High Serum N‐Acetyl‐ß‐D‐Glucosaminidase Activity Is a Predictor of 28‐Year Mortality in a Population of Community‐Dwelling Japanese—The Tanushimaru Study

Abstract

6. Hildrum B, Mykletun A, Holmen J et al. Effect of anxiety and depression on blood pressure: 11-year longitudinal population study. Br J Psychiatry 2008;193:108-113. 7. Paterniti S, Verdier-Taillefer MH, Geneste C et al. Whether high serum NAG activity would be a predictor of cerebro-and cardiovascular death was examined in a community-based cohort study. Serum NAG activity was measured in 1,070 apparently healthy participants (aged ! 20; 461 male, 609 female) in 1982 using a colorimetric method using an artificial substrate (NAG Test Shionogi). 5,6 Participants were periodically followed up for 28 years (follow-up rate 96.1%.) There were 410 (205 men, 205 women) deaths. Cause of death was cancer in 103 (25.1%) participants, cerebro-or cardiovascular disease (CVD) in 92 (22.4%), infection in 58 (14.1%), dementia in 58 (14.1%), and other causes in 99 (24.1%). Serum NAG activity was categorized into quartiles ( 10.0 IU/L (n = 268), 10.0-12.0 IU/L (n = 268), 12.1-14.0 IU/L (n = 268), and >14.0 IU/L (n = 266)). Baseline serum NAG activity was significantly associated with age, body mass index, blood pressure, total cholesterol, highdensity lipoprotein cholesterol, triglycerides, renal function, uric acid, fasting plasma glucose, medication for hypertension, and all-cause death but not cerebro-or cardiovascular death. Cox proportional hazard regression analysis demonstrated that serum NAG activity was an independent predictor of all-cause death (hazard ratio (HR) = 1.02; 95% confidence interval (CI) = 1.00-1.04, P = .01 per 1-IU/L difference). The HR of all-cause death in the highest quartile of serum NAG ( ! 14.0 IU/L) versus the lowest quartile, after adjustment for confounding factors, was 1.35 (95% CI = 1.02-1.83). Figure 1 shows the Kaplan-Meier curves for cumulative survival rate stratified according to NAG quartile. A significant difference (P < 001) was found, and the highest all-cause mortality was observed in the fourth quartile.Thus, serum NAG activity was an independent and significant predictor of all-cause death. Although high serum NAG activity was associated with all-cause death, the causal relationship was not delineated. Because serum NAG activity is associated with many cardiovascular risk factors and because high serum NAG activity was reported in individuals with cancer, 7-10 it was thought that it might be a predictor of cardiovascular or cancer death, but this was not found to be the case. There may be several reasons for the negative associations, the most likely being that the predictive power was not great enough for statistical analyses.The strength of the present study is that it is the first and the largest and longest prospective cohort study to show that serum NAG is a predictor of all-cause mortality in apparently healthy subjects. The limitations of the present study are that, although every effort was made to collect information about causes of death, it was not possible to clarify cause of death in all subjects because of the extended length of the follow-up period; that only a si...

Association of urinary KIM-1, L-FABP, NAG and NGAL with incident end-stage renal disease and mortality in American Indians with type 2 diabetes mellitus

“…In a community-based cohort of Swedish men [40], urinary NGAL was associated with cardiovascular and all-cause mortality independent of cardiovascular risk factors and GFR but the association disappeared when urinary albumin was included in the analysis. Serum NAG was previously associated with cardiovascular and all-cause mortality in a cohort of 1,070 apparently healthy Japanese individuals [41] and urinary NAG was associated with all-cause mortality among persons with heart failure [42]. …”