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Della Pepa G, Carli F, Sabatini S, Pezzica S, Russo M, Vitale M, Masulli M, Riccardi G, Rivellese AA, Vaccaro O, Bozzetto L, Gastaldelli A. Clusters of adipose tissue dysfunction in adults with type 2 diabetes identify those with worse lipidomic profile despite similar glycaemic control. Diabetes Metab Res Rev 2024; 40:e3798. [PMID: 38558269 DOI: 10.1002/dmrr.3798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/30/2023] [Accepted: 12/31/2023] [Indexed: 04/04/2024]
Abstract
AIMS To investigate clusters of adipose tissue dysfunction, that is, with adipose tissue insulin resistance (ADIPO-IR) and large waist circumference (WC), identify a worse lipidomic profile characterised by a high proportion of lipids rich in saturated fatty acids (SFA). MATERIALS AND METHODS Hierarchical clustering based on WC and ADIPO-IR (calculated as fasting plasma non-esterified fatty acids times fasting plasma insulin, FFA×INS), was performed in 192 adults with overweight/obesity and type 2 diabetes (T2D) treated with metformin (HbA1c = 7.8%). Free fatty acid composition and lipidomic profile were measured by mass spectrometry (GC-MS and LC-MSQTOF). Indexes of fatty acid desaturation (stearoyl-coA desaturase-1 activity, SCD116 = palmitoleic acid/palmitic acid and SCD118 = oleic acid/stearic acid) and of insulin resistance (HOMA-IR) were also calculated. RESULTS Three clusters were identified: CL1 (ADIPO-IR = 4.9 ± 2.4 and WC = 96±7 cm, mean ± SD), CL2 (ADIPO-IR = 6.5 ± 2.5 and WC = 114 ± 7 cm), and CL3 (ADIPO-IR = 15.0 ± 4.7 and WC = 107 ± 8 cm). Insulin concentrations, ADIPO-IR, and HOMA-IR significantly increased from CL1 to CL3 (all p < 0.001), while fasting glucose concentrations, HbA1c, dietary lipids and caloric intake were similar. Moreover, CL3 showed significantly higher concentrations of monounsaturated free fatty acids, oleic and palmitoleic acids, triglycerides (TAG) rich in saturated FA and associated with de novo lipogenesis (i.e., TAG 46-50), higher SCD116, SCD118, ceramide (d18:0/18:0), and phosphatidylcholine aa(36:5) compared with CL1/CL2 (all p < 0.005). CONCLUSIONS High ADIPO-IR and large WC identify a worse lipid profile in T2D characterised by complex lipids rich in SFA, likely due to de novo synthesis given higher plasma monounsaturated FFA and increased desaturase activity indexes. REGISTRATION NUMBER TRIAL ID NCT00700856 https://clinicaltrials.gov.
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Affiliation(s)
- Giuseppe Della Pepa
- Cardiometabolic Risk Unit, Institute of Clinical Physiology, National Research Council-CNR, Pisa, Italy
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Fabrizia Carli
- Cardiometabolic Risk Unit, Institute of Clinical Physiology, National Research Council-CNR, Pisa, Italy
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
| | - Silvia Sabatini
- Cardiometabolic Risk Unit, Institute of Clinical Physiology, National Research Council-CNR, Pisa, Italy
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
| | - Samantha Pezzica
- Cardiometabolic Risk Unit, Institute of Clinical Physiology, National Research Council-CNR, Pisa, Italy
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
| | - Marco Russo
- Cardiometabolic Risk Unit, Institute of Clinical Physiology, National Research Council-CNR, Pisa, Italy
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
| | - Marilena Vitale
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Angela A Rivellese
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Olga Vaccaro
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Lutgarda Bozzetto
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Amalia Gastaldelli
- Cardiometabolic Risk Unit, Institute of Clinical Physiology, National Research Council-CNR, Pisa, Italy
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Della Pepa G, Lupoli R, Masulli M, Boccia R, De Angelis R, Gianfrancesco S, Piccolo R, Rainone C, Rivellese AA, Annuzzi G, Bozzetto L. Blood glucose control and metabolic dysfunction-associated steatotic liver disease in people with type 1 diabetes. J Endocrinol Invest 2024:10.1007/s40618-024-02333-2. [PMID: 38498227 DOI: 10.1007/s40618-024-02333-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/07/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE Metabolic dysfunction-associated steatotic liver disease (MASLD) may have distinctive pathophysiological features in type 1 diabetes (T1D). We evaluated the independent role of blood glucose control on MASLD in T1D. METHODS In a cross-sectional study on 659 T1D adult patients, MASLD was assessed by the Fatty Liver Index (FLI) and the Hepatic Steatosis Index (HSI). Anthropometric, biochemical, and clinical parameters were retrieved from electronic records. Blood glucose control status was evaluated by dividing participants into subgroups according to the median value of HbA1c [7.6% (60 mmol/mol)], and this analysis was repeated excluding overweight/obese patients. RESULTS Patients with HbA1c above 7.6% (60 mmol/mol) showed significantly higher MASLD indices (HSI 38 ± 6 vs. 36 ± 5, p < 0.001; FLI 26 ± 26 vs.19 ± 19, p < 0.001), and higher proportions of MASLD identified by HSI (57 vs. 44%, p < 0.001) and FLI (14 vs. 7%, p < 0.001) than patients with HbA1c below 7.6% (60 mmol/mol). Similar results were obtained for HSI after the exclusion of overweight/obese patients. Stepwise linear regression analysis confirmed that HbA1c was independently associated with HSI (r = 0.496, p = 0.009) and FLI (r = 0.722, p = 0.007); waist circumference with HSI (r = 0.492, p < 0.001); and waist circumference (r = 0.700, p < 0.001), HDL cholesterol (r = 0.719, p < 0.001), and LDL cholesterol (r = 0.712, p < 0.001) with FLI. CONCLUSIONS Blood glucose control is a main factor associated with MASLD in adults with T1D, also independently of overweight and obesity. Appropriate therapeutic strategies focused on tight blood glucose control may also be needed for the prevention and treatment of MASLD in T1D.
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Affiliation(s)
- G Della Pepa
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy
- Cardiometabolic Risk Unit, Institute of Clinical Physiology, National Research Council-CNR, Via Giuseppe Moruzzi 1, 56100, Pisa, Italy
| | - R Lupoli
- Department of Molecular Medicine and Medical Biotechnology, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy
| | - M Masulli
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy
| | - R Boccia
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy
| | - R De Angelis
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy
| | - S Gianfrancesco
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy
| | - R Piccolo
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy
| | - C Rainone
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy
| | - A A Rivellese
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy
| | - G Annuzzi
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy.
| | - L Bozzetto
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy
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Tikhonoff V, Casiglia E, Virdis A, Grassi G, Angeli F, Arca M, Barbagallo CM, Bombelli M, Cappelli F, Cianci R, Cicero AFG, Cirillo M, Cirillo P, Dell'oro R, D'elia L, Desideri G, Ferri C, Galletti F, Gesualdo L, Giannattasio C, Iaccarino G, Mallamaci F, Maloberti A, Masi S, Masulli M, Mazza A, Mengozzi A, Muiesan ML, Nazzaro P, Palatini P, Parati G, Pontremoli R, Quarti‐Trevano F, Rattazzi M, Reboldi G, Rivasi G, Russo E, Salvetti M, Temporelli PL, Tocci G, Ungar A, Verdecchia P, Viazzi F, Volpe M, Borghi C. Prognostic Value and Relative Cutoffs of Triglycerides Predicting Cardiovascular Outcome in a Large Regional-Based Italian Database. J Am Heart Assoc 2024; 13:e030319. [PMID: 38293920 PMCID: PMC11056112 DOI: 10.1161/jaha.123.030319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Despite longstanding epidemiologic data on the association between increased serum triglycerides and cardiovascular events, the exact level at which risk begins to rise is unclear. The Working Group on Uric Acid and Cardiovascular Risk of the Italian Society of Hypertension has conceived a protocol aimed at searching for the prognostic cutoff value of triglycerides in predicting cardiovascular events in a large regional-based Italian cohort. METHODS AND RESULTS Among 14 189 subjects aged 18 to 95 years followed-up for 11.2 (5.3-13.2) years, the prognostic cutoff value of triglycerides, able to discriminate combined cardiovascular events, was identified by means of receiver operating characteristic curve. The conventional (150 mg/dL) and the prognostic cutoff values of triglycerides were used as independent predictors in separate multivariable Cox regression models adjusted for age, sex, body mass index, total and high-density lipoprotein cholesterol, serum uric acid, arterial hypertension, diabetes, chronic renal disease, smoking habit, and use of antihypertensive and lipid-lowering drugs. During 139 375 person-years of follow-up, 1601 participants experienced cardiovascular events. Receiver operating characteristic curve showed that 89 mg/dL (95% CI, 75.8-103.3, sensitivity 76.6, specificity 34.1, P<0.0001) was the prognostic cutoff value for cardiovascular events. Both cutoff values of triglycerides, the conventional and the newly identified, were accepted as multivariate predictors in separate Cox analyses, the hazard ratios being 1.211 (95% CI, 1.063-1.378, P=0.004) and 1.150 (95% CI, 1.021-1.295, P=0.02), respectively. CONCLUSIONS Lower (89 mg/dL) than conventional (150 mg/dL) prognostic cutoff value of triglycerides for cardiovascular events does exist and is associated with increased cardiovascular risk in an Italian cohort.
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Affiliation(s)
- Valérie Tikhonoff
- Department of MedicineUniversità degli Studi di PadovaVia Giustiniani 8Padua35128Italy
| | - Edoardo Casiglia
- Studium Patavinum, Department of MedicineUniversità degli Studi di PadovaPaduaItaly
| | - Agostino Virdis
- Department of Clinical and Experimental MedicineUniversity of PisaItaly
| | - Guido Grassi
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly
| | - Fabio Angeli
- Department of Medicine and SurgeryUniversity of InsubriaVareseItaly
| | - Marcello Arca
- Department of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Carlo M. Barbagallo
- Biomedical Department of Internal Medicine and SpecialisticsUniversity of PalermoItaly
| | - Michele Bombelli
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly
- Internal Medicine, Pio XI Hospital of Desio, ASST BrianzaDesioItaly
| | - Federica Cappelli
- Department of Clinical and Experimental MedicineUniversity of PisaItaly
| | - Rosario Cianci
- Department of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Arrigo F. G. Cicero
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences DepartmentAlma Mater Studiorum University of BolognaBolognaItaly
- IRCCS AOU S.Orsola di BolognaBolognaItaly
| | - Massimo Cirillo
- Department of Medicine “Scuola Medica Salernitana”University of SalernoBaronissi (SA)Italy
| | - Pietro Cirillo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation“Aldo Moro” University of BariBariItaly
| | - Raffaella Dell'oro
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly
| | - Lanfranco D'elia
- Department of Clinical Medicine and Surgery“Federico II” University of Naples Medical SchoolNaplesItaly
| | | | - Claudio Ferri
- Department of Life, Health and Environmental SciencesUniversity of L’AquilaItaly
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery“Federico II” University of Naples Medical SchoolNaplesItaly
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation“Aldo Moro” University of BariBariItaly
| | - Cristina Giannattasio
- Cardiology IV, “A.De Gasperi’s” DepartmentNiguarda Ca’ Granda HospitalMilanItaly
- School of Medicine and SurgeryMilano‐Bicocca UniversityMilanItaly
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences“Federico II” University of NaplesNaplesItaly
| | - Francesca Mallamaci
- CNR‐IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Cal UnitReggio CalabriaItaly
| | - Alessandro Maloberti
- Cardiology IV, “A.De Gasperi’s” DepartmentNiguarda Ca’ Granda HospitalMilanItaly
- School of Medicine and SurgeryMilano‐Bicocca UniversityMilanItaly
| | - Stefano Masi
- Department of Clinical and Experimental MedicineUniversity of PisaItaly
| | - Maria Masulli
- Department of Clinical Medicine and Surgery“Federico II” University of Naples Medical SchoolNaplesItaly
| | - Alberto Mazza
- Department of Internal MedicineSanta Maria della Misericordia General Hospital, AULSS 5 PolesanaRovigoItaly
| | | | | | - Pietro Nazzaro
- Department of Medical Basic Sciences, Neurosciences and Sense OrgansUniversity of Bari Medical SchoolBariItaly
| | - Paolo Palatini
- Studium Patavinum, Department of MedicineUniversità degli Studi di PadovaPaduaItaly
| | - Gianfranco Parati
- S. Luca HospitalIstituto Auxologico Italiano and University of Milan‐BicoccaMilanItaly
| | - Roberto Pontremoli
- Department of Internal MedicineUniversity of Genoa, and Policlinico San MartinoGenoaItaly
| | | | - Marcello Rattazzi
- Department of MedicineUniversità degli Studi di PadovaVia Giustiniani 8Padua35128Italy
- Medicina Interna ICa’ Foncello University HospitalTrevisoItaly
| | - Gianpaolo Reboldi
- Department of Medical and Surgical ScienceUniversity of PerugiaItaly
| | - Giulia Rivasi
- Department of Geriatric and Intensive Care MedicineCareggi Hospital and University of FlorenceItaly
| | - Elisa Russo
- Department of Internal MedicineUniversity of Genoa, and Policlinico San MartinoGenoaItaly
| | - Massimo Salvetti
- Department of Clinical and Experimental SciencesUniversity of BresciaItaly
| | - Pier Luigi Temporelli
- Division of Cardiac RehabilitationIstituti Clinici Scientifici Maugeri, IRCCS, Gattico‐VerunoItaly
| | - Giuliano Tocci
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and PsychologyUniversity of Rome Sapienza, Sant’Andrea HospitalRomeItaly
| | - Andrea Ungar
- Department of Geriatric and Intensive Care MedicineCareggi Hospital and University of FlorenceItaly
| | | | - Francesca Viazzi
- Department of Internal MedicineUniversity of Genoa, and Policlinico San MartinoGenoaItaly
| | - Massimo Volpe
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and PsychologyUniversity of Rome Sapienza, Sant’Andrea HospitalRomeItaly
- IRCCS San Raffaele RomeRomeItaly
| | - Claudio Borghi
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences DepartmentAlma Mater Studiorum University of BolognaBolognaItaly
- IRCCS AOU S.Orsola di BolognaBolognaItaly
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Mantovani A, Morieri ML, Aldigeri R, Palmisano L, Masulli M, Bonomo K, Baroni MG, Cossu E, Cimini FA, Cavallo G, Buzzetti R, Mignogna C, Leonetti F, Bacci S, Trevisan R, Pollis RM, Cas AD, de Kreutzenberg SV, Targher G. MASLD, hepatic steatosis and fibrosis are associated with the prevalence of chronic kidney disease and retinopathy in adults with type 1 diabetes mellitus. Diabetes Metab 2024; 50:101497. [PMID: 37992857 DOI: 10.1016/j.diabet.2023.101497] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/23/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023]
Abstract
AIM We examined whether metabolic dysfunction-associated steatotic liver disease (MASLD) with or without significant fibrosis (assessed by validated non-invasive biomarkers) was associated with an increased risk of prevalent chronic kidney disease (CKD) or diabetic retinopathy in people with type 1 diabetes mellitus (T1DM). METHODS We performed a retrospective multicenter cross-sectional study involving 1,409 adult outpatients with T1DM, in whom hepatic steatosis index (HSI) and fibrosis (FIB)-4 index were calculated for non-invasively detecting hepatic steatosis (defined by HSI > 36), with or without coexisting significant fibrosis (FIB-4 index ≥ 1.3 or < 1.3). CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 or urine albumin/creatinine ratio ≥ 3.0 mg/mmol. The presence of diabetic retinopathy was also recorded in all participants. RESULTS Patients with MASLD and significant fibrosis (n = 93) had a remarkably higher prevalence of CKD and diabetic retinopathy than their counterparts with MASLD without fibrosis (n = 578) and those without steatosis (n = 738). After adjustment for sex, diabetes duration, hemoglobin A1c, hypertension, and use of antihypertensive or lipid-lowering medications, patients with SLD and significant fibrosis had a higher risk of prevalent CKD (adjusted-odds ratio 1.76, 95 % confidence interval 1.05-2.96) than those without steatosis. Patients with MASLD without fibrosis had a higher risk of prevalent retinopathy (adjusted-odds ratio 1.49, 95 % CI 1.13-1.46) than those without steatosis. CONCLUSION This is the largest cross-sectional study showing that MASLD with and without coexisting significant fibrosis was associated, independently of potential confounders, with an increased risk of prevalent CKD and retinopathy in adults with T1DM.
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Affiliation(s)
- Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy
| | - Mario Luca Morieri
- Metabolic Diseases, Department of Medicine, University of Padua, Padua, Italy
| | | | - Luisa Palmisano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Katia Bonomo
- Diabetes and Metabolic Diseases Unit, San Luigi Gonzaga University Hospital, Turin, Italy
| | - Marco Giorgio Baroni
- Department of Clinical Medicine, Life, Health & Environmental Sciences, University of Aquila, L'Aquila, Italy; Neuroendocrinology and Metabolic Diseases, IRCCS Neuromed, Pozzilli, Italy
| | - Efisio Cossu
- Diabetology Unit, Policlinico Universitario of Cagliari, Cagliari, Italy
| | | | - Gisella Cavallo
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | | | - Carmen Mignogna
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Frida Leonetti
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Simonetta Bacci
- Section of Endocrinology, Department of Medicine, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | - Roberto Trevisan
- Metabolic Diseases, Department of Medicine, University of Padua, Padua, Italy; Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | | | - Alessandra Dei Cas
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Division of Nutritional and Metabolic Sciences, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | - Giovanni Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy; IRCCS Sacro Cuore - Don Calabria Hospital, Negrar di Valpolicella, Italy.
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5
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Csermely A, Mantovani A, Morieri ML, Palmisano L, Masulli M, Cossu E, Baroni MG, Bonomo K, Cimini FA, Cavallo G, Buzzetti R, Mignogna C, Leonetti F, Bacci S, Trevisan R, Pollis RM, Aldigeri R, Cas AD, de Kreutzenberg SV, Targher G. Association between different modalities of insulin administration and metabolic dysfunction-associated fatty liver disease in adults with type 1 diabetes mellitus. Diabetes Metab 2023; 49:101477. [PMID: 37708990 DOI: 10.1016/j.diabet.2023.101477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 09/16/2023]
Abstract
AIM We examined whether different insulin administration modalities, i.e., multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII by insulin pumps), are differently associated with the risk of having metabolic dysfunction-associated fatty liver disease (MAFLD), with or without coexisting significant liver fibrosis (assessed by validated non-invasive biomarkers), in adults with type 1 diabetes mellitus (T1DM). METHODS We conducted a retrospective, multicenter, cross-sectional study involving 1,417 adult individuals with established T1DM treated with MDI or CSII. We calculated hepatic steatosis index (HSI) and fibrosis (FIB)-4 index for non-invasively detecting MAFLD (defined by HSI >36), with or without coexisting significant fibrosis (defined by FIB-4 index ≥ 1.3 or <1.3, respectively). RESULTS Compared to the MDI group (n = 1,161), insulin-pump users (n = 256; 18.1%) were more likely to be younger (mean age: 40 vs. 48 years, P < 0.001), had better glycemic control (mean hemoglobin A1c: 7.7% vs. 7.9%, P = 0.025) and a markedly lower prevalence of MAFLD with coexisting significant fibrosis (2.7% vs. 8.1%, P = 0.010), but a comparable prevalence of MAFLD without fibrosis. In multinomial logistic regression analysis, CSII therapy was associated with a ∼70%-lower risk of MAFLD with significant fibrosis (unadjusted odds ratio 0.32, 95% confidence interval 0.14-0.70; P = 0.004), but this association was no longer significant after adjustment for age, hemoglobin A1c and other potential confounders. CONCLUSION The lower prevalence of MAFLD with coexisting significant fibrosis we observed in adults with T1DM using CSII therapy, compared to those using MDI therapy, is primarily mediated by inter-group differences in age.
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Affiliation(s)
- Alessandro Csermely
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy
| | - Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy
| | - Mario Luca Morieri
- Metabolic Diseases, Department of Medicine, University of Padua, Padua, Italy
| | - Luisa Palmisano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Efisio Cossu
- Diabetology Unit, Policlinico Universitario of Cagliari, Cagliari, Italy
| | - Marco Giorgio Baroni
- Department of Clinical Medicine, Life, Health and Environmental Sciences, University of Aquila, L'Aquila, Italy; Neuroendocrinology and Metabolic Diseases, IRCCS Neuromed, Pozzilli, Italy
| | - Katia Bonomo
- Diabetes and Metabolic Diseases Unit, San Luigi Gonzaga University Hospital, Turin, Italy
| | | | - Gisella Cavallo
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | | | - Carmen Mignogna
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Frida Leonetti
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Simonetta Bacci
- Section of Endocrinology, Department of Medicine, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | - Roberto Trevisan
- Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | | | | | - Alessandra Dei Cas
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Division of Nutritional and Metabolic Sciences, Azienda Ospedaliero-Universitaria, Parma, Italy
| | | | - Giovanni Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy; Metabolic Diseases Research Unit, IRCCS Sacro Cuore - Don Calabria Hospital, Negrar di Valpolicella, Italy.
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6
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Maloberti A, Mengozzi A, Russo E, Cicero AFG, Angeli F, Agabiti Rosei E, Barbagallo CM, Bernardino B, Bombelli M, Cappelli F, Casiglia E, Cianci R, Ciccarelli M, Cirillo M, Cirillo P, Desideri G, D'Elia L, Dell'Oro R, Facchetti R, Ferri C, Galletti F, Giannattasio C, Gesualdo L, Iaccarino G, Lippa L, Mallamaci F, Masi S, Masulli M, Mazza A, Muiesan ML, Nazzaro P, Parati G, Palatini P, Pauletto P, Pontremoli R, Pugliese NR, Quarti-Trevano F, Rattazzi M, Reboldi G, Rivasi G, Salvetti M, Tikhonoff V, Tocci G, Ungar A, Verdecchia P, Viazzi F, Volpe M, Virdis A, Grassi G, Borghi C. The Results of the URRAH (Uric Acid Right for Heart Health) Project: A Focus on Hyperuricemia in Relation to Cardiovascular and Kidney Disease and its Role in Metabolic Dysregulation. High Blood Press Cardiovasc Prev 2023; 30:411-425. [PMID: 37792253 PMCID: PMC10600296 DOI: 10.1007/s40292-023-00602-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023] Open
Abstract
The relationship between Serum Uric Acid (UA) and Cardiovascular (CV) diseases has already been extensively evaluated, and it was found to be an independent predictor of all-cause and cardiovascular mortality but also acute coronary syndrome, stroke and heart failure. Similarly, also many papers have been published on the association between UA and kidney function, while less is known on the role of UA in metabolic derangement and, particularly, in metabolic syndrome. Despite the substantial number of publications on the topic, there are still some elements of doubt: (1) the better cut-off to be used to refine CV risk (also called CV cut-off); (2) the needing for a correction of UA values for kidney function; and (3) the better definition of its role in metabolic syndrome: is UA simply a marker, a bystander or a key pathological element of metabolic dysregulation?. The Uric acid Right for heArt Health (URRAH) project was designed by the Working Group on uric acid and CV risk of the Italian Society of Hypertension to answer the first question. After the first papers that individuates specific cut-off for different CV disease, subsequent articles have been published responding to the other relevant questions. This review will summarise most of the results obtained so far from the URRAH research project.
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Affiliation(s)
- Alessandro Maloberti
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Department of Cardiology, Center for Translational and Experimental Cardiology (CTEC), University Hospital Zurich, University of Zurich, Schlieren, Switzerland
| | - Elisa Russo
- Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico SanMartino, Genoa, Italy
| | - Arrigo Francesco Giuseppe Cicero
- Hypertension and Cardiovascular Risk Research Group, Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, Bologna, Italy.
- Cardiovascular Medicine Unit, IRCCS AOU S. Orsola di Bologna, Pad. 25 - 1st Floor, Via Massarenti, 9, 40138, Bologna, Italy.
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
- Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Enrico Agabiti Rosei
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Carlo Maria Barbagallo
- Biomedical Department of Internal Medicine and Specialistics, University of Palermo, Palermo, Italy
| | - Bruno Bernardino
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Michele Bombelli
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Department of Internal Medicine, Pio XI Hospital of Desio, ASST Brianza, Desio, Italy
| | - Federica Cappelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Rosario Cianci
- Department of Translational and Precision Medicine, University of Rome La Sapienza, Rome, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Massimo Cirillo
- Department of Public Health, ''Federico II'' University of Naples, Naples, Italy
| | - Pietro Cirillo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, ''Aldo Moro'' University of Bari, Bari, Italy
| | - Giovambattista Desideri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Lanfranco D'Elia
- Department of Clinical Medicine and Surgery, ''Federico II'' University of Naples, Naples, Italy
| | - Raffaella Dell'Oro
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Clinica Medica, San Gerardo Hospital, Monza, Italy
| | - Rita Facchetti
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, ''Federico II'' University of Naples, Naples, Italy
| | - Cristina Giannattasio
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, ''Aldo Moro'' University of Bari, Bari, Italy
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences, ''Federico II'' University of Naples, Naples, Italy
| | - Luciano Lippa
- Italian Society of General Medicine (SIMG), Avezzano, L'Aquila, Italy
| | - Francesca Mallamaci
- Reggio Cal Unit, Clinical Epidemiology of Renal Diseases and Hypertension, CNR-IFC, Reggio Calabria, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Maria Masulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Alberto Mazza
- Department of Internal Medicine, Santa Maria della Misericordia General Hospital, AULSS 5 Polesana, Rovigo, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Pietro Nazzaro
- Department of Medical Basic Sciences, Neurosciences and Sense Organs, University of Bari Medical School, Bari, Italy
| | - Gianfranco Parati
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan, Italy
| | - Paolo Palatini
- Department of Medicine, University of Padua, Padua, Italy
| | - Paolo Pauletto
- Medicina Interna I, Ca' Foncello University Hospital, Treviso, Italy
| | - Roberto Pontremoli
- Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico SanMartino, Genoa, Italy
| | | | - Fosca Quarti-Trevano
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Clinica Medica, San Gerardo Hospital, Monza, Italy
| | | | - Gianpaolo Reboldi
- Department of Medical and Surgical Science, University of Perugia, 06100, Perugia, Italy
| | - Giulia Rivasi
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Giuliano Tocci
- Hypertension Unit, Division of Cardiology, Sant'Andrea Hospital, Rome, Italy
- Department of Clinical and Molecular Medicine, University of Rome Sapienza, Rome, Italy
| | - Andrea Ungar
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | | | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico SanMartino, Genoa, Italy
| | - Massimo Volpe
- Hypertension Unit, Division of Cardiology, Sant'Andrea Hospital, Rome, Italy
- IRCCS San Raffaele, Rome, Italy
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Guido Grassi
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Clinica Medica, San Gerardo Hospital, Monza, Italy
| | - Claudio Borghi
- Hypertension and Cardiovascular Risk Research Group, Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Cardiovascular Medicine Unit, IRCCS AOU S. Orsola di Bologna, Pad. 25 - 1st Floor, Via Massarenti, 9, 40138, Bologna, Italy
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Dei Cas A, Aldigeri R, Mantovani A, Masulli M, Palmisano L, Cavalot F, Bonomo K, Baroni MG, Cossu E, Cavallo G, Cimini FA, Buzzetti R, Mignogna C, Leonetti F, Bacci S, Trevisan R, Morieri ML, Pollis RM, Targher G, Vigili de Kreutzenberg S. Sex Differences in Cardiovascular Disease and Cardiovascular Risk Estimation in Patients With Type 1 Diabetes. J Clin Endocrinol Metab 2023; 108:e789-e798. [PMID: 36881927 DOI: 10.1210/clinem/dgad127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/09/2023]
Abstract
CONTEXT Patients with type 1 diabetes (T1D) have higher cardiovascular disease (CVD) risk than the general population. OBJECTIVE This observational study aims to evaluate sex-related differences in CVD prevalence and CVD risk estimates in a large cohort of T1D adults. METHODS We conducted a multicenter, cross-sectional study involving 2041 patients with T1D (mean age 46 years; 44.9% women). In patients without pre-existing CVD (primary prevention), we used the Steno type 1 risk engine to estimate the 10-year risk of developing CVD events. RESULTS CVD prevalence (n = 116) was higher in men than in women aged ≥55 years (19.2 vs 12.8%, P = .036), but comparable between the 2 sexes in those aged <55 years (P = .91). In patients without pre-existing CVD (n = 1925), mean 10-year estimated CVD risk was 15.4 ± 0.4% without any significant sex difference. However, stratifying this patient group by age, the 10-year estimated CVD risk was significantly higher in men than in women until age 55 years (P < .001), but this risk equalized after this age. Carotid artery plaque burden was significantly associated with age ≥55 years and with a medium and high 10-year estimated CVD risk, without any significant sex difference. Diabetic retinopathy and sensory-motor neuropathy were also associated with higher 10-year CVD risk and female sex. CONCLUSION Both men and women with T1D are at high CVD risk. The 10-year estimated CVD risk was higher in men aged <55 years than in women of similar age, but these sex differences disappeared at age ≥55 years, suggesting that female sex was no longer protective.
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Affiliation(s)
- Alessandra Dei Cas
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Division of Nutritional and Metabolic Sciences, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy
| | - Raffaella Aldigeri
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, 37124 Verona, Italy
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Luisa Palmisano
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Franco Cavalot
- Diabetes and Metabolic Diseases Unit, San Luigi Gonzaga University Hospital, 10043 Turin, Italy
| | - Katia Bonomo
- Diabetes and Metabolic Diseases Unit, San Luigi Gonzaga University Hospital, 10043 Turin, Italy
| | - Marco Giorgio Baroni
- Department of Clinical Medicine, Life, Health & Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy
- Neuroendocrinology and Metabolic Diseases, IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Efisio Cossu
- Unit of Diabetology, Policlinico Universitario of Cagliari, 09124 Cagliari, Italy
| | - Gisella Cavallo
- Department of Experimental Medicine, Sapienza University, 00185 Rome, Italy
| | | | - Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University, 00185 Rome, Italy
| | - Carmen Mignogna
- Department of Experimental Medicine, Sapienza University, 00185 Rome, Italy
| | - Frida Leonetti
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, 00185 Rome, Italy
| | - Simonetta Bacci
- Section of Endocrinology, Department of Medicine, IRCCS, Casa Sollievo della Sofferenza Hospital, 71013 San Giovanni Rotondo (FG), Italy
| | - Roberto Trevisan
- Department of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy
| | - Mario Luca Morieri
- Metabolic Diseases, Department of Medicine, University of Padua, 35128 Padua, Italy
| | | | - Giovanni Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, 37124 Verona, Italy
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Mantovani A, Morieri ML, Palmisano L, Masulli M, Cossu E, Baroni MG, Bonomo K, Cimini FA, Cavallo G, Buzzetti R, Mignogna C, Leonetti F, Bacci S, Trevisan R, Pollis RM, Aldigeri R, Cas AD, de Kreutzenberg SV, Targher G. Hepatic steatosis with significant fibrosis is associated with an increased 10-year estimated risk of cardiovascular disease in adults with type 1 diabetes mellitus. Cardiovasc Diabetol 2023; 22:204. [PMID: 37563618 PMCID: PMC10416459 DOI: 10.1186/s12933-023-01945-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/28/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND We assessed whether hepatic steatosis with or without significant fibrosis (determined by validated non-invasive biomarkers) is associated with an increased 10-year estimated risk for cardiovascular disease (CVD) in people with type 1 diabetes mellitus (T1DM). METHODS We conducted a retrospective, multicenter, cross-sectional study involving 1,254 adults with established T1DM without pre-existing CVD. We used the hepatic steatosis index (HSI) and fibrosis (FIB)-4 index for non-invasively detecting hepatic steatosis (defined as HSI > 36), with or without coexisting significant fibrosis (defined as FIB-4 index ≥ 1.3 or < 1.3). We calculated the Steno type 1 risk engine and the atherosclerotic CVD (ASCVD) risk score to estimate the 10-year risk of developing a first fatal or nonfatal CVD event. RESULTS Using the Steno type 1 risk engine, a significantly greater proportion of patients with hepatic steatosis and significant fibrosis (n = 91) had a high 10-year estimated CVD risk compared to those with hepatic steatosis alone (n = 509) or without steatosis (n = 654) (75.8% vs. 23.2% vs. 24.9%, p < 0.001). After adjustment for sex, BMI, diabetes duration, hemoglobin A1c, chronic kidney disease, and lipid-lowering medication use, patients with hepatic steatosis and significant fibrosis had an increased 10-year estimated risk of developing a first fatal or nonfatal CVD event (adjusted-odds ratio 11.4, 95% confidence interval 3.54-36.9) than those without steatosis. We observed almost identical results using the ASCVD risk calculator. CONCLUSIONS The 10-year estimated CVD risk is remarkably greater in T1DM adults with hepatic steatosis and significant fibrosis than in their counterparts with hepatic steatosis alone or without steatosis.
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Affiliation(s)
- Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy
| | - Mario Luca Morieri
- Metabolic Diseases, Department of Medicine, University of Padua, Padua, Italy
| | - Luisa Palmisano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Efisio Cossu
- Diabetology Unit, Policlinico Universitario of Cagliari, Cagliari, Italy
| | - Marco Giorgio Baroni
- Department of Clinical Medicine, Life, Health and Environmental Sciences, University of Aquila, L'Aquila, Italy
- Neuroendocrinology and Metabolic Diseases, IRCCS Neuromed, Pozzilli, Italy
| | - Katia Bonomo
- Diabetes and Metabolic Diseases Unit, San Luigi Gonzaga University Hospital, Turin, Italy
| | | | - Gisella Cavallo
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | | | - Carmen Mignogna
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Frida Leonetti
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Simonetta Bacci
- Section of Endocrinology, Department of Medicine, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | - Roberto Trevisan
- Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | | | - Raffaella Aldigeri
- Division of Nutritional and Metabolic Sciences, Azienda Ospedaliero-Universitaria, Parma, Italy
| | - Alessandra Dei Cas
- Division of Nutritional and Metabolic Sciences, Azienda Ospedaliero-Universitaria, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Giovanni Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy.
- IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy.
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani, 1, Verona, 37126, Italy.
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9
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D'Elia L, Masulli M, Iacone R, Russo O, Strazzullo P, Galletti F. Relationship between leptin and white blood cells: a potential role in infection susceptibility and severity-the Olivetti Heart Study. Intern Emerg Med 2023; 18:1429-1436. [PMID: 37217748 PMCID: PMC10202358 DOI: 10.1007/s11739-023-03313-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 05/12/2023] [Indexed: 05/24/2023]
Abstract
A number of evidence showed an emerging role of leptin on immune system, involving inflammation, and innate and adaptive immunity. Few observational studies have evaluated the relationship between leptin and immunity, albeit with low statistical power and methodological differences. Therefore, the aim of this study was to evaluate the potential role of leptin on the immunity, expressed as white blood cells (WBC)-and its subpopulations, by comprehensive multivariate models in a sample of adult men. A cross-sectional evaluation of a general population comprised 939 subjects participating in the Olivetti Heart Study, with available leptin levels and WBC-and its subpopulations. WBC were significantly and positively associated with leptin, C-reactive protein and HOMA index (p < 0.05), but not with age and anthropometric indices (p > 0.05). The multivariate analysis confirmed the association between leptin and WBC, after accounting for main confounders (p < 0.05). Additional analysis on WBC subpopulations showed a positive and significant correlation between leptin and lymphocytes, monocytes and eosinophils (p < 0.05), but not with neutrophils and basophils (p > 0.05). After stratification by body weight, the positive and significant association between leptin and WBC-and its subpopulations-was found in excess body weight participants. The results of this study indicate a direct relationship between leptin levels and WBC-and its subpopulations-in excess body weight participants. These results support the hypothesis that leptin has modulatory functions on immunity and role in the pathophysiology of immune-related diseases, in particular in those associated with excess body weight.
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Affiliation(s)
- Lanfranco D'Elia
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples Medical School, Via S. Pansini, 5, 80131, Naples, Italy.
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples Medical School, Via S. Pansini, 5, 80131, Naples, Italy
| | - Roberto Iacone
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples Medical School, Via S. Pansini, 5, 80131, Naples, Italy
| | - Ornella Russo
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples Medical School, Via S. Pansini, 5, 80131, Naples, Italy
| | - Pasquale Strazzullo
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples Medical School, Via S. Pansini, 5, 80131, Naples, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples Medical School, Via S. Pansini, 5, 80131, Naples, Italy.
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Della Pepa G, Lupoli R, Masulli M, Boccia R, De Angelis R, Gianfrancesco S, Rainone C, Albarosa Rivellese A, Annuzzi G, Bozzetto L. Insulin pump therapy in type 1 diabetes is associated with lower indices of Non-Alcoholic Fatty Liver in non-obese women but not men. Diabetes Res Clin Pract 2023:110816. [PMID: 37419390 DOI: 10.1016/j.diabres.2023.110816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 05/20/2023] [Accepted: 07/03/2023] [Indexed: 07/09/2023]
Abstract
AIM Non-Alcoholic Fatty Liver Disease (NAFLD) is a raising concern in type 1 diabetes (T1D) patients. We evaluated whether multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII) may differentially affect NAFLD. METHODS NAFLD was assessed by Fatty Liver Index (FLI) and Hepatic Steatosis Index (HSI) in 659 T1D patients treated by MDI (n=414, 65% men) or CSII (n=245, 50% men) without alcohol abuse or other liver diseases. Clinical and metabolic differences between MDI and CSII participants were also evaluated according to sex. RESULTS Compared with the MDI cohort, CSII users had a significantly lower FLI (20.2±21.2 vs. 24.8±24.3; p=0.003), HSI (36.2±4.4 vs. 37.4±4.4; p=0.003), waist circumference (84.6±11.8 vs. 86.9±13.7 cm; p=0.026), plasma triglyceride (76.0±45.8 vs. 84.7±58.3 mg/dl; p=0.035), and daily insulin dose (0.53±0.22 vs. 0.64±0.25 IU/kg body weight; p<0.001). In CSII users, lower FLI and HSI were observed in women (p=0.009 and p=0.033, respectively) but not in men (p=0.676 and p=0.131, respectively). Women on CSII also had lower daily insulin doses, plasma triglyceride, and visceral adiposity index than women on MDI. CONCLUSION CSII is associated with lower NAFLD indices in women with T1D. This may relate to the lower peripheral insulin in the context of a permissive hormonal milieu.
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Affiliation(s)
- Giuseppe Della Pepa
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy; Institute of Clinical Physiology, National Research Council-CNR, Pisa, Italy
| | - Roberta Lupoli
- Department of Molecular Medicine and Medical Biotechnology, Federico II University, Naples, Italy
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Rosalia Boccia
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Raffaele De Angelis
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | | | - Carmen Rainone
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | | | - Giovanni Annuzzi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
| | - Lutgarda Bozzetto
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
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11
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Vitale M, Giosuè A, Sieri S, Krogh V, Massimino E, Rivellese AA, Riccardi G, Vaccaro O, Masulli M. Legume Consumption and Blood Pressure Control in Individuals with Type 2 Diabetes and Hypertension: Cross-Sectional Findings from the TOSCA.IT Study. Nutrients 2023; 15:2895. [PMID: 37447221 DOI: 10.3390/nu15132895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Our aims were to evaluate the relationship of habitual legume consumption with blood pressure (BP) control in a large cohort of people with T2D and hypertension, and to investigate whether specific nutritional components of legumes or other foods may contribute to regulate BP levels. METHODS We studied 1897 participants with T2D and hypertension. Dietary habits were assessed through a validated food frequency questionnaire. Sex-specific quartiles of legume consumption were created. RESULTS Higher legume consumption was associated with a lower intake of energy, carbohydrates, glycaemic load, alcohol, and sodium, and a significantly greater intake of proteins, fat, monounsaturated, polyunsaturated, fibre, potassium, and polyphenols. Significantly lower systolic and diastolic BP values were observed in the highest vs. lowest quartile of legume consumption (132.9 ± 6.7 vs. 137.3 ± 7.0 mmHg, p < 0.001; 78.9 ± 4.1 vs. 81.0 ± 4.2 mmHg, p = 0.002; respectively), as well as the proportion of people meeting the treatment targets (61.3% vs. 37.4% and 71.3% vs. 52.4%, respectively, p < 0.01). This association was independent from other foods whose consumption is associated with the high legume intake. CONCLUSIONS In people with T2D and hypertension, three servings of legumes per week are associated with significantly better BP control. This gives further support to current dietary guidelines in recommending the frequent consumption of legumes, as a "ready-to-use" dietary strategy to achieve optimal BP control.
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Affiliation(s)
- Marilena Vitale
- Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy
| | - Annalisa Giosuè
- Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy
| | - Sabina Sieri
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20121 Milan, Italy
| | - Vittorio Krogh
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20121 Milan, Italy
| | - Elena Massimino
- Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy
| | | | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy
| | - Olga Vaccaro
- Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy
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Della Pepa G, Lombardi G, Gianfrancesco S, Piccolo R, Chirico G, Pellegrino M, Santella L, Tecce N, Volpicelli A, Sollo E, Bozzetto L, Masulli M, Riccardi G, Rivellese AA, Saldalamacchia G. Triticum vulgare Extract and Polyhexanide (Fitostimoline ® Hydrogel/Fitostimoline ® Plus Gauze) versus Saline Gauze Dressing in Patients with Diabetic Foot Ulcers: Results of a Randomized Controlled Trial. J Clin Med 2023; 12:jcm12103596. [PMID: 37240701 DOI: 10.3390/jcm12103596] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/13/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The use of dressings is an essential component of the standard of care for diabetic foot ulcers (DFUs); however, despite the wide variety of dressings available, there is a lack of evidence from head-to-head randomized controlled trials. We evaluated the efficacy and safety of Triticum vulgare extract and polyhexanide (Fitostimoline® hydrogel/Fitostimoline® Plus gauze) versus saline gauze dressings in patients with DFUs. METHODS This study involved a monocentric, two-arm, open-label, controlled trial in patients with DFUs (Grades I or II, Stage A or C, based on the Texas classification) randomized to 12 weeks of dressing with Fitostimoline® hydrogel/Fitostimoline® Plus gauze or saline gauze. The number of patients with complete healing, the reduction in DFU size, and the presence of local signs and symptoms of the wound and perilesional skin were evaluated every two weeks and at the end of treatment. RESULTS A total of 40 adult patients were recruited (20 patients in each treatment group). The proportion of patients with complete healing was similar between the two groups (61% vs. 74%, p = 0.495, Fitostimoline® hydrogel/Fitostimoline® Plus gauze vs. saline gauze, respectively), without significant differences, as well as the reduction in DFU size. A significant improvement in local signs and symptoms of the wound and signs of perilesional skin in the Fitostimoline® hydrogel/Fitostimoline® Plus gauze compared with the saline gauze group was observed. CONCLUSIONS In a clinical setting, the use of Fitostimoline® hydrogel/Fitostimoline® Plus gauze dressing in patients with DFUs significantly improves signs and symptoms of the wound and signs of perilesional skin compared with saline gauze dressing with a similar efficacy in terms of wound healing.
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Affiliation(s)
- Giuseppe Della Pepa
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
- Cardiometabolic Risk Unit, Institute of Clinical Physiology, National Research Council-CNR, 56100 Pisa, Italy
| | - Gianluca Lombardi
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | | | - Roberto Piccolo
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Giovanni Chirico
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Micaela Pellegrino
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Luigi Santella
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Nicola Tecce
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Anastasia Volpicelli
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Elena Sollo
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Lutgarda Bozzetto
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | | | - Gennaro Saldalamacchia
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
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13
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Mengozzi A, Pugliese NR, Desideri G, Masi S, Angeli F, Barbagallo CM, Bombelli M, Cappelli F, Casiglia E, Cianci R, Ciccarelli M, Cicero AFG, Cirillo M, Cirillo P, Dell’Oro R, D’Elia L, Ferri C, Galletti F, Gesualdo L, Giannattasio C, Grassi G, Iaccarino G, Lippa L, Mallamaci F, Maloberti A, Masulli M, Mazza A, Muiesan ML, Nazzaro P, Palatini P, Parati G, Pontremoli R, Quarti-Trevano F, Rattazzi M, Reboldi G, Rivasi G, Russo E, Salvetti M, Tikhonoff V, Tocci G, Ungar A, Verdecchia P, Viazzi F, Volpe M, Borghi C, Virdis A. Serum Uric Acid Predicts All-Cause and Cardiovascular Mortality Independently of Hypertriglyceridemia in Cardiometabolic Patients without Established CV Disease: A Sub-Analysis of the URic acid Right for heArt Health (URRAH) Study. Metabolites 2023; 13:metabo13020244. [PMID: 36837863 PMCID: PMC9959524 DOI: 10.3390/metabo13020244] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
High serum uric acid (SUA) and triglyceride (TG) levels might promote high-cardiovascular risk phenotypes across the cardiometabolic spectrum. However, SUA predictive power in the presence of normal and high TG levels has never been investigated. We included 8124 patients from the URic acid Right for heArt Health (URRAH) study cohort who were followed for over 20 years and had no established cardiovascular disease or uncontrolled metabolic disease. All-cause mortality (ACM) and cardiovascular mortality (CVM) were explored by the Kaplan-Meier estimator and Cox multivariable regression, adopting recently defined SUA cut-offs for ACM (≥4.7 mg/dL) and CVM (≥5.6 mg/dL). Exploratory analysis across cardiometabolic subgroups and a sensitivity analysis using SUA/serum creatinine were performed as validation. SUA predicted ACM (HR 1.25 [1.12-1.40], p < 0.001) and CVM (1.31 [1.11-1.74], p < 0.001) in the whole study population, and according to TG strata: ACM in normotriglyceridemia (HR 1.26 [1.12-1.43], p < 0.001) and hypertriglyceridemia (1.31 [1.02-1.68], p = 0.033), and CVM in normotriglyceridemia (HR 1.46 [1.23-1.73], p < 0.001) and hypertriglyceridemia (HR 1.31 [0.99-1.64], p = 0.060). Exploratory and sensitivity analyses confirmed our findings, suggesting a substantial role of SUA in normotriglyceridemia and hypertriglyceridemia. In conclusion, we report that SUA can predict ACM and CVM in cardiometabolic patients without established cardiovascular disease, independent of TG levels.
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Affiliation(s)
- Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital Zurich, University of Zurich, 8952 Schlieren, Switzerland
- Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Correspondence: or or ; Tel.:+39-05-099-2558
| | | | - Giovambattista Desideri
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
- Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, 21100 Varese, Italy
| | - Carlo Maria Barbagallo
- Biomedical Department of Internal Medicine and Specialistics, University of Palermo, 90100 Palermo, Italy
| | - Michele Bombelli
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Federica Cappelli
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Edoardo Casiglia
- Studium Patavinum, Department of Medicine, University of Padua, 35100 Padua, Italy
| | - Rosario Cianci
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Michele Ciccarelli
- Department of Advanced Biomedical Sciences, “Federico II” University of Naples, 80133 Naples, Italy
| | - Arrigo F. G. Cicero
- Department Hypertension and Cardiovascular Disease Research Center, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
- Heart-Chest-Vascular Department, IRCCS AOU of Bologna, 40126 Bologna, Italy
| | - Massimo Cirillo
- Department of Public Health, “Federico II” University of Naples, 80133 Naples, Italy
| | - Pietro Cirillo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, “Aldo Moro” University of Bari, 70122 Bari, Italy
| | - Raffaella Dell’Oro
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Lanfranco D’Elia
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80133 Naples, Italy
| | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80133 Naples, Italy
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, “Aldo Moro” University of Bari, 70122 Bari, Italy
| | - Cristina Giannattasio
- Cardiology IV, “A.De Gasperi’s” Department, Niguarda Ca’ Granda Hospital, 20162 Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences, “Federico II” University of Naples, 80133 Naples, Italy
| | - Luciano Lippa
- Italian Society of General Medicine (SIMG), 67051 Avezzano, Italy
| | - Francesca Mallamaci
- CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Cal Unit, 89124 Reggio Calabria, Italy
| | - Alessandro Maloberti
- Cardiology IV, “A.De Gasperi’s” Department, Niguarda Ca’ Granda Hospital, 20162 Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80133 Naples, Italy
| | - Alberto Mazza
- Department of Internal Medicine, Santa Maria Della Misericordia General Hospital, AULSS 5 Polesana, 45100 Rovigo, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy
| | - Pietro Nazzaro
- Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), Neurosciences and Sense Organs, University of Bari Medical School, 70122 Bari, Italy
| | - Paolo Palatini
- Studium Patavinum, Department of Medicine, University of Padua, 35100 Padua, Italy
| | - Gianfranco Parati
- S. Luca Hospital, Istituto Auxologico Italiano & University of Milan-Bicocca, 20126 Milan, Italy
| | - Roberto Pontremoli
- Department of Internal Medicine, University of Genoa; IRCSS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Fosca Quarti-Trevano
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Marcello Rattazzi
- Department of Medicine—DIMED, University of Padova, Medicina Interna 1°, Ca’ Foncello University Hospital, 31100 Treviso, Italy
| | - Gianpaolo Reboldi
- Department of Medical and Surgical Science, University of Perugia, 06100 Perugia, Italy
| | - Giulia Rivasi
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital, University of Florence, 50121 Florence, Italy
| | - Elisa Russo
- Department of Internal Medicine, University of Genoa; IRCSS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy
| | | | - Giuliano Tocci
- Department of Clinical and Molecular Medicine, University of Rome Sapienza, 00185 Rome, Italy
| | - Andrea Ungar
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital, University of Florence, 50121 Florence, Italy
| | | | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa; IRCSS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, University of Rome Sapienza, 00185 Rome, Italy
| | - Claudio Borghi
- Department Hypertension and Cardiovascular Disease Research Center, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
- Heart-Chest-Vascular Department, IRCCS AOU of Bologna, 40126 Bologna, Italy
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
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14
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Palatini P, Virdis A, Masi S, Mengozzi A, Casiglia E, Tikhonoff V, Cicero AFG, Ungar A, Parati G, Rivasi G, Salvetti M, Barbagallo CM, Bombelli M, Dell'Oro R, Bruno B, Lippa L, D'Elia L, Masulli M, Verdecchia P, Reboldi G, Angeli F, Mallamaci F, Cirillo M, Rattazzi M, Cirillo P, Gesualdo L, Mazza A, Giannattasio C, Maloberti A, Volpe M, Tocci G, Iaccarino G, Nazzaro P, Galletti F, Ferri C, Desideri G, Viazzi F, Pontremoli R, Muiesan ML, Grassi G, Borghi C. Hyperuricemia increases the risk of cardiovascular mortality associated with very high HdL-cholesterol level. Nutr Metab Cardiovasc Dis 2023; 33:323-330. [PMID: 36642602 DOI: 10.1016/j.numecd.2022.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/07/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Whether the association between very high HDL-cholesterol levels and cardiovascular mortality (CVM) is modulated by some facilitating factors is unclear. Aim of the study was to investigate whether the risk of CVM associated with very high HDL-cholesterol is increased in subjects with hyperuricemia. METHODS AND RESULTS Multivariable Cox analyses were made in 18,072 participants from the multicentre URRAH study stratified by sex and HDL-cholesterol category. During a median follow-up of 11.4 years there were 1307 cases of CVM. In multivariable Cox models a J-shaped association was found in the whole population, with the highest risk being present in the high HDL-cholesterol group [>80 mg/dL, adjusted hazard ratio (HR), 1.28; 95%CI, 1.02-1.61; p = 0.031)]. However, a sex-specific analysis revealed that this association was present only in women (HR, 1.34; 95%CI, 1.02-1.77; p = 0.034) but not in men. The risk of CVM related to high HDL-cholesterol was much greater in the women with high uric acid (>0.30 mmol/L, HR 1.61; 95%CI, 1.08-2.39) than in those with low uric acid (HR, 1.17; 95%CI, 0.80-1.72, p for interaction = 0.016). In women older than 70 years with hyperuricemia the risk related to high HDL-cholesterol was 1.83 (95%CI, 1.19-2.80, p < 0.005). Inclusion of BMI in the models weakened the strength of the associations. CONCLUSION Our data indicate that very high HDL-cholesterol levels in women are associated with CVM in a J-shaped fashion. The risk of CVM is increased by concomitant hyperuricemia suggesting that a proinflammatory/oxidative state can enhance the detrimental cardiovascular effects associated with high HDL-cholesterol.
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Affiliation(s)
- Paolo Palatini
- Department of Medicine, Studium Patavinum, University of Padova, Padua, Italy.
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | | | | | | | | | - Andrea Ungar
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Italy
| | - Gianfranco Parati
- S. Luca Hospital, Istituto Auxologico Italiano & University of Milan-Bicocca, Milan, Italy
| | - Giulia Rivasi
- Department of Medical and Surgical Science, University of Perugia, Perugia, Italy; Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Carlo M Barbagallo
- Biomedical Department of Internal Medicine and Specialistics, University of Palermo, Palermo, Italy
| | - Michele Bombelli
- Department of Cardiovascular, Neural and Metabolic Sciences, Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Raffaella Dell'Oro
- Department of Cardiovascular, Neural and Metabolic Sciences, Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Berardino Bruno
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Luciano Lippa
- Italian Society of General Medicine (SIMG), Avezzano, L'Aquila, Italy
| | - Lanfranco D'Elia
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples Medical School, Naples, Italy
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples Medical School, Naples, Italy
| | | | - Gianpaolo Reboldi
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Varese, Italy; Department of Medicine and Cardiopulmonary Rehabilitation. Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Francesca Mallamaci
- CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Cal Unit, Reggio Calabria, Italy
| | - Massimo Cirillo
- Department of Public Health, "Federico II" University of Naples, Napoli, Italy
| | - Marcello Rattazzi
- Department of Medicine - DIMED, University of Padova, Medicina Interna 1, Ca' Foncello University Hospital, Treviso, Italy
| | - Pietro Cirillo
- Department of Emergency and Organ Transplantation - Nephrology, Dialysis and Transplantation Unit, Aldo Moro University of Bari, Bari, Italy
| | - Loreto Gesualdo
- Department of Emergency and Organ Transplantation - Nephrology, Dialysis and Transplantation Unit, Aldo Moro University of Bari, Bari, Italy
| | - Alberto Mazza
- Department of Internal Medicine, Hypertension Unit, General Hospital, Rovigo, Italy
| | - Cristina Giannattasio
- Cardiology IV, 'A. De Gasperis' Department, Niguarda Ca' Granda Hospital, Health Science Department, Milano-Bicocca University, Milano, Italy
| | - Alessandro Maloberti
- Cardiology IV, 'A. De Gasperis' Department, Niguarda Ca' Granda Hospital, Health Science Department, Milano-Bicocca University, Milano, Italy
| | - Massimo Volpe
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | - Giuliano Tocci
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Napoli, Italy
| | - Pietro Nazzaro
- Department of Medical Basic Sciences, Neurosciences and Sense Organs, University of Bari Medical School, Bari, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples Medical School, Naples, Italy
| | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giovambattista Desideri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa and Policlinico San Martino, Genova, Italy
| | - Roberto Pontremoli
- Department of Internal Medicine, University of Genoa and Policlinico San Martino, Genova, Italy
| | | | - Guido Grassi
- Department of Cardiovascular, Neural and Metabolic Sciences, Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Claudio Borghi
- Alma Mater Studiorum University of Bologna, Bologna, Italy
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15
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D'Elia L, Masulli M, Iacone R, Russo O, Strazzullo P, Galletti F. Consistent smoking and development of arterial stiffening in adult men: Results of the Olivetti Heart Study. Vasc Med 2023; 28:54-56. [PMID: 36341501 DOI: 10.1177/1358863x221130378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Lanfranco D'Elia
- Department of Clinical Medicine and Surgery, ESH Excellence Center of Hypertension, "Federico II" University of Naples Medical School, Naples, Campania, Italy
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, ESH Excellence Center of Hypertension, "Federico II" University of Naples Medical School, Naples, Campania, Italy
| | - Roberto Iacone
- Department of Clinical Medicine and Surgery, ESH Excellence Center of Hypertension, "Federico II" University of Naples Medical School, Naples, Campania, Italy
| | - Ornella Russo
- Department of Clinical Medicine and Surgery, ESH Excellence Center of Hypertension, "Federico II" University of Naples Medical School, Naples, Campania, Italy
| | - Pasquale Strazzullo
- Department of Clinical Medicine and Surgery, ESH Excellence Center of Hypertension, "Federico II" University of Naples Medical School, Naples, Campania, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, ESH Excellence Center of Hypertension, "Federico II" University of Naples Medical School, Naples, Campania, Italy
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16
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Casiglia E, Tikhonoff V, Virdis A, Grassi G, Angeli F, Barbagallo CM, Bombelli M, Cicero AF, Cirillo M, Cirillo P, Dell’Oro R, D’elia L, Desideri G, Ferri C, Galletti F, Gesualdo L, Giannattasio C, Iaccarino G, Lippa L, Mallamaci F, Masi S, Maloberti A, Masulli M, Mazza A, Mengozzi A, Muiesan ML, Nazzaro P, Palatini P, Parati G, Pontremoli R, Quarti-Trevano F, Rattazzi M, Reboldi G, Rivasi G, Salvetti M, Tocci G, Ungar A, Verdecchia P, Viazzi F, Volpe M, Borghi C. Serum uric acid / serum creatinine ratio as a predictor of cardiovascular events. Detection of prognostic cardiovascular cut-off values. J Hypertens 2023; 41:180-186. [PMID: 36453660 PMCID: PMC9794153 DOI: 10.1097/hjh.0000000000003319] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/28/2022] [Accepted: 10/04/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE In the frame of the Uric Acid Right for Heart Health (URRAH) study, a nationwide multicenter study involving adult participants recruited on a regional community basis from all the territory of Italy under the patronage of the Working Group on Uric Acid and Cardiovascular Risk of the Italian Society of Hypertension, we searched for the cut-off values of the ratio between serum uric acid (SUA) and serum creatinine (sCr) able to predict cardiovascular (CV) events. METHODS Among 20 724 participants followed-up for 126 ± 64 months, after detecting cut-off by the receiver operating characteristic curves, we calculated by Cox models adjusted for confounders having CV events as dependent variable the hazard ratio (HR) of SUA/sCr > cut-off. We also verified if the role of cut-off varied with increasing SUA/sCr. RESULTS A plausible prognostic cut-off of SUA/sCr was found and was the same in the whole database, in men and in women (>5.35). The HR of SUA/sCr > cut-off was 1.159 (95% confidence interval [CI] 1.092-1.131, P < 0.03) in all, 1.161 (95% CI 1.021-1.335, P < 0.02) in men, and 1.444 (95% CI 1.012-1.113, P < 0.03) in women. In increasing quintiles of SUA/sCr the cut-offs were >3.08, >4.87, >5.35, >6.22 and >7.58, respectively. The HRs significantly increased from the 3rd to the 5th quintile (1.21, 95% CI 1.032-1.467, P = 0.018; 1.294, 95% CI 1.101-1.521, P = 0.002; and 1.642, 95% CI 1.405-1.919, P < 0.0001; respectively), that is, over 5.35, whereas the 2nd quintile was not significantly different from the 1st (reference). CONCLUSION Having SUA/sCr >5.35 is an independent CV risk indicator both in men and women. The cut-off is dynamic and significantly increases with increasing SUA/sCr.
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Affiliation(s)
| | | | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Varese
| | - Carlo M. Barbagallo
- Biomedical Department of Internal Medicine and Specialistics, University of Palermo, Palermo
| | - Michele Bombelli
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza
| | - Arrigo F.G. Cicero
- Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, Bologna
| | - Massimo Cirillo
- Department of Public Health, “Federico II” University of Naples, Naples
| | - Pietro Cirillo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, “Aldo Moro” University of Bari, Bari
| | - Raffaella Dell’Oro
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza
| | - Lanfranco D’elia
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples Medical School, Naples
| | | | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples Medical School, Naples
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, “Aldo Moro” University of Bari, Bari
| | - Cristina Giannattasio
- Cardiology IV, “A.De Gasperi's” Department, Niguarda Ca’ Granda Hospital, Milan
- School of Medicine and Surgery, Milano-Bicocca University, Milan
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences, “Federico II” University of Naples, Naples
| | - Luciano Lippa
- Italian Society of General Medicine (SIMG), Avezzano, L’Aquila
| | - Francesca Mallamaci
- CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Cal Unit, Reggio Calabria
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | - Alessandro Maloberti
- Cardiology IV, “A.De Gasperi's” Department, Niguarda Ca’ Granda Hospital, Milan
- School of Medicine and Surgery, Milano-Bicocca University, Milan
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples Medical School, Naples
| | - Alberto Mazza
- Department of Internal Medicine, Santa Maria della Misericordia General Hospital, AULSS 5 Polesana, Rovigo
| | | | | | - Pietro Nazzaro
- Department of Medical Basic Sciences, Neurosciences and Sense Organs, University of Bari Medical School, Bari
| | | | - Gianfranco Parati
- S. Luca Hospital, Istituto Auxologico Italiano & University of Milan-Bicocca, Milan
| | - Roberto Pontremoli
- Department of Internal Medicine, University of Genoa, and Policlinico San Martino, Genoa
| | - Fosca Quarti-Trevano
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza
| | - Marcello Rattazzi
- Department of Medicine, University of Padua, Padua
- Medicina Interna I, Ca’ Foncello University Hospital, Treviso
| | - Gianpaolo Reboldi
- Department of Medical and Surgical Science, University of Perugia, Perugia
| | - Giulia Rivasi
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia
| | - Giuliano Tocci
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant’Andrea Hospital, Rome
| | - Andrea Ungar
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence
| | | | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa, and Policlinico San Martino, Genoa
| | - Massimo Volpe
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant’Andrea Hospital, Rome
| | - Claudio Borghi
- Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, Bologna
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Vitale M, Della Pepa G, Costabile G, Bozzetto L, Cipriano P, Signorini S, Leoni V, Riccardi G, Vaccaro O, Masulli M. Association between Diet Quality and Index of Non-Alcoholic Steatohepatitis in a Large Population of People with Type 2 Diabetes: Data from the TOSCA.IT Study. Nutrients 2022; 14:nu14245339. [PMID: 36558498 PMCID: PMC9783620 DOI: 10.3390/nu14245339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Background: There are still open questions with respect to the optimal dietary treatment in patients with type 2 diabetes (T2D) and coexisting non-alcoholic steatohepatitis (NASH). The aim of this study is to investigate, in patients with T2D, the association between NASH, dietary component intake, food groups and adherence to the Mediterranean diet. Methods: Cross-sectional analysis of 2026 people with T2D (1136 men and 890 women). The dietary habits were assessed with the European Prospective Investigation into Cancer and Nutrition (EPIC) questionnaire. NASH was identified by the Index Of NASH (ION). Based on the cluster analysis two dietary patterns were identified: the NASH and the NO-NASH pattern. Results: The macronutrient composition of the diet was similar in the two patterns. However, the NASH pattern compared with the NO-NASH pattern was characterized by a significantly lower content of fibre (p < 0.001), β-carotene (p < 0.001), vitamin C (p < 0.001), vitamin E (p < 0.001), polyphenols (p = 0.026) and antioxidant capacity (p < 0.001). With regard to food consumption, the NASH pattern compared with NO-NASH pattern was characterized by higher intake of rice (p = 0.021), potatoes (p = 0.013), red (p = 0.004) and processed meat (p = 0.003), and a lower intake of wholegrain bread (p = 0.019), legumes and nuts (p = 0.049), vegetables (p = 0.047), fruits (p = 0.002), white meat (p = 0.001), fatty fish (p = 0.005), milk and yogurt (p < 0.001). Conclusions: NO-NASH dietary pattern was characterized by a food consumption close to the Mediterranean dietary model, resulting in a higher content of polyphenols, vitamins, and fibre. These finding highlight the potential for dietary components in the prevention/treatment of NASH in people with T2D.
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Affiliation(s)
- Marilena Vitale
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| | - Giuseppe Della Pepa
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| | - Giuseppina Costabile
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| | - Lutgarda Bozzetto
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| | - Paola Cipriano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| | - Stefano Signorini
- Laboratory of Clinical Biochemistry, Hospital Pius XI of Desio, ASST-Brianza, 20833 Desio, Italy
| | - Valerio Leoni
- Laboratory of Clinical Biochemistry, Hospital Pius XI of Desio, ASST-Brianza, 20833 Desio, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, 20216 Monza, Italy
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| | - Olga Vaccaro
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-081-746-3665
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
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18
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D’Elia L, Masulli M, Cappuccio FP, Zarrella AF, Strazzullo P, Galletti F. Dietary Potassium Intake and Risk of Diabetes: A Systematic Review and Meta-Analysis of Prospective Studies. Nutrients 2022; 14:nu14224785. [PMID: 36432472 PMCID: PMC9697076 DOI: 10.3390/nu14224785] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 10/29/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Dietary potassium intake is positively associated with reduction of cardiovascular risk. Several data are available on the relationship between dietary potassium intake, diabetes risk and glucose metabolism, but with inconsistent results. Therefore, we performed a meta-analysis of the prospective studies that explored the effect of dietary potassium intake on the risk of diabetes to overcome these limitations. (2) Methods: A random-effects dose-response meta-analysis was carried out for prospective studies. A potential non-linear relation was investigated using restricted cubic splines. (3) Results: A total of seven prospective studies met the inclusion criteria. Dose-response analysis detected a non-linear relationship between dietary potassium intake and diabetes risk, with significant inverse association starting from 2900 mg/day by questionnaire and between 2000 and 5000 mg/day by urinary excretion. There was high heterogeneity among studies, but no evidence of publication bias was found. (4) Conclusions: The results of this meta-analysis indicate that habitual dietary potassium consumption is associated with risk of diabetes by a non-linear dose-response relationship. The beneficial threshold found supports the campaigns in favour of an increase in dietary potassium intake to reduce the risk of morbidity and mortality. Further studies should be carried out to explore this topic.
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Affiliation(s)
- Lanfranco D’Elia
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples Medical School, 80131 Naples, Italy
- Correspondence:
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples Medical School, 80131 Naples, Italy
| | - Francesco P. Cappuccio
- World Health Organization Collaborating Centre for Nutrition, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
- Department of Medicine, University Hospital Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Aquilino F. Zarrella
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples Medical School, 80131 Naples, Italy
| | - Pasquale Strazzullo
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples Medical School, 80131 Naples, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples Medical School, 80131 Naples, Italy
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19
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Tecce N, Masulli M, Palmisano L, Gianfrancesco S, Piccolo R, Pacella D, Bozzetto L, Massimino E, Della Pepa G, Lupoli R, Vaccaro O, Riccardi G, Capaldo B. Performance of 2019 ESC risk classification and the Steno type 1 risk engine in predicting cardiovascular events in adults with type 1 diabetes: A retrospective study. Diabetes Res Clin Pract 2022; 190:110001. [PMID: 35863552 DOI: 10.1016/j.diabres.2022.110001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/17/2022] [Accepted: 07/15/2022] [Indexed: 11/28/2022]
Abstract
AIMS The study compares the performance of the European Society of Cardiology (ESC) risk criteria and the Steno Type 1 Risk Engine (ST1RE) in the prediction of cardiovascular (CV) events. METHODS 456 adults with type 1 diabetes (T1D) were retrospectively studied. During 8.5 ± 5.5 years of observation, twenty-four patients (5.2%) experienced a CV event. The predictive performance of the two risk models was evaluated by classical metrics and the event-free survival analysis. RESULTS The ESC criteria show excellent sensitivity (91.7%) and suboptimal specificity (64.4 %) in predicting CV events in the very high CV risk group, but a poor performance in the high/moderate risk groups. The ST1RE algorithm shows a good predictive performance in all CV risk categories. Using ESC classification, the event-free survival analysis shows a significantly higher event rate in the very high CV risk group compared to the high/moderate risk group (p < 0.0019). Using the ST1RE algorithm, a significant difference in the event-free survival curve was found between the three CV risk categories (p < 0.0001). CONCLUSIONS In T1D the ESC classification has a good performance in predicting CV events only in those at very high CV risk, whereas the ST1RE algorithm has a good performance in all risk categories.
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Affiliation(s)
- Nicola Tecce
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Luisa Palmisano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | | | - Roberto Piccolo
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Daniela Pacella
- Department of Public Health, Federico II University, Naples, Italy
| | - Lutgarda Bozzetto
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Elena Massimino
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Giuseppe Della Pepa
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Roberta Lupoli
- Department of Molecular Medicine and Medical Biotechnology, Federico II University, Naples, Italy
| | - Olga Vaccaro
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Brunella Capaldo
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
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20
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Masulli M, D'Elia L, Angeli F, Barbagallo CM, Bilancio G, Bombelli M, Bruno B, Casiglia E, Cianci R, Cicero AFG, Cirillo M, Cirillo P, Dell'Oro R, Desideri G, Ferri C, Gesualdo L, Giannattasio C, Grassi G, Iaccarino G, Lippa L, Mallamaci F, Maloberti A, Masi S, Mazza A, Mengozzi A, Muiesan ML, Nazzaro P, Palatini P, Parati G, Pontremoli R, Quarti-Trevano F, Rattazzi M, Reboldi G, Rivasi G, Salvetti M, Tikhonoff V, Tocci G, Ungar A, Verdecchia P, Viazzi F, Virdis A, Volpe M, Borghi C, Galletti F. Serum uric acid levels threshold for mortality in diabetic individuals: The URic acid Right for heArt Health (URRAH) project. Nutr Metab Cardiovasc Dis 2022; 32:1245-1252. [PMID: 35282979 DOI: 10.1016/j.numecd.2022.01.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM The URRAH (URic acid Right for heArt Health) Study has identified cut-off values of serum uric acid (SUA) predictive of total mortality at 4.7 mg/dl, and cardiovascular (CV) mortality at 5.6 mg/dl. Our aim was to validate these SUA thresholds in people with diabetes. METHODS AND RESULTS The URRAH subpopulation of people with diabetes was studied. All-cause and CV deaths were evaluated at the end of follow-up. A total of 2570 diabetic subjects were studied. During a median follow-up of 107 months, 744 deaths occurred. In the multivariate Cox regression analyses adjusted for several confounders, subjects with SUA ≥5.6 mg/dl had higher risk of total (HR: 1.23, 95%CI: 1.04-1.47) and CV mortality (HR:1.31, 95%CI:1.03-1.66), than those with SUA <5.6 mg/dl. Increased all-cause mortality risk was shown in participants with SUA ≥4.7 mg/dl vs SUA below 4.7 mg/dl, but not statistically significant after adjustment for all confounders. CONCLUSIONS SUA thresholds previously proposed by the URRAH study group are predictive of total and CV mortality also in people with diabetes. The threshold of 5.6 mg/dl can predict both total and CV mortality, and so is candidate to be a clinical cut-off for the definition of hyperuricemia in patients with diabetes.
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Affiliation(s)
- Maria Masulli
- Department of Clinical Medicine and Surgery, 'Federico II' University of Naples, Naples, Italy
| | - Lanfranco D'Elia
- Department of Clinical Medicine and Surgery, 'Federico II' University of Naples, Naples, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Varese, Italy and Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Carlo M Barbagallo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Giancarlo Bilancio
- Department "Scuola Medica Salernitana", Baronissi, SA, University of Salerno
| | - Michele Bombelli
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Berardino Bruno
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Edoardo Casiglia
- Studium Patavinum, Department of Medicine, University of Padua, Padua, Italy
| | - Rosario Cianci
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Arrigo F G Cicero
- Hypertension and Cardiovascular Risk Factors Research Center, Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy
| | - Massimo Cirillo
- Department of Public Health, "Federico II" University of Naples, Naples, Italy
| | - Pietro Cirillo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, "Aldo Moro" University of Bari, Bari, Italy
| | - Raffaella Dell'Oro
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giovambattista Desideri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, "Aldo Moro" University of Bari, Bari, Italy
| | - Cristina Giannattasio
- Cardiology IV, "A.De Gasperi's" Department, Niguarda Ca' Granda Hospital, Milan, Italy; School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Naples, Italy
| | - Luciano Lippa
- Italian Society of General Medicine, Avezzano, L'Aquila, Italy
| | - Francesca Mallamaci
- CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Cal Unit, Reggio Calabria, Italy
| | - Alessandro Maloberti
- Cardiology IV, "A.De Gasperi's" Department, Niguarda Ca' Granda Hospital, Milan, Italy; School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alberto Mazza
- Department of Internal Medicine, Santa Maria Della Misericordia General Hospital, AULSS 5 Polesana, Rovigo, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Pietro Nazzaro
- Department of Biomedical Science and Oncology, University of Bari, Bari, Italy
| | - Paolo Palatini
- Studium Patavinum, Department of Medicine, University of Padua, Padua, Italy
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Roberto Pontremoli
- Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Fosca Quarti-Trevano
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marcello Rattazzi
- Studium Patavinum, Department of Medicine, University of Padua, Padua, Italy; Medicina Interna I, Ca' Foncello University Hospital, Treviso, Italy
| | - Gianpaolo Reboldi
- Department of Medicine and Centro di Ricerca Clinica e Traslazionale (CERICLET), University of Perugia, Perugia, Italy
| | - Giulia Rivasi
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Giuliano Tocci
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Andrea Ungar
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | | | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Massimo Volpe
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Claudio Borghi
- Hypertension and Cardiovascular Risk Factors Research Center, Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, 'Federico II' University of Naples, Naples, Italy.
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Vitacolonna E, Masulli M, Palmisano L, Stuppia L, Franzago M. Inositols, Probiotics, and Gestational Diabetes: Clinical and Epigenetic Aspects. Nutrients 2022; 14:nu14081543. [PMID: 35458105 PMCID: PMC9028601 DOI: 10.3390/nu14081543] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 03/30/2022] [Accepted: 04/05/2022] [Indexed: 02/06/2023] Open
Abstract
There is growing interest in the potential role of different stereoisomers of inositol or their combination as well as probiotics supplementation in healthy glucose metabolism during pregnancy and in promoting offspring health. The aim of this review is to clarify the effects of several inositol and probiotics-based supplements in the prevention and treatment of gestational diabetes (GDM). Moreover, we will discuss the epigenetic aspects and their short- and long-term effects in response to probiotic intervention as well as the possible implications of these findings in guiding appropriate supplementation regimens in pregnancy.
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Affiliation(s)
- Ester Vitacolonna
- Department of Medicine and Aging, School of Medicine and Health Sciences, “G. d’Annunzio” University, Chieti-Pescara, Via dei Vestini, 66100 Chieti, Italy;
- Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University, Chieti-Pescara, 66100 Chieti, Italy;
- Correspondence:
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (M.M.); (L.P.)
| | - Luisa Palmisano
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy; (M.M.); (L.P.)
| | - Liborio Stuppia
- Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University, Chieti-Pescara, 66100 Chieti, Italy;
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health Sciences, “G. d’Annunzio” University, Chieti-Pescara, 66100 Chieti, Italy
| | - Marica Franzago
- Department of Medicine and Aging, School of Medicine and Health Sciences, “G. d’Annunzio” University, Chieti-Pescara, Via dei Vestini, 66100 Chieti, Italy;
- Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University, Chieti-Pescara, 66100 Chieti, Italy;
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22
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Della Pepa G, Russo M, Vitale M, Carli F, Vetrani C, Masulli M, Riccardi G, Vaccaro O, Gastaldelli A, Rivellese AA, Bozzetto L. Pioglitazone even at low dosage improves NAFLD in type 2 diabetes: clinical and pathophysiological insights from a subgroup of the TOSCA.IT randomised trial. Diabetes Res Clin Pract 2021; 178:108984. [PMID: 34311022 DOI: 10.1016/j.diabres.2021.108984] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 07/17/2021] [Accepted: 07/21/2021] [Indexed: 02/07/2023]
Abstract
AIMS Non-Alcoholic Fatty Liver Disease (NAFLD) and type 2 diabetes (T2D) share pathophysiological mechanisms and possible therapeutic strategies. We evaluated the effects of 1-year treatment with pioglitazone or sulphonylureas on indirect indices of NAFLD in people with T2D and the role of insulin-resistance and glucotoxicity in determining these effects. METHODS Patients with T2D (n = 195) aged 50-75 years, poorly controlled with metformin 2 g/day, were randomly allocated to add-on pioglitazone (n = 98) or sulphonylureas (n = 97) within the TOSCA.IT trial. Plasma insulin, glucose, and liver enzymes were measured at baseline and after 1-year. Indirect indices of NAFLD (Liver Fat Equation [LFE], Hepatic Steatosis Index [HSI], and Index of NASH [ION]), and insulin resistance (HOMA-IR, Visceral Adiposity Index [VAI] and adipose tissue Insulin Resistance [ADIPO-IR]) were calculated. RESULTS Indices of NAFLD improved after pioglitazone, but not after sulphonylureas; differences between changes (1-year minus baseline) were respectively: -1.76 ± 3.84 vs. 0.28 ± 3.75 for LFE; -1.35 ± 2.78 vs. -0.27 ± 2.63 for HSI; -9.75 ± 43 vs. 3.24 ± 31 for ION; p < 0.05 for all. Indices of insulin resistance decreased after pioglitazone, but not after sulphonylureas: -0.95 ± 4.57 vs. 0.37 ± 3.34 for HOMA-IR, p = 0.032; -1.25 ± 4.11 vs. 1.36 ± 5.43 for ADIPO-IR, p = 0.001; -0.53 ± 1.88 vs. 0.03 ± 2.36 for VAI, p = 0.074. Changes in NAFLD indices were similar with different doses of pioglitazone (15, 30, or 45 mg/day), and were independent of blood glucose control. CONCLUSIONS One-year treatment with pioglitazone even at low dosage significantly improved liver steatosis and inflammation, systemic and adipose tissue insulin resistance in patients with T2D. The beneficial effects of pioglitazone on NAFLD were independent of blood glucose control.
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Affiliation(s)
- Giuseppe Della Pepa
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Marco Russo
- Cardiometabolic Risk Unit, Institute of Clinical Physiology, CNR, Pisa, Italy; University of Siena, Siena, Italy
| | - Marilena Vitale
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Fabrizia Carli
- Cardiometabolic Risk Unit, Institute of Clinical Physiology, CNR, Pisa, Italy
| | - Claudia Vetrani
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Olga Vaccaro
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Amalia Gastaldelli
- Cardiometabolic Risk Unit, Institute of Clinical Physiology, CNR, Pisa, Italy.
| | - Angela A Rivellese
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
| | - Lutgarda Bozzetto
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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23
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Masulli M, Della Pepa G, Cocozza S, Capasso M, Pignataro P, Vitale M, Gastaldelli A, Russo M, Dolce P, Riccardi G, Rivellese AA, Vaccaro O. The Pro12Ala polymorphism of PPARγ2 modulates beta cell function and failure to oral glucose-lowering drugs in patients with type 2 diabetes. Diabetes Metab Res Rev 2021; 37:e3392. [PMID: 32783395 DOI: 10.1002/dmrr.3392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/18/2020] [Accepted: 08/06/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND We evaluate whether the Pro12Ala polymorphism of peroxisome proliferator-activated receptor γ2 (PPARγ2) has a role in the progression of diabetes by modulating the occurrence of treatment failure to glucose-lowering drugs. METHODS We studied 215 patients with type 2 diabetes participating in the Thiazolidinediones Or Sulphonylureas and Cardiovascular Accidents Intervention Trial study. All participants were insufficiently controlled (glycated haemoglobin [HbA1c ] 7.0%-9.0%) with metformin 2 g/day and were randomly allocated to add-on pioglitazone or a sulfonylurea. Treatment failure was defined as HbA1c ≥8% on two consecutive visits, 3 months apart. RESULTS Carriers or non-carriers of the polymorphism had similar age, body mass index, and diabetes duration. Ala carriers had lower fasting plasma insulin, better insulin sensitivity (Homeostasis Model Assessment [HOMA]2-%S), and worse beta cell secretion (HOMA2-%B) than non-carriers. During 24 months of follow-up, 32.5% among the Ala carriers and 8.6% among non-carriers (P < 0.001) developed treatment failure with a cumulative incidence of 18.6 vs 4.6/100 person-years. Those patients who developed treatment failure were older, had a younger age at diabetes diagnosis (48 ± 10 vs 52 ± 7 years; P = 0.032), higher HbA1c (8.1 ± 0.5 vs 7.7 ± 0.5%; P < 0.001), and lower HOMA2-%B (30 ± 12 vs 46 ± 29; P = 0.015) at study entry, as compared to those who did not develop treatment failure. At multivariate analysis, the Pro12Ala polymorphism was significantly associated with treatment failure (hazard ratio [HR] 4.45; 95% confidence interval [CI] 1.79-11.1; P < 0.001); HbA1c at study entry was the other independent predictor of failure in this study population. CONCLUSION The Pro12Ala polymorphism is associated with a greater insulin sensitivity, reduced beta cell function and a substantially increased risk of treatment failure.
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Affiliation(s)
- Maria Masulli
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giuseppe Della Pepa
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Sara Cocozza
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Mario Capasso
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy
- CEINGE Advanced Biotechnologies, Naples, Italy
| | - Piero Pignataro
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Marilena Vitale
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | | | - Marco Russo
- Institute of Clinical Physiology National Research Council, Pisa, Italy
| | - Pasquale Dolce
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Angela A Rivellese
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Olga Vaccaro
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Vitale M, Calabrese I, Massimino E, Shivappa N, Hebert JR, Auciello S, Grioni S, Krogh V, Sartore G, Signorini S, Rivellese AA, Riccardi G, Vaccaro O, Masulli M. Dietary inflammatory index score, glucose control and cardiovascular risk factors profile in people with type 2 diabetes. Int J Food Sci Nutr 2020; 72:529-536. [PMID: 33045863 DOI: 10.1080/09637486.2020.1832054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We examined the relationships between the dietary inflammatory index (DII®), dietary habits and cardiovascular risk factor profiles in people with type 2 diabetes mellitus (T2DM). Energy-adjusted DII (E-DII™) scores were calculated from a Food Frequency Questionnaire in 2568 T2DM patients from different parts of Italy. Analyses were conducted according to quartiles of sex-specific E-DII scores. Higher, more pro-inflammatory, (quartile 4) E-DII scores were associated with overall poor quality of the diet characterised by higher content of refined carbohydrates, added sugars, saturated fat and cholesterol and lower unsaturated fat, fibre and polyphenols compared to quartile 1. Higher E-DII scores also were associated with higher waist circumference (105.4 vs. 103.5 cm; p = 0.002), triglycerides (154.6 vs. 146.1 mg/dL; p = 0.005), diastolic blood pressure (80.05 vs. 78.6 mmHg; p = 0.04) and lower HDL-cholesterol (45.3 vs. 47.4 mg/dL; p = 0.04). In conclusion, E-DII is a potent marker of overall quality of the diet and is associated with an unfavourable cardiovascular risk factor profile.
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Affiliation(s)
- Marilena Vitale
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Ilaria Calabrese
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Elena Massimino
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Nitin Shivappa
- Department of Epidemiology and Biostatistics and Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC, USA
| | - James R Hebert
- Department of Epidemiology and Biostatistics and Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC, USA
| | - Stefania Auciello
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Sara Grioni
- Unità di Epidemiologia e Prevenzione, Fondazione IRCCS, Istituto Nazionale Tumori, Milano, Italy
| | - Vittorio Krogh
- Unità di Epidemiologia e Prevenzione, Fondazione IRCCS, Istituto Nazionale Tumori, Milano, Italy
| | | | | | - Angela A Rivellese
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Olga Vaccaro
- Department of Pharmacy, Federico II University of Naples, Naples, Italy
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
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Tecce N, Masulli M, Lupoli R, Della Pepa G, Bozzetto L, Palmisano L, Rivellese AA, Riccardi G, Capaldo B. Evaluation of cardiovascular risk in adults with type 1 diabetes: poor concordance between the 2019 ESC risk classification and 10-year cardiovascular risk prediction according to the Steno Type 1 Risk Engine. Cardiovasc Diabetol 2020; 19:166. [PMID: 33010807 PMCID: PMC7533035 DOI: 10.1186/s12933-020-01137-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/23/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Patients with type 1 diabetes (T1D) have higher mortality risk compared to the general population; this is largely due to increased rates of cardiovascular disease (CVD). As accurate CVD risk stratification is essential for an appropriate preventive strategy, we aimed to evaluate the concordance between 2019 European Society of Cardiology (ESC) CVD risk classification and the 10-year CVD risk prediction according to the Steno Type 1 Risk Engine (ST1RE) in adults with T1D. METHODS A cohort of 575 adults with T1D (272F/303M, mean age 36 ± 12 years) were studied. Patients were stratified in different CVD risk categories according to ESC criteria and the 10-year CVD risk prediction was estimated with ST1RE within each category. RESULTS Men had higher BMI, WC, SBP than women, while no difference was found in HbA1c levels between genders. According to the ESC classification, 92.5% of patients aged < 35 years and 100% of patients ≥ 35 years were at very high/high risk. Conversely, using ST1RE to predict the 10-year CVD risk within each ESC category, among patients at very high risk according to ESC, almost all (99%) had a moderate CVD risk according to ST1RE if age < 35 years; among patients aged ≥35 years, the majority (59.1%) was at moderate risk and only 12% had a predicted very high risk by ST1RE. The presence of target organ damage or three o more CV risk factors, or early onset T1D of long duration (> 20 years) alone identified few patients (< 30%) among those aged ≥35 years, who were at very high risk according to ESC, in whom this condition was confirmed by ST1RE; conversely, the coexistence of two or more of these criteria identified about half of the patients at high/very high risk also according to this predicting algorithm. When only patients aged ≥ 50 years were considered, there was greater concordance between ESC classification and ST1RE prediction, since as many as 78% of those at high/very high risk according to ESC were confirmed as such also by ST1RE. CONCLUSIONS Using ESC criteria, a large proportion (45%) of T1D patients without CVD are classified at very high CVD risk; however, among them, none of those < 35 years and only 12% of those ≥ 35 years could be confirmed at very high CVD risk by the ST1RE predicting algorithm. More studies are needed to characterize the clinical and metabolic features of T1D patients that identify those at very high CVD risk, in whom a very aggressive cardioprotective treatment would be justified.
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Affiliation(s)
- Nicola Tecce
- Department of Clinical Medicine and Surgery, Federico II University, Via S. Pansini 5, 80131, Naples, Italy
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, Federico II University, Via S. Pansini 5, 80131, Naples, Italy.
| | - Roberta Lupoli
- Department of Molecular Medicine and Medical Biotechnology, Federico II University, Naples, Italy
| | - Giuseppe Della Pepa
- Department of Clinical Medicine and Surgery, Federico II University, Via S. Pansini 5, 80131, Naples, Italy
| | - Lutgarda Bozzetto
- Department of Clinical Medicine and Surgery, Federico II University, Via S. Pansini 5, 80131, Naples, Italy
| | - Luisa Palmisano
- Department of Clinical Medicine and Surgery, Federico II University, Via S. Pansini 5, 80131, Naples, Italy
| | - Angela Albarosa Rivellese
- Department of Clinical Medicine and Surgery, Federico II University, Via S. Pansini 5, 80131, Naples, Italy
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, Federico II University, Via S. Pansini 5, 80131, Naples, Italy
| | - Brunella Capaldo
- Department of Clinical Medicine and Surgery, Federico II University, Via S. Pansini 5, 80131, Naples, Italy
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Vaccaro O, Vitale M, Costanzo S, Masulli M, Riccardi G, De Curtis A, Donati MB, Rivellese AA, de Gaetano G, Iacoviello L. Cardiovascular risk factors control according to diabetes status and prior cardiovascular events in patients managed in different settings. Diabetes Res Clin Pract 2020; 168:108370. [PMID: 32827595 DOI: 10.1016/j.diabres.2020.108370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/04/2020] [Accepted: 08/10/2020] [Indexed: 11/17/2022]
Abstract
AIMS To document in recent cohorts the degree of control of major cardiovascular (CV) risk factors according to diabetes status and prior CV disease in different settings. METHODS We studied men and women aged 50-75 years of whom 3028 with type 2 diabetes mellitus (T2DM) managed at diabetes clinics participants of the TOSCA.IT (NCT00700856) study recruited in 2008-2014; 742 with T2DM managed mainly in primary care and 6753 without diabetes participating in the Moli-sani (NCT03242109) study and recruited in 2005-2010 from an adult general population. RESULTS Among people without a prior CV event people with diabetes managed at diabetes clinics have lower LDL-cholesterol and blood pressure and a more frequent use of lipid-lowering and antihypertensive medications as compared to people with diabetes managed mainly in primary care and to people without diabetes. The proportions achieving the recommended treatment targets are respectively 47.4% vs 33.4% vs 29.5% for LDL-cholesterol and 42.6% vs 9.5% vs 47.4% for blood pressure. Figures for the participants with prior CV events were 26.8% vs 15.1% vs 42.5% for LDL-cholesterol and 43.8% vs 8.5% vs 43.6% for blood pressure. CONCLUSIONS The study documents that in modern cohorts a large proportion of people with or without diabetes does not achieve the treatment targets for LDL-cholesterol and blood pressure, both in primary and secondary CV prevention. People with diabetes attending diabetes clinics achieve a better control of major CV risk factors than those managed mainly in primary care, thus highlighting the relevant role of a structured model of care.
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Affiliation(s)
- Olga Vaccaro
- Dept. of Clinical Medicine and Surgery, "Federico II" University of Naples, Italy.
| | - Marilena Vitale
- Dept. of Clinical Medicine and Surgery, "Federico II" University of Naples, Italy
| | - Simona Costanzo
- Dept. of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Maria Masulli
- Dept. of Clinical Medicine and Surgery, "Federico II" University of Naples, Italy
| | - Gabriele Riccardi
- Dept. of Clinical Medicine and Surgery, "Federico II" University of Naples, Italy
| | - Amalia De Curtis
- Dept. of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | | | | | - Giovanni de Gaetano
- Dept. of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Licia Iacoviello
- Dept. of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Isernia, Italy; Research Center in Epidemiology and Preventive Medicine (EPIMED), Dept. of Medicine and Surgery, University of Insubria, Varese, Italy
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Masulli M, Lucisano G, Bonora E, Del Prato S, Rivellese AA, Signorini S, Mocarelli P, Riccardi G, Vaccaro O, Nicolucci A. A few clinical features improve the prediction of mortality and cardiovascular outcomes in patients with type 2 diabetes. Eur J Prev Cardiol 2020; 28:e1-e3. [PMID: 33624040 DOI: 10.1093/eurjpc/zwaa002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/18/2020] [Accepted: 07/14/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Maria Masulli
- Department of Clinical Medicine and Surgery, Federico II University, Via S. Pansini 5, 80131 Naples, Italy
| | - Giuseppe Lucisano
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, via Tiziano Vecellio 2, 65124 Pescara, Italy
| | - Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, Piazzale Aristide Stefani 1, 37129 Verona, Italy
| | - Stefano Del Prato
- Department of Clinical & Experimental Medicine, University of Pisa, Lungarno Pacinotti 43, 56126 Pisa, Italy
| | - Angela A Rivellese
- Department of Clinical Medicine and Surgery, Federico II University, Via S. Pansini 5, 80131 Naples, Italy
| | - Stefano Signorini
- University Department of Laboratory Medicine, Hospital of Desio, via Giuseppe Mazzini 1, 20832 Desio (MB), Italy
| | - Paolo Mocarelli
- University Department of Laboratory Medicine, Hospital of Desio, via Giuseppe Mazzini 1, 20832 Desio (MB), Italy
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, Federico II University, Via S. Pansini 5, 80131 Naples, Italy
| | - Olga Vaccaro
- Department of Clinical Medicine and Surgery, Federico II University, Via S. Pansini 5, 80131 Naples, Italy
| | - Antonio Nicolucci
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, via Tiziano Vecellio 2, 65124 Pescara, Italy
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Capaldo B, Annuzzi G, Creanza A, Giglio C, De Angelis R, Lupoli R, Masulli M, Riccardi G, Rivellese AA, Bozzetto L. Blood Glucose Control During Lockdown for COVID-19: CGM Metrics in Italian Adults With Type 1 Diabetes. Diabetes Care 2020; 43:e88-e89. [PMID: 32540921 PMCID: PMC7372051 DOI: 10.2337/dc20-1127] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/25/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Brunella Capaldo
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Giovanni Annuzzi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Annalisa Creanza
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Clemente Giglio
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Raffaele De Angelis
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Roberta Lupoli
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | | | - Lutgarda Bozzetto
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
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Masulli M, Vitacolonna E, Fraticelli F, Della Pepa G, Mannucci E, Monami M. Effects of probiotic supplementation during pregnancy on metabolic outcomes: A systematic review and meta-analysis of randomized controlled trials. Diabetes Res Clin Pract 2020; 162:108111. [PMID: 32194215 DOI: 10.1016/j.diabres.2020.108111] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/13/2020] [Accepted: 03/02/2020] [Indexed: 01/06/2023]
Abstract
AIM To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of probiotics in pregnancy on the incidence of gestational diabetes (GDM) and fasting plasma glucose (FPG). METHODS A MEDLINE, EMBASE, Scopus and Cochrane search (up to May 30th, 2019) was performed to identify RCTs of comparison of probiotics with placebo/active comparators in pregnant women. Principal endpoints were the incidence of GDM and the change of FPG. Other maternal and fetal outcomes were secondary endpoints. Mantel-Haenszel Odds Ratio with 95% CI (MH-OR) was calculated for dichotomous outcomes, whereas standardized differences in means was calculated for continuous variables. (PROSPERO registration CRD42019139889). FINDINGS A total of 17 RCTs, all versus placebo, was identified. The overall quality of the trials was satisfactory. No effect of probiotics on incidence of GDM (MH-OR: 0.77[0.51,1.16], p = 0.21,I2:62%) was observed, with a small but significant reduction of FPG (mean difference -1.01 [-1.96, -0.06]mg/dl, p = 0.02, I2:46%). Among secondary endpoints, a significant reduction of maternal insulin (both in women with or without diabetes) was observed in the probiotics group. INTERPRETATION Probiotics during pregnancy do not reduce the incidence of GDM, with a very little (statistically but not clinically significant) reduction of fasting plasma glucose.
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Affiliation(s)
- Maria Masulli
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Italy.
| | - Ester Vitacolonna
- Department of Medicine and Aging, School of Medicine and Health Sciences, "G. d'Annunzio" University, Chieti, Pescara, Italy
| | - Federica Fraticelli
- Department of Medicine and Aging, School of Medicine and Health Sciences, "G. d'Annunzio" University, Chieti, Pescara, Italy
| | - Giuseppe Della Pepa
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Italy
| | | | - Matteo Monami
- Diabetology, Careggi Hospital and University of Florence, Italy
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Vaccaro O, Nicolucci A, Lucisano G, Masulli M, Riccardi G. Response to Letter to the Editor: "Cardiovascular Effects of Pioglitazone or Sulfonylureas According to Pretreatment Risk: Moving Toward Personalized Care". J Clin Endocrinol Metab 2020; 105:5731505. [PMID: 32036387 DOI: 10.1210/clinem/dgz135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/16/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Olga Vaccaro
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Antonio Nicolucci
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Giuseppe Lucisano
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
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Vitale M, Masulli M, Rivellese AA, Bonora E, Babini AC, Sartore G, Corsi L, Buzzetti R, Citro G, Baldassarre MPA, Bossi AC, Giordano C, Auciello S, Dall’Aglio E, Iannarelli R, Tonutti L, Sacco M, Di Cianni G, Clemente G, Gregori G, Grioni S, Krogh V, Riccardi G, Vaccaro O. Pasta Consumption and Connected Dietary Habits: Associations with Glucose Control, Adiposity Measures, and Cardiovascular Risk Factors in People with Type 2 Diabetes-TOSCA.IT Study. Nutrients 2019; 12:nu12010101. [PMID: 31905885 PMCID: PMC7019547 DOI: 10.3390/nu12010101] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/18/2019] [Accepted: 12/25/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Pasta is a refined carbohydrate with a low glycemic index. Whether pasta shares the metabolic advantages of other low glycemic index foods has not really been investigated. The aim of this study is to document, in people with type-2 diabetes, the consumption of pasta, the connected dietary habits, and the association with glucose control, measures of adiposity, and major cardiovascular risk factors. Methods: We studied 2562 participants. The dietary habits were assessed with the European Prospective Investigation into Cancer and Nutrition (EPIC) questionnaire. Sex-specific quartiles of pasta consumption were created in order to explore the study aims. Results: A higher pasta consumption was associated with a lower intake of proteins, total and saturated fat, cholesterol, added sugar, and fiber. Glucose control, body mass index, prevalence of obesity, and visceral obesity were not significantly different across the quartiles of pasta intake. No relation was found with LDL cholesterol and triglycerides, but there was an inverse relation with HDL-cholesterol. Systolic blood pressure increased with pasta consumption; but this relation was not confirmed after correction for confounders. Conclusions: In people with type-2 diabetes, the consumption of pasta, within the limits recommended for total carbohydrates intake, is not associated with worsening of glucose control, measures of adiposity, and major cardiovascular risk factors.
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Affiliation(s)
- Marilena Vitale
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (M.V.); (M.M.); (A.A.R.); (S.A.); (G.R.)
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (M.V.); (M.M.); (A.A.R.); (S.A.); (G.R.)
| | - Angela Albarosa Rivellese
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (M.V.); (M.M.); (A.A.R.); (S.A.); (G.R.)
| | - Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, 37138 Verona, Italy;
| | | | - Giovanni Sartore
- Dipartimento di Medicina, University of Padova, 35100 Padova, Italy;
| | - Laura Corsi
- Dipartimento di Diabetologia e Malattie del Metabolismo, ASL 4 Chiavarese, 16043 Genova, Italy;
| | - Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University, 04100 Rome, Italy;
| | - Giuseppe Citro
- UO Endocrinologia e Diabetologia, ASP, 85100 Potenza, Italy;
| | - Maria Pompea Antonia Baldassarre
- CeSI-MeT-Centro di Scienze dell’Invecchiamento e Medicina Traslazionale-University G. D’Annunzio of Chieti, 66100 Pescara, Italy;
| | - Antonio Carlo Bossi
- UOC Malattie Endocrine e Centro Regionale per il Diabete Mellito, ASST Bergamo Ovest di Treviglio, 24047 Treviglio, Italy;
| | - Carla Giordano
- Section of Endocrinology, Diabetology and Metabolic Diseases, University of Palermo, 90127 Palermo, Italy;
| | - Stefania Auciello
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (M.V.); (M.M.); (A.A.R.); (S.A.); (G.R.)
| | - Elisabetta Dall’Aglio
- Dipartimento di Medicina Clinica e Sperimentale, University of Parma, 43100 Parma, Italy;
| | - Rossella Iannarelli
- UOSD Diabetologia e Malattie del Metabolismo, Ospedale San Salvatore, 67100 L’Aquila, Italy;
| | - Laura Tonutti
- SOC di Endocrinologia e Malattie del Metabolismo, AOU S. Maria della Misericordia, 33100 Udine, Italy;
| | - Michele Sacco
- Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), 65124 Pescara, Italy;
| | | | - Gennaro Clemente
- IRPPS Research National Council, Penta di Fisciano, 84025 Salerno, Italy;
| | | | - Sara Grioni
- Unità di Epidemiologia e Prevenzione, Fondazione IRCCS, Istituto Nazionale Tumori, 20133 Milano, Italy; (S.G.); (V.K.)
| | - Vittorio Krogh
- Unità di Epidemiologia e Prevenzione, Fondazione IRCCS, Istituto Nazionale Tumori, 20133 Milano, Italy; (S.G.); (V.K.)
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (M.V.); (M.M.); (A.A.R.); (S.A.); (G.R.)
| | - Olga Vaccaro
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (M.V.); (M.M.); (A.A.R.); (S.A.); (G.R.)
- Correspondence: ; Tel.: +39-081-746-3665; Fax: +39-081-746-4736
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Vaccaro O, Lucisano G, Masulli M, Bonora E, Del Prato S, Rivellese AA, Giorda CB, Mocarelli P, Squatrito S, Maggioni AP, Riccardi G, Nicolucci A. Cardiovascular Effects of Pioglitazone or Sulfonylureas According to Pretreatment Risk: Moving Toward Personalized Care. J Clin Endocrinol Metab 2019; 104:3296-3302. [PMID: 31058962 DOI: 10.1210/jc.2019-00361] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/30/2019] [Indexed: 12/30/2022]
Abstract
CONTEXT Hypoglycemic drugs with proven cardiovascular (CV) benefits are recommended for patients with type 2 diabetes and CV disease. Whether the beneficial effects extend to those at lower risk remains unclear. AIM We investigated the long-term CV effects of pioglitazone or sulfonylureas (SUs) across the spectrum of pretreatment CV risk. METHODS Among 2820 participants of the TOSCA.IT trial, four subgroups with different risk of outcome-a composite of all-cause death, nonfatal myocardial infarction, nonfatal stroke, urgent coronary revascularization-were identified by the RECursive Partitioning and AMalgamation (RECPAM) method. Within each group, the effect of SUs or pioglitazone on the outcome was evaluated. RESULTS Sex was the first splitting variable, followed by urinary albumin-to-creatinine ratio (UACR) (>9 mg/g or ≤9 mg/g) and body mass index (BMI) (>28.7 or ≤28.7 kg/m2). Female patients had the lowest risk (reference); male patients with UACR >9 mg/g and BMI >28.7 kg/m2 had the highest risk [hazard ratio (HR), 5.58; 95% CI, 3.32 to 9.69]. Patients in this group present a cluster of conditions suggestive of marked insulin resistance (higher BMI, waist circumference, triglycerides, blood pressure, and UACR and lower high-density lipoprotein cholesterol) than the other groups. Treatment with pioglitazone in this group was associated with a significantly lower occurrence of the outcome than SUs (HR, 0.48; 95% CI, 0.25 to 0.76). No significant difference between study treatments was observed in the other RECPAM classes. CONCLUSIONS It is possible to identify patients with type 2 diabetes early in the stage of their disease and who are largely free from evident CV disease in whom add-on pioglitazone to metformin confers CV protection as compared with SUs.
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Affiliation(s)
- Olga Vaccaro
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Giuseppe Lucisano
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, Verona, Italy
| | - Stefano Del Prato
- Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - Angela A Rivellese
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | | | - Paolo Mocarelli
- University Department of Laboratory Medicine, Hospital of Desio, Desio (MB), Italy
| | | | | | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Antonio Nicolucci
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
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Vitale M, Masulli M, Calabrese I, Rivellese AA, Bonora E, Signorini S, Perriello G, Squatrito S, Buzzetti R, Sartore G, Babini AC, Gregori G, Giordano C, Clemente G, Grioni S, Dolce P, Riccardi G, Vaccaro O. Impact of a Mediterranean Dietary Pattern and Its Components on Cardiovascular Risk Factors, Glucose Control, and Body Weight in People with Type 2 Diabetes: A Real-Life Study. Nutrients 2018; 10:nu10081067. [PMID: 30103444 PMCID: PMC6115857 DOI: 10.3390/nu10081067] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/03/2018] [Accepted: 08/07/2018] [Indexed: 11/16/2022] Open
Abstract
This study evaluates the relation of a Mediterranean dietary pattern and its individual components with the cardiovascular risk factors profile, plasma glucose and body mass index (BMI) in people with type 2 diabetes. We studied 2568 participants at 57 diabetes clinics. Diet was assessed with the EPIC (European Prospective Investigation into Cancer and Nutrition) questionnaire, adherence to the Mediterranean diet was evaluated with the relative Mediterranean diet score (rMED). A high compared to a low score was associated with a better quality of diet and a greater adherence to the nutritional recommendations for diabetes. However, even in the group achieving a high score, only a small proportion of participants met the recommendations for fiber and saturated fat (respectively 17% and 30%). Nonetheless, a high score was associated with lower values of plasma lipids, blood pressure, glycated hemoglobin, and BMI. The relationship of the single food items components of the rMED score with the achievement of treatment targets for plasma lipids, blood pressure, glucose, and BMI were also explored. The study findings support the Mediterranean dietary model as a suitable model for type 2 diabetes and the concept that the beneficial health effects of the Mediterranean diet lie primarily in its synergy among various nutrients and foods rather than on any individual component.
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Affiliation(s)
- Marilena Vitale
- Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | - Ilaria Calabrese
- Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | | | - Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, 37134 Verona, Italy.
| | - Stefano Signorini
- University Department Laboratory Medicine, Hospital of Desio, 20832 Monza, Italy.
| | - Gabriele Perriello
- Endocrinology and Metabolism, University of Perugia, 06126, Perugia, Italy.
| | - Sebastiano Squatrito
- Diabetes Unit, University Hospital Garibaldi-Nesima of Catania, 95122 Catania, Italy.
| | - Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University, 04100 Rome, Italy.
| | - Giovanni Sartore
- Department of Medicine, University of Padua, 35100 Padova, Italy.
| | | | - Giovanna Gregori
- Diabetes Unit, Azienda Sanitaria Toscana Nord-Ovest, Massa Carrara, 54100 Massa Carrara, Italy.
| | - Carla Giordano
- Section of Endocrinology, Diabetology and Metabolic Diseases, University of Palermo, 90127 Palermo, Italy.
| | - Gennaro Clemente
- Institute for Research on Population and Social Policies-National Research Council, 84084 Fisciano, Italy.
| | - Sara Grioni
- Unità di Epidemiologia e Prevenzione, Fondazione IRCCS, Istituto Nazionale Tumori, 20133 Milano, Italy.
| | - Pasquale Dolce
- Department of Public Health, Federico II University of Naples, 80131 Naples, Italy.
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | - Olga Vaccaro
- Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
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Vaccaro O, Masulli M, Riccardi G. Glucose lowering strategies and cardiovascular disease in type 2 diabetes - teachings from the TOSCA.IT study. Nutr Metab Cardiovasc Dis 2018; 28:722-726. [PMID: 29804832 DOI: 10.1016/j.numecd.2018.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/17/2018] [Accepted: 04/19/2018] [Indexed: 11/25/2022]
Abstract
TOSCA.IT is an institutional, non-industry-supported, head-to-head study comparing long term cardiovascular effects, efficacy and safety of two antidiabetes drugs (pioglitazone vs sulphonylureas) used in combination with metformin in patients with type 2 diabetes mellitus. The study results show that in the absence of clinically evident cardiovascular disease both treatment strategies represent suitable alternatives; however, in consideration of the greater durability of the metabolic effects, the lower risk of hypoglycemia and the potential benefit on atherosclerotic cardiovascular disease, the combination of metformin and pioglitazone may be considered as the preferential therapeutic option. In this review the study is critically evaluated against the background of the evidence accumulated over the last decade on the impact of different glucose lowering drugs on cardiovascular events in people with type 2 diabetes.
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Affiliation(s)
- O Vaccaro
- Dept. Clinical Medicine and Surgery, Federico II University Medical School, Via Pansini 5, 80131, Naples, Italy.
| | - M Masulli
- Dept. Clinical Medicine and Surgery, Federico II University Medical School, Via Pansini 5, 80131, Naples, Italy
| | - G Riccardi
- Dept. Clinical Medicine and Surgery, Federico II University Medical School, Via Pansini 5, 80131, Naples, Italy
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Vaccaro O, Masulli M, Nicolucci A, Bonora E, Del Prato S, Maggioni AP, Rivellese AA, Squatrito S, Giorda CB, Sesti G, Mocarelli P, Lucisano G, Sacco M, Signorini S, Cappellini F, Perriello G, Babini AC, Lapolla A, Gregori G, Giordano C, Corsi L, Buzzetti R, Clemente G, Di Cianni G, Iannarelli R, Cordera R, La Macchia O, Zamboni C, Scaranna C, Boemi M, Iovine C, Lauro D, Leotta S, Dall'Aglio E, Cannarsa E, Tonutti L, Pugliese G, Bossi AC, Anichini R, Dotta F, Di Benedetto A, Citro G, Antenucci D, Ricci L, Giorgino F, Santini C, Gnasso A, De Cosmo S, Zavaroni D, Vedovato M, Consoli A, Calabrese M, di Bartolo P, Fornengo P, Riccardi G. Effects on the incidence of cardiovascular events of the addition of pioglitazone versus sulfonylureas in patients with type 2 diabetes inadequately controlled with metformin (TOSCA.IT): a randomised, multicentre trial. Lancet Diabetes Endocrinol 2017; 5:887-897. [PMID: 28917544 DOI: 10.1016/s2213-8587(17)30317-0] [Citation(s) in RCA: 183] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND The best treatment option for patients with type 2 diabetes in whom treatment with metformin alone fails to achieve adequate glycaemic control is debated. We aimed to compare the long-term effects of pioglitazone versus sulfonylureas, given in addition to metformin, on cardiovascular events in patients with type 2 diabetes. METHODS TOSCA.IT was a multicentre, randomised, pragmatic clinical trial, in which patients aged 50-75 years with type 2 diabetes inadequately controlled with metformin monotherapy (2-3 g per day) were recruited from 57 diabetes clinics in Italy. Patients were randomly assigned (1:1), by permuted blocks randomisation (block size 10), stratified by site and previous cardiovascular events, to add-on pioglitazone (15-45 mg) or a sulfonylurea (5-15 mg glibenclamide, 2-6 mg glimepiride, or 30-120 mg gliclazide, in accordance with local practice). The trial was unblinded, but event adjudicators were unaware of treatment assignment. The primary outcome, assessed with a Cox proportional-hazards model, was a composite of first occurrence of all-cause death, non-fatal myocardial infarction, non-fatal stroke, or urgent coronary revascularisation, assessed in the modified intention-to-treat population (all randomly assigned participants with baseline data available and without any protocol violations in relation to inclusion or exclusion criteria). This study is registered with ClinicalTrials.gov, number NCT00700856. FINDINGS Between Sept 18, 2008, and Jan 15, 2014, 3028 patients were randomly assigned and included in the analyses. 1535 were assigned to pioglitazone and 1493 to sulfonylureas (glibenclamide 24 [2%], glimepiride 723 [48%], gliclazide 745 [50%]). At baseline, 335 (11%) participants had a previous cardiovascular event. The study was stopped early on the basis of a futility analysis after a median follow-up of 57·3 months. The primary outcome occurred in 105 patients (1·5 per 100 person-years) who were given pioglitazone and 108 (1·5 per 100 person-years) who were given sulfonylureas (hazard ratio 0·96, 95% CI 0·74-1·26, p=0·79). Fewer patients had hypoglycaemias in the pioglitazone group than in the sulfonylureas group (148 [10%] vs 508 [34%], p<0·0001). Moderate weight gain (less than 2 kg, on average) occurred in both groups. Rates of heart failure, bladder cancer, and fractures were not significantly different between treatment groups. INTERPRETATION In this long-term, pragmatic trial, incidence of cardiovascular events was similar with sulfonylureas (mostly glimepiride and gliclazide) and pioglitazone as add-on treatments to metformin. Both of these widely available and affordable treatments are suitable options with respect to efficacy and adverse events, although pioglitazone was associated with fewer hypoglycaemia events. FUNDING Italian Medicines Agency, Diabete Ricerca, and Italian Diabetes Society.
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Affiliation(s)
- Olga Vaccaro
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, Verona, Italy
| | - Stefano Del Prato
- Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - Aldo P Maggioni
- National Association of Hospital Cardiologists (ANMCO) Research Center, Florence, Italy
| | - Angela A Rivellese
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | | | - Carlo B Giorda
- Diabetes Unit, Azienda Sanitaria Locale (ASL) Torino 5, Torino, Italy
| | - Giorgio Sesti
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Paolo Mocarelli
- University Department Laboratory Medicine, Hospital of Desio, Monza, Italy
| | - Giuseppe Lucisano
- Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Michele Sacco
- Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Stefano Signorini
- University Department Laboratory Medicine, Hospital of Desio, Monza, Italy
| | | | | | | | | | - Giovanna Gregori
- Diabetes Unit, Massa Carrara, Azienda Unità Sanitarie Locali (USL) Toscana Nord Ovest, Carrara, Italy
| | - Carla Giordano
- Section of Endocrinology, Diabetology and Metabolic Diseases, University of Palermo, Palermo, Italy
| | - Laura Corsi
- Diabetes Unit, ASL 4 Chiavarese, Chiavari, Italy
| | | | - Gennaro Clemente
- Institute for Research on Population and Social Policies-National Research Council, Penta di Fisciano, Italy
| | | | - Rossella Iannarelli
- Diabetes Unit, Department of Medicine, San Salvatore Hospital, L'Aquila, Italy
| | - Renzo Cordera
- Diabetes Unit, School of Medicine, University of Genova, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Martino Hospital, Genova, Italy
| | - Olga La Macchia
- Endocrinology, Azienda Ospedaliero Universitaria Ospedali Riuniti, Foggia, Italy
| | | | - Cristiana Scaranna
- Endocrinology and Diabetology, Azienda Socio Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
| | - Massimo Boemi
- Diabetes and Metabolism Unit, IRCCS Istituto Nazionale Riposo e Cura Anziani, Ancona, Italy
| | - Ciro Iovine
- Diabetes Unit, University of Naples Federico II, Naples, Italy
| | - Davide Lauro
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Sergio Leotta
- UOC Diabetologia Ospedale Sandro Pertini, Rome, Italy
| | | | | | - Laura Tonutti
- Endocrinology, Diabetes, Metabolism and Clinical Nutrition Unit, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | | | | | - Francesco Dotta
- Diabetes Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Antonino Di Benedetto
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Citro
- Endocrinology and Diabetes Unit, Azienda Sanitaria Locale di Potenza, Potenza, Italy
| | | | | | - Francesco Giorgino
- Department of Emergency and Organ Transplantation, Endocrinology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Apulia, Italy
| | - Costanza Santini
- Department Endocrinology and Diabetology, Cesena Hospital, Cesena, Italy
| | - Agostino Gnasso
- Department of Clinical and Experimental Medicine, Magna Graecia University of Catanzaro, Italy
| | - Salvatore De Cosmo
- Unit of Internal Medicine, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | - Monica Vedovato
- Metabolism Unit, Azienda Ospedaliera di Padova, Padova, Italy
| | - Agostino Consoli
- Department of Medicine and Aging Sciences, and Aging and Translational Medicine Research Center (CeSI-Met), D'Annunzio University, Chieti-Pescara, Italy
| | | | - Paolo di Bartolo
- Diabetes Unit, Ravenna Internal Medicine Department, Romagna Local Health Unit, Ravenna, Italy
| | - Paolo Fornengo
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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36
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Vitale M, Vaccaro O, Masulli M, Bonora E, Del Prato S, Giorda CB, Nicolucci A, Squatrito S, Auciello S, Babini AC, Bani L, Buzzetti R, Cannarsa E, Cignarelli M, Cigolini M, Clemente G, Cocozza S, Corsi L, D'Angelo F, Dall'Aglio E, Di Cianni G, Fontana L, Gregori G, Grioni S, Giordano C, Iannarelli R, Iovine C, Lapolla A, Lauro D, Laviola L, Mazzucchelli C, Signorini S, Tonutti L, Trevisan R, Zamboni C, Riccardi G, Rivellese AA. Polyphenol intake and cardiovascular risk factors in a population with type 2 diabetes: The TOSCA.IT study. Clin Nutr 2016; 36:1686-1692. [PMID: 27890487 DOI: 10.1016/j.clnu.2016.11.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/28/2016] [Accepted: 11/01/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND The role of polyphenol intake on cardiovascular risk factors is little explored, particularly in people with diabetes. AIM To evaluate the association between the intake of total polyphenols and polyphenol classes with the major cardiovascular risk factors in a population with type 2 diabetes. METHODS Dietary habits were investigated in 2573 males and females participants of the TOSCA.IT study. The European Prospective Investigation on Cancer and Nutrition (EPIC) questionnaire was used to assess dietary habits. In all participants, among others, we assessed anthropometry, plasma lipids, blood pressure, C-reactive protein and HbA1c following a standard protocol. The USDA and Phenol-Explorer databases were used to estimate the polyphenol content of the habitual diet. RESULTS Average intake of polyphenols was 683.3 ± 5.8 mg/day. Flavonoids and phenolic acids were the predominant classes (47.5% and 47.4%, respectively). After adjusting for potential confounders, people with the highest intake of energy-adjusted polyphenols (upper tertile) had a more favorable cardiovascular risk factors profile as compared to people with the lowest intake (lower tertile) (BMI was 30.7 vs 29.9 kg/m2, HDL-cholesterol was 45.1 vs 46.9 mg/dl, LDL-cholesterol was 103.2 vs 102.1 mg/dl, triglycerides were 153.4 vs 148.0 mg/dl, systolic and diastolic blood pressure were respectively 135.3 vs 134.3 and 80.5 vs 79.6 mm/Hg, HbA1c was 7.70 vs 7.67%, and C-reactive Protein was 1.29 vs 1.25 mg/dl, p < .001 for all). The findings were very similar when the analysis was conducted separately for flavonoids or phenolic acids, the two main classes of polyphenols consumed in this population. CONCLUSIONS Polyphenol intake is associated with a more favorable cardiovascular risk factors profile, independent of major confounders. These findings support the consumption of foods and beverages rich in different classes of polyphenols particularly in people with diabetes. CLINICAL TRIAL http://www.clinicaltrials.gov; Study ID number: NCT00700856.
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Affiliation(s)
- Marilena Vitale
- Dipartimento di Medicina Clinica e Chirurgia, Università"Federico II", Naples, Italy
| | - Olga Vaccaro
- Dipartimento di Medicina Clinica e Chirurgia, Università"Federico II", Naples, Italy
| | - Maria Masulli
- Dipartimento di Medicina Clinica e Chirurgia, Università"Federico II", Naples, Italy
| | - Enzo Bonora
- Dipartimento di Endocrinologia, Diabetologia e Metabolismo, Università di Verona, Italy
| | - Stefano Del Prato
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Italy
| | | | - Antonio Nicolucci
- CORESEARCH, Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | | | - Stefania Auciello
- Dipartimento di Medicina Clinica e Chirurgia, Università"Federico II", Naples, Italy
| | | | - Laura Bani
- Dipartimento di Patologia Sperimentale, Ospedale di Desio, Università di Milano Bicocca, Italy
| | - Raffaella Buzzetti
- UOC di Diabetologia Universitaria, Ospedale Santa Maria Goretti, Latina, Italy
| | | | - Mauro Cignarelli
- UO Endocrinologia e Malattie del Metabolismo, AOU di Foggia, Italy
| | - Massimo Cigolini
- Dipartimento di Endocrinologia, Diabetologia e Metabolismo, Università di Verona, Italy
| | - Gennaro Clemente
- IRPPS Research National Council, Penta di Fisciano, Salerno, Italy
| | - Sara Cocozza
- Dipartimento di Medicina Clinica e Chirurgia, Università"Federico II", Naples, Italy
| | - Laura Corsi
- SSD Diabetologia e Malattie del Metabolismo, ASL 4 Chiavarese, Genova, Italy
| | - Federica D'Angelo
- UOC Malattie Metaboliche e Diabetologia, INRCA-IRCCS Institute, Ancona, Italy
| | | | | | - Lucia Fontana
- UOC Diabetologia e Dietologia, Ospedale Pertini, Roma, Italy
| | - Giovanna Gregori
- UO Diabetologia e Malattie del Metabolismo, USL1 di Massa e Carrara, Italy
| | - Sara Grioni
- Unità di Epidemiologia e Prevenzione, Fondazione IRCCS, Istituto Nazionale Tumori, Milano, Italy
| | - Carla Giordano
- Dipartimento di Endocrinologia e Malattie Metaboliche, Università di Palermo, Italy
| | - Rossella Iannarelli
- UOSD Diabetologia e Malattie del Metabolismo, Ospedale San Salvatore, L'Aquila, Italy
| | - Ciro Iovine
- Dipartimento di Medicina Clinica e Chirurgia, Università"Federico II", Naples, Italy
| | | | - Davide Lauro
- Dipartimento di Medicina Interna, Università di Tor Vergata, Roma, Italy
| | - Luigi Laviola
- Dipartimento Emergenza e Trapianti di Organi, Università"Aldo Moro", Bari, Italy
| | | | - Stefano Signorini
- Dipartimento di Patologia Sperimentale, Ospedale di Desio, Università di Milano Bicocca, Italy
| | - Laura Tonutti
- SOC di Endocrinologia e Malattie del Metabolismo, AOU S. Maria della Misericordia, Udine, Italy
| | - Roberto Trevisan
- USC Malattie Endocrine-Diabetologia, ASST "Papa Giovanni XXIII", Bergamo, Italy
| | - Chiara Zamboni
- UO Malattie Metaboliche, Dietologia e Nutrizione Clinica, AOU Arcispedale S. Anna, Ferrara, Italy
| | - Gabriele Riccardi
- Dipartimento di Medicina Clinica e Chirurgia, Università"Federico II", Naples, Italy
| | - Angela A Rivellese
- Dipartimento di Medicina Clinica e Chirurgia, Università"Federico II", Naples, Italy.
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37
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Vitale M, Masulli M, Cocozza S, Anichini R, Babini AC, Boemi M, Bonora E, Buzzetti R, Carpinteri R, Caselli C, Ceccarelli E, Cignarelli M, Citro G, Clemente G, Consoli A, Corsi L, De Gregorio A, Di Bartolo P, Di Cianni G, Fontana L, Garofolo M, Giorda CB, Giordano C, Grioni S, Iovine C, Longhitano S, Mancastroppa G, Mazzucchelli C, Montani V, Mori M, Perriello G, Rinaldi ME, Ruffo MC, Salvi L, Sartore G, Scaranna C, Tonutti L, Zamboni C, Zogheri A, Krogh V, Cappellini F, Signorini S, Riccardi G, Vaccaro O. Sex differences in food choices, adherence to dietary recommendations and plasma lipid profile in type 2 diabetes - The TOSCA.IT study. Nutr Metab Cardiovasc Dis 2016; 26:879-885. [PMID: 27212622 DOI: 10.1016/j.numecd.2016.04.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 02/08/2016] [Accepted: 04/01/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND AIMS Diabetic women have a more adverse plasma lipid profile than men. Sex differences in dietary habits may play a role, but are little investigated. The study evaluates the quality of diet, adherence to the nutritional recommendations of the Diabetes and Nutrition Study Group and their relation with plasma lipid in men and women with diabetes. METHODS AND RESULTS We studied 2573 people, aged 50-75, enrolled in the TOSCA.IT study (clinicaltrials.gov; NCT00700856). Plasma lipids were measured centrally. Diet was assessed with a semi-quantitative food frequency questionnaire. Women had a more adverse plasma lipid profile than men. Women consumed significantly more legumes, vegetables, fruits, eggs, milk, vegetable oils, and added sugar, whereas men consumed more starchy foods, soft drinks and alcoholic beverages. This stands for a higher proportion (%) of energy intake from saturated fat and added sugar (12.0 ± 2.4 vs 11.5 ± 2.5 and 3.4 ± 3.2 vs 2.3 ± 3.2, P < 0.04), and a higher intake of fiber (11.2 ± 2.8 vs 10.4 ± 2.6 g/1000 Kcal/day) in women. Adherence to the recommendations for saturated fat and fiber consumption was associated with significantly lower LDL-cholesterol regardless of sex. Adherence to the recommendations for added sugars was associated with significantly lower triglycerides and higher HDL-cholesterol in men and women. CONCLUSIONS Men and women with diabetes show significant differences in adherence to nutritional recommendations, but sex differences in plasma lipid profile are unlikely to be explained by nutritional factors. Adherence to the nutritional recommendations is associated with a better plasma lipid profile regardless of sex, thus reinforcing the importance of substituting saturated for unsaturated fat sources, increasing fiber and reducing added sugar intake.
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Affiliation(s)
- M Vitale
- Dipartimento di Medicina Clinica e Chirurgia, Università "Federico II" di Napoli, Italy
| | - M Masulli
- Dipartimento di Medicina Clinica e Chirurgia, Università "Federico II" di Napoli, Italy
| | - S Cocozza
- Dipartimento di Medicina Clinica e Chirurgia, Università "Federico II" di Napoli, Italy
| | - R Anichini
- UO di Diabetologia, USL 3, Pistoia, Italy
| | - A C Babini
- Diabetologia, Ospedale Infermi, Rimini, Italy
| | - M Boemi
- UOC Malattie Metaboliche e Diabetologia, Istituto INRCA-IRCCS, Ancona, Italy
| | - E Bonora
- Dipartimento di Medicina, Divisione di Endocrinologia, Diabete e Metabolismo, Università di Verona, Italy
| | - R Buzzetti
- UOC di Diabetologia Universitaria, Ospedale Santa Maria Goretti, Latina, Italy
| | - R Carpinteri
- UO di Malattie Metaboliche e Diabetologia, AO Treviglio, Italy
| | - C Caselli
- UOD Endocrinologia e Diabetologia, AUSL della Romagna, Cesena, Italy
| | - E Ceccarelli
- UOC Diabetologia, Dipartimento di Medicina, Chirurgia e Neuroscienze, Università di Siena, Italy
| | | | - G Citro
- UO Endocrinologia e Diabetologia, ASP, Potenza, Italy
| | - G Clemente
- Dipartimento di Medicina Clinica e Chirurgia, Università "Federico II" di Napoli, Italy
| | - A Consoli
- DMSI e CeSI-Met, Università di Chieti-Pescara, Italy
| | - L Corsi
- SSD Diabetologia e Malattie Metaboliche, ASL 4 Chiavarese, Genova, Italy
| | - A De Gregorio
- UOSD Diabetologia, Ospedale San Salvatore, L'Aquila, Italy
| | - P Di Bartolo
- UO di Diabetologia Ravenna, A. Usl Romagna, Italy
| | | | - L Fontana
- UOC Diabetologia e Dietologia, Ospedale S. Pertini, Roma, Italy
| | - M Garofolo
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Italy
| | | | - C Giordano
- Endocrinologia e Malattie Metaboliche, Università di Palermo, Italy
| | - S Grioni
- Unità di Epidemiologia e Prevenzione, Fondazione IRCCS, Istituto Nazionale Tumori, Milano, Italy
| | - C Iovine
- Dipartimento di Medicina Clinica e Chirurgia, Università "Federico II" di Napoli, Italy
| | - S Longhitano
- Dipartimento di Medicina Clinica e Sperimentale, Università di Catania, Italy
| | - G Mancastroppa
- Dipartimento di Medicina Clinica e Sperimentale, Università di Parma, Italy
| | | | - V Montani
- UOSD, Presidio Ospedaliero di Atri, Italy
| | - M Mori
- SSD Diabetologia, ASL 1, Massa Carrara, Italy
| | | | - M E Rinaldi
- Dipartimento di Medicina dei Sistemi, Università degli Studi di Roma "Tor Vergata", Italy
| | - M C Ruffo
- Dipartimento di Medicina Interna, Policlinico di Messina, Italy
| | - L Salvi
- Dipartimento di Medicina Clinica e Molecolare, Università "La Sapienza", Roma, Italy
| | - G Sartore
- DPT Medicina, Università degli Studi di Padova, Italy
| | - C Scaranna
- USC Malattie Endocrine e Diabetologia, AO Papa Giovanni XXIII, Bergamo, Italy
| | - L Tonutti
- SOC di Endocrinologia e Malattie del Metabolismo, AOU S. Maria della Misericordia, Udine, Italy
| | - C Zamboni
- UO Malattie Metaboliche, Dietologia e Nutrizione Clinica, AOU Arcispedale S. Anna, Ferrara, Italy
| | - A Zogheri
- UO di Diabetologia, Ospedale di Prato, Italy
| | - V Krogh
- Unità di Epidemiologia e Prevenzione, Fondazione IRCCS, Istituto Nazionale Tumori, Milano, Italy
| | - F Cappellini
- Dipartimento di Patologia Sperimentale, Ospedale di Desio, Università di Milano Bicocca, Italy
| | - S Signorini
- Dipartimento di Patologia Sperimentale, Ospedale di Desio, Università di Milano Bicocca, Italy
| | - G Riccardi
- Dipartimento di Medicina Clinica e Chirurgia, Università "Federico II" di Napoli, Italy
| | - O Vaccaro
- Dipartimento di Medicina Clinica e Chirurgia, Università "Federico II" di Napoli, Italy.
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Vitale M, Masulli M, Rivellese AA, Babini AC, Boemi M, Bonora E, Buzzetti R, Ciano O, Cignarelli M, Cigolini M, Clemente G, Citro G, Corsi L, Dall'Aglio E, Del Prato S, Di Cianni G, Dolci MA, Giordano C, Iannarelli R, Iovine C, Lapolla A, Lauro D, Leotta S, Mazzucchelli C, Montani V, Perriello G, Romano G, Romeo F, Santarelli L, di Cola RS, Squatrito S, Tonutti L, Trevisan R, Turco AA, Zamboni C, Riccardi G, Vaccaro O. Influence of dietary fat and carbohydrates proportions on plasma lipids, glucose control and low-grade inflammation in patients with type 2 diabetes-The TOSCA.IT Study. Eur J Nutr 2015; 55:1645-51. [PMID: 26303195 DOI: 10.1007/s00394-015-0983-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 06/29/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE The optimal macronutrient composition of the diet for the management of type 2 diabetes is debated, particularly with regard to the ideal proportion of fat and carbohydrates. The aim of the study was to explore the association of different proportions of fat and carbohydrates of the diet-within the ranges recommended by different guidelines-with metabolic risk factors. METHODS We studied 1785 people with type 2 diabetes, aged 50-75, enrolled in the TOSCA.IT Study. Dietary habits were assessed using a validated food-frequency questionnaire (EPIC). Anthropometry, fasting lipids, HbA1c and C-reactive protein (CRP) were measured. RESULTS Increasing fat intake from <25 to ≥35 % is associated with a significant increase in LDL-cholesterol, triglycerides, HbA1c and CRP (p < 0.05). Increasing carbohydrates intake from <45 to ≥60 % is associated with significantly lower triglycerides, HbA1c and CRP (p < 0.05). A fiber intake ≥15 g/1000 kcal is associated with a better plasma lipids profile and lower HbA1c and CRP than lower fiber consumption. A consumption of added sugars of ≥10 % of the energy intake is associated with a more adverse plasma lipids profile and higher CRP than lower intake. CONCLUSIONS In people with type 2 diabetes, variations in the proportion of fat and carbohydrates of the diet, within the relatively narrow ranges recommended by different nutritional guidelines, significantly impact on the metabolic profile and markers of low-grade inflammation. The data support the potential for reducing the intake of fat and added sugars, preferring complex, slowly absorbable, carbohydrates.
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Affiliation(s)
- M Vitale
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - M Masulli
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - A A Rivellese
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - A C Babini
- Diabetology, Infermi Hospital, Rimini, Italy
| | - M Boemi
- UOC Malattie Metaboliche e Diabetologia, INRCA-IRCCS Institute, Ancona, Italy
| | - E Bonora
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy
| | - R Buzzetti
- UOC di Diabetologia Universitaria, Ospedale Santa Maria Goretti, Latina, Italy
| | - O Ciano
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - M Cignarelli
- Division of Endocrinology and Metabolism, University of Foggia, Foggia, Italy
| | - M Cigolini
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Verona, Verona, Italy
| | - G Clemente
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - G Citro
- UO Endocrinologia e Diabetologia, ASP, Potenza, Italy
| | - L Corsi
- SSD Diabetologia e Malattie del Metabolismo, ASL 4 Chiavarese, Genova, Italy
| | - E Dall'Aglio
- Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - S Del Prato
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - M A Dolci
- UO Diabetologia, USL 1, Massa e Carrara, Italy
| | - C Giordano
- Endocrinology and Metabolic Diseases, University of Palermo, Palermo, Italy
| | - R Iannarelli
- UO Diabetologia, Ospedale San Salvatore, L'Aquila, Italy
| | - C Iovine
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - A Lapolla
- Department of Medicine, University of Padova, Padova, Italy
| | - D Lauro
- Department of Internal Medicine, Tor Vergata University, Rome, Italy
| | - S Leotta
- Unit of Diabetology, Sandro Pertini Hospital, Rome, Italy
| | - C Mazzucchelli
- Department of Internal Medicine, University of Genova, IRCCS San Martino, Genova, Italy
| | - V Montani
- UOSD, Presidio Ospedaliero di Atri, Atri, Italy
| | - G Perriello
- MISEM, University of Perugia, Perugia, Italy
| | - G Romano
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - F Romeo
- Diabetologia, ASL Torino 5, Torino, Italy
| | - L Santarelli
- Presidio Ospedaliero di Lanciano, Lanciano, Italy
| | - R Schiano di Cola
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - S Squatrito
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - L Tonutti
- SOC di Endocrinologia e Malattie del Metabolismo, AOU "S. Maria della Misericordia", Udine, Italy
| | - R Trevisan
- Endocrinology and Diabetes Unit, AO Papa Giovanni XXIII, Bergamo, Italy
| | - A A Turco
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - C Zamboni
- Unità Operativa di Malattie Metaboliche, Dietologia e Nutrizione Clinica, AOU Arcispedale "S. Anna", Ferrara, Italy
| | - G Riccardi
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - O Vaccaro
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy.
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Vaccaro O, Masulli M, Bonora E, Del Prato S, Riccardi G. Cardiovascular outcome trials of glucose-lowering strategies in type 2 diabetes. Lancet 2014; 384:1096. [PMID: 25241718 DOI: 10.1016/s0140-6736(14)61672-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Olga Vaccaro
- Department of of Clinical Medicine and Surgery, Federico II University, Naples 80138, Italy; Società Italiana di Diabetologia, Rome, Italy.
| | - Maria Masulli
- Department of of Clinical Medicine and Surgery, Federico II University, Naples 80138, Italy; Società Italiana di Diabetologia, Rome, Italy
| | - Enzo Bonora
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Verona Medical School and Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Società Italiana di Diabetologia, Rome, Italy
| | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, University of Pisa School of Medicine, Pisa, Italy; Società Italiana di Diabetologia, Rome, Italy
| | - Gabriele Riccardi
- Department of of Clinical Medicine and Surgery, Federico II University, Naples 80138, Italy; Società Italiana di Diabetologia, Rome, Italy
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Cammarota S, Bruzzese D, Catapano AL, Citarella A, De Luca L, Manzoli L, Masulli M, Menditto E, Mezzetti A, Riegler S, Putignano D, Tragni E, Novellino E, Riccardi G. Lower incidence of macrovascular complications in patients on insulin glargine versus those on basal human insulins: a population-based cohort study in Italy. Nutr Metab Cardiovasc Dis 2014; 24:10-17. [PMID: 23806740 DOI: 10.1016/j.numecd.2013.04.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 02/25/2013] [Accepted: 04/05/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIM The aim of this study was to compare the use of insulin glargine and intermediate/long-acting human insulin (HI) in relation to the incidence of complications in diabetic patients. METHODS AND RESULTS A population-based cohort study was conducted using administrative data from four local health authorities in the Abruzzo Region (900,000 inhabitants). Diabetic patients without macrovascular diseases and treated with either intermediate/long-acting HI or glargine were followed for 3-years; the incidence of diabetic (macrovascular, microvascular and metabolic) complications was ascertained by hospital discharge claims and estimated using Cox proportional hazard models. Propensity score (PS) matching was also used to adjust for significant differences in the baseline characteristics between the two groups. RESULTS Overall, 1921 diabetic patients were included: 744 intermediate/long-acting HI and 1177 glargine users. During the 3-year follow-up, 209 (28.1%) incident events of any diabetic complication occurred in the intermediate/long-acting HI and 159 (13.5%) in the glargine group. After adjustment for covariates, glargine users had an HR (95% CI) of 0.57 (0.44-0.74) for any diabetic complication and HRs of 0.61 (0.44-0.84), 0.58 (0.33-1.04) and 0.35 (0.18-0.70) for macrovascular, microvascular and metabolic complications, respectively, compared to intermediate/long-acting HI users. PS analyses supported these findings. CONCLUSIONS The use of glargine is associated with a lower risk of macrovascular complications compared with traditional basal insulins. However, limitations inherent to the study design including the short length of observation and the lack of data on metabolic control or diabetes duration, do not allow us to consider this association as a proof of causality.
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Affiliation(s)
- S Cammarota
- CIRFF, "Federico II" University of Naples, Italy
| | - D Bruzzese
- Department of Preventive Medical Sciences, "Federico II" University of Naples, Italy
| | - A L Catapano
- SEFAP, Department of Pharmacological Sciences, University of Milan, Italy; Multimedica IRCCS, S.S. Giovanni, Italy
| | - A Citarella
- CIRFF, "Federico II" University of Naples, Italy
| | - L De Luca
- CIRFF, "Federico II" University of Naples, Italy
| | - L Manzoli
- Section of Hygiene, Epidemiology, Pharmacology and Legal Medicine, University of Chieti, and Regional Health Care Agency of Abruzzo, Italy
| | - M Masulli
- Department of Clinical and Experimental Medicine, "Federico II" University of Naples, Italy
| | - E Menditto
- CIRFF, "Federico II" University of Naples, Italy
| | - A Mezzetti
- Clinical Research Centre, "G. D'Annunzio" University Foundation, Chieti, Italy
| | - S Riegler
- CIRFF, "Federico II" University of Naples, Italy
| | - D Putignano
- CIRFF, "Federico II" University of Naples, Italy
| | - E Tragni
- SEFAP, Department of Pharmacological Sciences, University of Milan, Italy
| | - E Novellino
- CIRFF, "Federico II" University of Naples, Italy
| | - G Riccardi
- Department of Clinical and Experimental Medicine, "Federico II" University of Naples, Italy.
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Cammarota S, Falconio LM, Bruzzese D, Catapano AL, Casula M, Citarella A, De Luca L, Flacco ME, Manzoli L, Masulli M, Menditto E, Mezzetti A, Riegler S, Novellino E, Riccardi G. Lower rate of cardiovascular complications in patients on bolus insulin analogues: a retrospective population-based cohort study. PLoS One 2013; 8:e79762. [PMID: 24244557 PMCID: PMC3820645 DOI: 10.1371/journal.pone.0079762] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 09/26/2013] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Few studies are available evaluating the impact of rapid-acting insulin analogues on long-term diabetes outcomes. Our aim was to compare the use of rapid-acting insulin analogues versus human regular insulin in relation to the occurrence of diabetic complications in a cohort of diabetic patients through the analysis of administrative databases. METHODS A population-based cohort study was conducted using administrative data from four local health authorities in the Abruzzo Region (900,000 inhabitants). Diabetic patients free of macrovascular disease at baseline and treated either with human regular insulin or rapid-acting insulin analogues were followed for a maximum of 3 years. The incidence of diabetic complications was ascertained by hospital discharge claims. Hazard ratios (HRs) and 95% CIs of any diabetic complication and macrovascular, microvascular and metabolic complications were estimated separately using Cox proportional hazard models adjusted for patients' characteristics and anti-diabetic drug use. Propensity score matching was also used to adjust for significant difference in the baseline characteristics between the two treatment groups. RESULTS A total of 2,286 patients were included: 914 receiving human regular insulin and 1,372 rapid-acting insulin analogues. During the follow-up, 286 (31.3%) incident events occurred in the human regular insulin group and 235 (17.1%) in the rapid-acting insulin analogue group. After propensity score-based matched-pair analyses, rapid-acting insulin analogues users had a HR of 0.73 (0.58-0.92) for any diabetes-related complication and HRs of 0.73 (0.55-0.93) and 0.55 (0.32-0.96) for macrovascular and metabolic complications respectively, as compared with human regular insulin users. No difference between the two groups was found for microvascular complications. CONCLUSIONS Our findings suggest that the use of rapid-acting insulin analogues is associated with a lower risk of cardiovascular and metabolic complications compared with human regular insulin use.
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MESH Headings
- Aged
- Aged, 80 and over
- Cardiovascular Diseases/drug therapy
- Cardiovascular Diseases/etiology
- Cardiovascular Diseases/metabolism
- Cardiovascular Diseases/pathology
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/drug therapy
- Diabetes Mellitus, Type 1/metabolism
- Diabetes Mellitus, Type 1/pathology
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/drug therapy
- Diabetes Mellitus, Type 2/metabolism
- Diabetes Mellitus, Type 2/pathology
- Female
- Humans
- Hypoglycemic Agents/therapeutic use
- Insulin, Regular, Human/therapeutic use
- Insulin, Short-Acting/therapeutic use
- Male
- Middle Aged
- Proportional Hazards Models
- Retrospective Studies
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Affiliation(s)
- Simona Cammarota
- Center of Pharmacoeconomics and Drug Utilization (CIRFF), “Federico II” University of Naples, Naples, Italy
| | - Lucio Marcello Falconio
- Center of Pharmacoeconomics and Drug Utilization (CIRFF), “Federico II” University of Naples, Naples, Italy
| | - Dario Bruzzese
- Department of Preventive Medical Sciences, “Federico II” University of Naples, Naples, Italy
| | - Alberico Luigi Catapano
- Epidemiology and Preventive Pharmacology Centre (SEFAP), Department of Pharmacological Sciences, University of Milan, Milan, Italy
- Multimedica IRCCS, S.S. Giovanni, Milan, Italy
| | - Manuela Casula
- Epidemiology and Preventive Pharmacology Centre (SEFAP), Department of Pharmacological Sciences, University of Milan, Milan, Italy
| | - Anna Citarella
- Center for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Luigi De Luca
- Center of Pharmacoeconomics and Drug Utilization (CIRFF), “Federico II” University of Naples, Naples, Italy
| | - Maria Elena Flacco
- Section of Hygiene, Epidemiology, Pharmacology and Legal Medicine, "G. D'Annunzio" University Foundation, Chieti, Italy
| | - Lamberto Manzoli
- Section of Hygiene, Epidemiology, Pharmacology and Legal Medicine, "G. D'Annunzio" University Foundation, Chieti, Italy
| | - Maria Masulli
- Department of Clinical and Experimental Medicine, “Federico II” University of Naples, Naples, Italy
| | - Enrica Menditto
- Center of Pharmacoeconomics and Drug Utilization (CIRFF), “Federico II” University of Naples, Naples, Italy
| | - Andrea Mezzetti
- Clinical Research Centre, “G. D'Annunzio” University Foundation, Chieti, Italy
| | - Salvatore Riegler
- Center of Pharmacoeconomics and Drug Utilization (CIRFF), “Federico II” University of Naples, Naples, Italy
| | - Ettore Novellino
- Center of Pharmacoeconomics and Drug Utilization (CIRFF), “Federico II” University of Naples, Naples, Italy
| | - Gabriele Riccardi
- Department of Clinical and Experimental Medicine, “Federico II” University of Naples, Naples, Italy
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Mancini M, Masulli M, Liuzzi R, Mainenti PP, Ragucci M, Maurea S, Riccardi G, Vaccaro O. Renal duplex sonographic evaluation of type 2 diabetic patients. J Ultrasound Med 2013; 32:1033-1040. [PMID: 23716525 DOI: 10.7863/ultra.32.6.1033] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the renal volume and intrarenal hemodynamics with duplex sonography in a group of diabetic patients with normal renal function in comparison to nondiabetic controls. METHODS The renal volume and resistive index (RI) of segmental arteries were assessed by duplex sonography in 88 diabetic patients (44 male and 44 female; median age, 58 years [range, 37-69 years]) and 73 nondiabetic control participants (48 male and 25 female; median age, 53 years [range, 27-75 years]) without renal artery stenosis. RESULTS Both renal volume and RI values in the diabetic patients were significantly higher compared to the controls (mean volume ± SD: diabetic patients, 197.3 ± 47.6 mL; controls, 162.5 ± 35.2 mL; P < .0001; RI: diabetic patients, 0.70 ± 0.05; controls, 0.59 ± 0.06; P < .0001). Renal hypertrophy was present even in diabetic patients without proteinuria (renal volume: patients without proteinuria, 198.3 ± 45.9 mL; controls, 162.5 ± 35.2 mL; P < .005). Patients with higher RI values had significantly greater proteinuria (RI <0.75, 15.9 mg/g [range, 4.2-1718.9 mg/g]; RI >0.75, 37.9 mg/g [range, 11.34-2087.0 mg/g]; P < .02). CONCLUSIONS Changes in renal volume and hemodynamics are detectable on sonography in diabetic patients. Those changes are also present in patients without proteinuria or signs of renal atherosclerosis and with both normal and increased glomerular filtration rates. These results indicate a potential role of duplex sonography in the early identification of morphologic and hemodynamic renal changes in type 2 diabetic patients.
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Affiliation(s)
- Marcello Mancini
- Institute of Biostructure and Bioimaging, National Research Council, Federico II University School of Medicine, Naples, Italy
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Vaccaro O, Masulli M, Bonora E, Del Prato S, Nicolucci A, Rivellese AA, Riccardi G. The TOSCA.IT trial: a study designed to evaluate the effect of pioglitazone versus sulfonylureas on cardiovascular disease in type 2 diabetes. Diabetes Care 2012; 35:e82. [PMID: 23173143 PMCID: PMC3507553 DOI: 10.2337/dc12-0954] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Olga Vaccaro
- From the Department of Clinical and Experimental Medicine, Università degli Studi di Napoli Federico II, Naples, Italy
- Società Italiana di Diabetologia, Rome, Italy
| | - Maria Masulli
- From the Department of Clinical and Experimental Medicine, Università degli Studi di Napoli Federico II, Naples, Italy
- Società Italiana di Diabetologia, Rome, Italy
| | - Enzo Bonora
- Società Italiana di Diabetologia, Rome, Italy
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Verona Medical School and Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Stefano Del Prato
- Società Italiana di Diabetologia, Rome, Italy
- Department of Internal Medicine, University of Pisa, Pisa, Italy
| | - Antonio Nicolucci
- Società Italiana di Diabetologia, Rome, Italy
- Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Chieti, Italy
| | - Angela A. Rivellese
- From the Department of Clinical and Experimental Medicine, Università degli Studi di Napoli Federico II, Naples, Italy
- Società Italiana di Diabetologia, Rome, Italy
| | - Gabriele Riccardi
- From the Department of Clinical and Experimental Medicine, Università degli Studi di Napoli Federico II, Naples, Italy
- Società Italiana di Diabetologia, Rome, Italy
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Vaccaro O, Masulli M, Bonora E, Del Prato S, Giorda CB, Maggioni AP, Mocarelli P, Nicolucci A, Rivellese AA, Squatrito S, Riccardi G. Addition of either pioglitazone or a sulfonylurea in type 2 diabetic patients inadequately controlled with metformin alone: impact on cardiovascular events. A randomized controlled trial. Nutr Metab Cardiovasc Dis 2012; 22:997-1006. [PMID: 23063367 DOI: 10.1016/j.numecd.2012.09.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 08/27/2012] [Accepted: 09/01/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND AIMS Metformin is the first-line therapy in type 2 diabetes. In patients inadequately controlled with metformin, the addition of a sulfonylurea or pioglitazone are equally plausible options to improve glycemic control. However, these drugs have profound differences in their mechanism of action, side effects, and impact on cardiovascular risk factors. A formal comparison of these two therapies in terms of cardiovascular morbidity and mortality is lacking. The TOSCA.IT study was designed to explore the effects of adding pioglitazone or a sulfonylurea on cardiovascular events in type 2 diabetic patients inadequately controlled with metformin. METHODS Multicentre, randomized, open label, parallel group trial of 48 month duration. Type 2 diabetic subjects, 50-75 years, BMI 20-45 Kg/m(2), on secondary failure to metformin monotherapy will be randomized to add-on a sulfonylurea or pioglitazone. The primary efficacy outcome is a composite endpoint of all-cause mortality, nonfatal myocardial infarction, nonfatal stroke, and unplanned coronary revascularization. Principal secondary outcome is a composite ischemic endpoint of sudden death, fatal and non-fatal myocardial infarction and stroke, endovascular or surgical intervention on the coronary, leg or carotid arteries, major amputations. Side effects, quality of life and economic costs will also be evaluated. Efficacy, safety, tolerability, and study conduct will be monitored by an independent Data Safety Monitoring Board. End points will be adjudicated by an independent external committee. CONCLUSIONS TOSCA.IT is the first on-going study investigating the head-to-head comparison of adding a sulfonylurea or pioglitazone to existing metformin treatment in terms of hard cardiovascular outcomes. REGISTRATION Clinicaltrials.gov ID NCT00700856.
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Affiliation(s)
- O Vaccaro
- Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy.
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Masulli M, Patti L, Riccardi G, Vaccaro O, Annuzzi G, Ebbesson SO, Fabsitz RR, Howard WJ, Otvos JD, Roman MJ, Wang H, Weissman NJ, Howard BV, Rivellese AA. Relation among lipoprotein subfractions and carotid atherosclerosis in Alaskan Eskimos (from the GOCADAN Study). Am J Cardiol 2009; 104:1516-21. [PMID: 19932785 DOI: 10.1016/j.amjcard.2009.07.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Revised: 07/08/2009] [Accepted: 07/08/2009] [Indexed: 10/20/2022]
Abstract
Studies have been inconsistent regarding whether lipoprotein particle subfraction measures are useful indicators of cardiovascular risk. The present study evaluated the relation between lipoprotein particle concentrations and size, analyzed using nuclear magnetic resonance spectroscopy and measures of carotid atherosclerosis in a population with high cardiovascular risk but little hyperlipidemia. In this cross-sectional, population-based sample of Alaska Eskimos >or=35 years old (n = 656), a greater carotid intimal medial thickness was associated with greater low-density lipoprotein (LDL) cholesterol (p = 0.03) and total LDL particle concentration (p = 0.04), independently of other traditional risk factors. The effects of LDL cholesterol and LDL particle concentration on intimal medial thickness were additive (p = 0.015). Carotid plaque was associated with greater levels of LDL cholesterol (p = 0.01), greater concentrations of large LDL particles (p = 0.003), and a reduction in the size of the very-low-density lipoprotein particles (p = 0.03). The effects of LDL cholesterol and large LDL particles on the plaque score were additive. In conclusion, the carotid intimal medial thickness was associated with greater LDL particle concentrations. The association was strongest in those with greater LDL cholesterol levels. Plaque was associated with greater concentrations of LDL cholesterol, large LDL particles, and smaller very-low-density lipoprotein particles. It might be beneficial to determine the lipoprotein subfractions in populations with little hyperlipidemia.
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Masulli M, Mancini M, Liuzzi R, Daniele S, Mainenti PP, Vergara E, Genovese S, Salvatore M, Vaccaro O. Measurement of the intrarenal arterial resistance index for the identification and prediction of diabetic nephropathy. Nutr Metab Cardiovasc Dis 2009; 19:358-364. [PMID: 18805683 DOI: 10.1016/j.numecd.2008.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Revised: 06/06/2008] [Accepted: 07/11/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS High intrarenal resistance index (RI) predicts renal function in several conditions; its use in the prediction of diabetic nephropathy (DN) is little explored. We aimed (1) to compare RI in diabetic and non diabetic hypertensive patients, and (2) to evaluate whether high RI is associated with clinical signs of DN and its progression over time. DESIGN observational, prospective. PARTICIPANTS 92 type 2 diabetic patients and 37 non-diabetic controls aged 40-70, with hypertension and normal renal function. We measured ultrasound RI and, among others, creatinine, estimated glomerular filtration rate and urinary albumin excretion rate (AER) at baseline and after 4.5 years follow-up. Progression of albuminuric state (i.e., transition from baseline normo-microalbuminuria to follow-up micro-macroalbuminuria) was evaluated. RI was significantly higher in diabetic than non-diabetic participants (0.69+/-0.05 vs 0.59+/-0.05, p<0.001). Diabetic patients with RI>or=0.73, i.e., above the 80th percentile of the RI distribution, had significantly higher baseline AER and a more frequent progression of the albuminuric state compared to patients with RI<0.73 (27.7microg/mg [12.1-235.4] vs 15.1microg/mg [8.6-33.4]; 52.9% vs 9.5%, respectively). AER increased significantly from baseline to follow-up in patients with RI>or=0.73 (from 27.7microg/mg [12.1-235.4] to 265.0microg/mg [23.8-1018.1], p<0.01), but not in those with RI<0.73 (from 15.1microg/mg [8.6-33.4] to 16.1microg/mg [10.7-67.2], ns). OR for progression of albuminuric state, adjusted for established predictors of DN, including baseline AER, was 5.01 (1.4-17.7, 95% CI) for patients with RI>or=0.73 vs <0.73. Findings were confirmed in patients with normoalbuminuria at baseline. CONCLUSIONS In diabetic patients, high RI (>or=0.73) is associated with features of DN and its progression over time, independent of albuminuria.
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Affiliation(s)
- M Masulli
- Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy.
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Masulli M, Riccardi G, Galasso R, Vaccaro O. Relationship between smoking habits and the features of the metabolic syndrome in a non-diabetic population. Nutr Metab Cardiovasc Dis 2006; 16:364-370. [PMID: 16829345 DOI: 10.1016/j.numecd.2005.06.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2005] [Revised: 06/14/2005] [Accepted: 06/16/2005] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Cigarette smoking is a risk factor for type 2 diabetes mellitus. The effect of smoking on the pathogenic factors for the development of diabetes is little explored. We evaluate the relation of smoking with the features of the insulin resistance syndrome, insulin resistance, and insulin secretion. METHODS 2412 non-diabetic men, aged 35-65 years, were studied. Smoking habit was investigated by questionnaire. Anthropometry, blood pressure, forced expiratory volume (FEV1), fasting glucose, triglycerides, total and HDL cholesterol, plasma free fatty acids (FFA), insulin and fibrinogen were measured. HOMA-IR and HOMA beta cell were calculated. The metabolic syndrome was defined according to ATP III criteria. RESULTS The metabolic syndrome was more prevalent in smokers than non-smokers (OR: 1.34; 95% CI 1.01-1.77). This was mainly due to a higher prevalence of dyslipidemia - high triglycerides (46.1% vs 29.9%, p<0.001), or low HDL cholesterol (42.2% vs 30.4%, p<0.001), in smokers. In smokers, other features of insulin resistance - i.e. obesity, hypertension, and hyperglycemia were significantly less frequent and FFA were lower (p<0.001). Plasma insulin and HOMA beta cell were similar in the two groups (8.3 vs 8.0microU/ml and 80.7% vs 82.9%, respectively), but HOMA-IR was significantly lower in smokers (p<0.001) due to the lower glucose values observed in these people. CONCLUSIONS Among the features of the metabolic syndrome, only dyslipidemia is associated with chronic smoking. Smoking in not associated with enhanced insulin resistance, or with impaired insulin secretion. Alternative hypotheses should be explored for the increased risk of diabetes in smokers.
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Affiliation(s)
- Maria Masulli
- Department of Clinical and Experimental Medicine, Federico II University of Naples, II Policlinico, Via S. Pansini 5, 80131 Napoli, Italy.
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Masulli M, Di Bonito P, Galasso R, Donnarumma G, Lapice E, Riccardi G, Vaccaro O. Mo-P1:25 Changing the definition for normoglycemia: Impact on disease prevalence and associated cardiovascular risk. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)80160-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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