Microalbuminuria in a Middle-Aged Workforce: Effect of hyperglycemia and ethnicity

Metcalf, Patricia; Baker, John; Scragg, Robert; Dryson, Evan; Scott, Alastair; Wild, C. J.

doi:10.2337/diacare.16.11.1485

Cited by 62 publications

(32 citation statements)

References 20 publications

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“…We indeed found positive associations between UAE and age, BP, BMI, and plasma glucose in both genders, but we only observed gender differences in these relations in age, BMI, and plasma glucose. Finally, Metcalf et al (16,17), in their multivariate regression model to predict urinary albumin concentration mentioned the interaction of BMI and gender. Unfortunately, this interaction was not further explored in the results of the multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Risk Factors Are Differently Associated with Urinary Albumin Excretion in Men and Women

Verhave¹,

Hillege

Burgerhof

et al. 2003

Journal of the American Society of Nephrology

107

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Abstract. Cardiovascular morbidity and mortality is not equally distributed among genders, men being more affected than women. It is not clear whether this is only related to a higher prevalence of the cardiovascular risk factors or to a similar prevalence of the risk factors as in women but a greater vascular susceptibility to these risk factors in men. This was tested by studying the association between various cardiovascular risk factors and urinary albumin excretion (UAE) in a large cohort of male and female subjects. While the prevalence of smoking and hypercholesterolemia was comparable between the genders, obesity was more common in women, and diabetes and hypertension were more frequent in men. The prevalence of microalbuminuria was about twofold higher in men. Interestingly, for a given level of any risk factor, UAE was higher in men than in women. On multivariate analysis with UAE as the dependent variable, an interaction with gender was found for the risk factors age, body mass index, and plasma glucose. Thus, for a higher age, body mass index, and glucose, the UAE is significantly increased in men when compared with women. It is concluded that gender differences exist in the association between cardiovascular risk factors and UAE. This is consistent with a larger vascular susceptibility to these risk factors in men as compared with women.Cardiovascular risk differs between men and women. Men have a higher cardiovascular morbidity and mortality than women (1,2). The lifetime risk of developing coronary heart disease is one in two for men and one in three for women (3). This raises the question why men are more prone to cardiovascular morbidity and mortality. Is it because the prevalence of cardiovascular risk factors, such as hypertension, obesity, diabetes, and smoking, is higher in men? Or is the vasculature in men more sensitive to a given risk factor than in women, or is it a combination of both (1,4)? An increased urinary albumin excretion (UAE) is considered as a marker of damage of the vascular endothelium, the latter being the underlying cause of cardiovascular diseases, and it has been shown that an elevated UAE is associated with a higher cardiovascular morbidity and mortality (5-7). Interestingly, the prevalence of microalbuminuria is higher in men than in women (8 -11).We hypothesize that the known cardiovascular risk factors have a more harmful effect on the vascular endothelium in men as compared with women. We tested this hypothesis by studying the association between cardiovascular risk factors and UAE in a large cohort of male and female subjects, as part of the PREVEND study. Material and Methods Study Design and PopulationAs part of the PREVEND study (Prevention of Renal and Vascular End-Stage Disease), all inhabitants of the city of Groningen, the Netherlands, aged between 28 to 75 yr were asked to answer a short questionnaire and send in a morning urine sample. The aim of the PREVEND study is to determine the relation between microalbuminuria (the dichotomized parameter of elevate...

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Section: Discussionmentioning

confidence: 99%

Cardiovascular Risk Factors Are Differently Associated with Urinary Albumin Excretion in Men and Women

Verhave¹,

Hillege

Burgerhof

et al. 2003

Journal of the American Society of Nephrology

107

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“…Microalbuminuria was de®ned as a urinary albumin concentration b 28 mg/L for males and b 28 mg/L for females and a high albumin:creatinine ration as b 2.25 mg/mol for males and b 2.78 mg/mol for females based on reference intervals determined from the same population. 15 Reference intervals were the 2.5th and 87.5th percentiles determined from participants after excluding those with Albustix positive albuminuria, diabetes mellitus, bac- …”

Section: Analysesmentioning

confidence: 99%

“…18 By comparison, Allawi et al 5 reported microalbuminuria in 26% of Asian Indian people with NIDDM, Collins et al 6 reported prevalences of 26% in men and 30% in women from the Paci®c Island of Nauru, Haffner et al 8 reported a prevalence of microalbuminuria of 13% in non-diabetic Mexican Americans, Robbins et al 19 reported prevalences in American Indians of 28.3% in Arizona, 15.1% in Oklahoma and 13.8% in North and South Dakota, and we have reported prevalences of microalbuminuria in European, Maori, Paci®c Island and Asian New Zealanders of 2.7%, 15.6%, 13.0% and 8.0%, respectively. 15 There is no simple explanation for the ethnic differences in prevalences of microalbuminuria. In the New Zealand study, glycaemia was the most signi®cant determinant of urinary albumin concentrations in a multivariate model including blood glucose levels, age, gender, ethnic group, body mass index, blood pressure, blood lipid levels, cigarette smoking, and alcohol consumption.…”

Section: Introductionmentioning

confidence: 99%

“…In the New Zealand study, glycaemia was the most signi®cant determinant of urinary albumin concentrations in a multivariate model including blood glucose levels, age, gender, ethnic group, body mass index, blood pressure, blood lipid levels, cigarette smoking, and alcohol consumption. 15 Although Maori and Paci®c Islanders living in New Zealand have a higher prevalence of cardiovascular disease than Europeans, 20 it is possible that indices of body morphology, such as obesity, may also be important in relation to urinary albumin excretion as proposed by Cassuto et al 21 Here, we have examined the relationship between urinary albumin concentration and measures of height, weight, waist and hip girth (a measure of truncal obesity), and urinary creatinine excretion (a measure of muscle mass) in 3960 healthy middle-aged European, Maori and Paci®c Island workers. Our aims were to determine whether measures of body morphology may account for some of the ethnic variability in urinary albumin concentrations.…”

Section: Introductionmentioning

confidence: 99%

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Associations between body morphology and microalbuminuria in healthy middle-aged European, Maori and Pacific Island New Zealanders

Metcalf

Scragg

Dryson³

1997

Int J Obes

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OBJECTIVE: To examine the relationship between albuminuria and measures of body morphology. DESIGN: Cross-sectional study of European, Maori and Paci®c Island workers aged 40 y and over. SUBJECTS: 3960 non-diabetic, non-hypertensive, non-lipidaemic, non-proteinuric middle-aged men and women. MEASUREMENTS: Height, weight, waist, hip, fasting and 2 h glucose, systolic and diastolic blood pressure, urinary creatinine and urinary albumin measurements. RESULTS: After adjusting for age and gender, the relative risks (95% con®dence interval) of microalbuminuria were 4.87-fold (3.10±7.64) higher in Maori, and 4.96-fold (3.40±7.24) higher in Paci®c Islanders compared to European New Zealanders. In contrast, age and gender adjusted relative risks (95% con®dence interval) for high albumin:creatinine ratios were 6.38 (4.27, 9.53) in Maori and 5.14 (3.54, 7.48) in Paci®c Islanders compared to European workers. Workers with microalbuminuria had higher urinary creatinine concentrations than those with urinary albumin in the normal range. Age and gender adjusted partial correlation coef®cients between urinary albumin concentrations and the inverse of urinary creatinine concentrations were highest in European and Maori workers. Apart from Paci®c Islanders, urinary creatinine concentrations accounted for over 20% of the variation in urinary albumin concentrations in healthy individuals. Other independent predictors of urinary albumin concentrations were waist measurements, short stature and body mass index in Europeans and Paci®c Islanders, and systolic blood pressure levels and gender in Europeans. After adjusting for age, gender, waist, height, 2 h glucose, urinary creatinine, systolic blood pressure and body mass index Maori and Paci®c Islanders still had signi®cantly higher urinary albumin concentrations than Europeans. CONCLUSION: Urinary creatinine concentrations were signi®cantly associated with urinary albumin concentrations in all ethnic groups, and, with the exception of Paci®c Islanders, accounted for a large proportion of the variation in urinary albumin concentrations in healthy individuals. Urinary albumin concentrations were associated with measures of obesity and short stature in Europeans and Paci®c Islanders, and systolic blood pressure levels and gender in Europeans. However, measures of body morphology did not completely explain the higher urinary albumin concentrations in Maori or Paci®c Islanders.

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“…These results suggest specific, early damage of podocytes and, particularly, of the slit diaphragm as a consequence of diabetes. Type 2 diabetic patients may already have microalbuminuria at the time of diagnosis, as may healthy subjects with impaired glucose tolerance [19] and insulin resistance [20]. We investigated whether the offspring of type 2 diabetic patients, who are prone to diabetes, exhibit podocyte protein nephrin in urine in association with insulin resistance.…”

Section: Introductionmentioning

confidence: 99%

A 100-kDa urinary protein is associated with insulin resistance in offspring of type 2 diabetic patients

et al. 2005

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Aims/hypothesis: One-third of normoalbuminuric type 1 diabetic patients show immunoreactive nephrin in urine. Offspring of type 2 diabetic patients are insulinresistant and susceptible to the development of diabetes. We investigated whether the offspring of type 2 diabetic patients show nephrin in urine and whether possible nephrinuria is associated with insulin resistance. Methods: : Urinary proteins from timed overnight urine collections from 128 offspring of type 2 diabetic patients and 9 control subjects were analysed by western blotting using an antibody against nephrin. Glucose metabolism was assessed by OGTT and IVGTT and the euglycaemic-hyperinsulinaemic clamp technique. Results: Of the offspring, 12.5% were strongly and 14.1% weakly positive for a 100-kDa urinary protein. All controls were negative. During the first 10 min of an IVGTT, the offspring strongly positive for the urinary protein had a higher inysulin response than the offspring without the protein (3,700 vs 2,306 pmol l −1 min −1 , p=0.007). Insulin sensitivity (the rate of wholebody glucose uptake divided by the steady-state insulin level×100) was lower among the offspring strongly positive for the urinary protein than among the offspring negative for the protein (11.3 vs 15.8 μmol kg −1 min −1 pmol −1 l −1 , p=0.008). Conclusions/interpretation: A 100-kDa urinary protein detectable with a nephrin antibody is associated with insulin resistance in offspring of type 2 diabetic patients.

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Microalbuminuria in a Middle-Aged Workforce: Effect of hyperglycemia and ethnicity

Cited by 62 publications

References 20 publications

Cardiovascular Risk Factors Are Differently Associated with Urinary Albumin Excretion in Men and Women

Cardiovascular Risk Factors Are Differently Associated with Urinary Albumin Excretion in Men and Women

Associations between body morphology and microalbuminuria in healthy middle-aged European, Maori and Pacific Island New Zealanders

A 100-kDa urinary protein is associated with insulin resistance in offspring of type 2 diabetic patients

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