and prediabetes. In hypertensive persons however serum potassium levels in the first and second quartile compared with the highest quartile were independently significantly associated with prediabetes after multivariable adjustment (OR for prediabetes, 2.02 [95% CI 1.27, 3.21] for quartile 2 and 2.00 [95% CI 1.27, 3.15] for quartile 1), while in persons without hypertension no association was found. In multinomial logistic regression analysis these findings could be confirmed. In hypertensive participants after multivariable adjustment the associations were statistically significant for i-IGT and NDD (i-IGT OR 1.23; NDD OR 1.41). However, in non-hypertensive persons, all associations between serum potassium levels and each of the categories of impaired glucose regulation were non-significant. CONCLUSIONS/INTERPRETATION Serum potassium levels were independently associated with prediabetes and NDD in hypertensive adults from the general population.
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Affiliation(s)
- C Meisinger
- Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Institute of Epidemiology II, Neuherberg, Germany.
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Chatterjee R, Colangelo LA, Yeh HC, Anderson CA, Daviglus ML, Liu K, Brancati FL. Potassium intake and risk of incident type 2 diabetes mellitus: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Diabetologia 2012; 55:1295-303. [PMID: 22322920 PMCID: PMC3934349 DOI: 10.1007/s00125-012-2487-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 01/05/2012] [Indexed: 10/14/2022]
Abstract
AIMS/HYPOTHESIS Serum potassium has been found to be a significant predictor of diabetes risk, but the effect of dietary potassium on diabetes risk is not clear. We sought to determine if dietary potassium is associated with risk of incident type 2 diabetes in young adults. METHODS We used data from the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Potassium intake was measured by (1) an average of three 24 h urinary potassium collections at the 5-year study visit, and (2) the CARDIA dietary assessment instrument at baseline. Incident type 2 diabetes cases were ascertained on the basis of use of diabetes medication and laboratory measurements. Analyses were adjusted for relevant confounders including intake of fruit and vegetables and other dietary factors. RESULTS Of 1,066 participants with urinary potassium measurements, 99 (9.3%) developed diabetes over 15 years of follow-up. In multivariate models, adults in the lowest urinary potassium quintile were more than twice as likely to develop diabetes as their counterparts in the highest quintile (HR 2.45; 95% CI 1.08, 5.59). Of 4,754 participants with dietary history measurements, 373 (7.8%) developed diabetes over 20 years of follow-up. In multivariate models, African-Americans had a significantly increased risk of diabetes with lower potassium intake, which was not found in whites. CONCLUSIONS/INTERPRETATION Low dietary potassium is associated with increased risk of incident diabetes in African-Americans. Randomised clinical trials are needed to determine if potassium supplementation, from either dietary or pharmacological sources, could reduce the risk of diabetes, particularly in higher-risk populations.
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Affiliation(s)
- R Chatterjee
- Duke University School of Medicine, Sutton Station Internal Medicine, 5832 Fayetteville Road, Suite 113, Durham, NC 27713, USA.
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Abstract
The rising incidence and prevalence of Type 2 diabetes worldwide requires us to try to identify the determinants of this epidemic and to identify improved measures to prevent and treat this condition. While obesity is a major risk factor for diabetes, there are other risk factors that could potentially be corrected more easily. Potassium, both serum levels and to a lesser extent dietary intake levels, has been associated with incident diabetes. Lower levels of potassium have been found to be associated with a higher risk of diabetes in some studies. This article will review the literature available describing these associations and will help to identify where further research is needed.
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Affiliation(s)
| | - Hsin-Chieh Yeh
- Department of Medicine and Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - David Edelman
- Department of Medicine, Duke University, Durham, NC, USA
| | - Frederick Brancati
- Department of Medicine and Epidemiology, Johns Hopkins University, Baltimore, MD, USA
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Naimi AI, Kaufman JS, Howe CJ, Robinson WR. Mediation considerations: serum potassium and the racial disparity in diabetes risk. Am J Clin Nutr 2011; 94:614-6. [PMID: 21775571 DOI: 10.3945/ajcn.111.018176] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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