Is microalbuminuria part of the prediabetic state? The Mexico City Diabetes Study

Haffner, Steven M.; Gonzales, Calle A.; Valdéz, Rodolfo; Mykkänen, Leena; Hazuda, Helen P.; Mitchell, Braxton D.; Monterrosa, Ana; Stern, Michael P.

doi:10.1007/bf02374491

Cited by 73 publications

(68 citation statements)

References 45 publications

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“…Dysfunction of these cells may increase intraglomerular pressure and/or decrease glomerular charge and size selectivity and thus cause microalbuminuria. Alternatively, hyperhomocysteinemia and (micro)albuminuria could be associated through a common pathophysiological pathway; eg, inadequate vitamin B 6 , B 12 , and/or folate status could be the common antecedent leading to hyperhomocysteinemia on the one hand and to the development of (micro)albuminuria on the other. However, there is no evidence that inadequate B-vitamin status can directly cause (micro)albuminuria.…”

Section: Discussionmentioning

confidence: 99%

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Serum Homocysteine Levels Are Associated With the Development of (Micro)albuminuria

Jager

Kostense

Nijpels

et al. 2001

ATVB

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Abstract-Microalbuminuria is a strong indicator of the risk of future cardiovascular disease and renal dysfunction.Slightly increased levels of homocysteine, an independent risk factor for atherothrombotic disease, have recently been found to be associated with the presence of (micro)albuminuria. However, it is unknown whether increased homocysteine levels precede the occurrence of (micro)albuminuria. Normoalbuminuric subjects (nϭ316, 66 with non-insulin-dependent diabetes mellitus [NIDDM]) of an age-stratified, sex-stratified, and glucose tolerance-stratified sample of a population-based cohort study were investigated at baseline and after a mean follow-up duration of 6.1 years. Development of (micro)albuminuria was defined as a mean albumin-to-creatinine ratio Ͼ2.0 mg/mmol at the follow-up examination. The cumulative incidence of (micro)albuminuria was 14.0% (9.7 % to 18.3%) among nondiabetic subjects and 22.7% (12.9% to 32.5%) among NIDDM patients. Age-adjusted, sex-adjusted, and glucose tolerance status-adjusted logistic regression analyses showed development of (micro)albuminuria to be significantly associated with baseline homocysteine levels Ͼ19.0 mol/L compared with homocysteine levels Ͻ9.1 mol/L (odds ratio [OR] 5.1, 95% CI 1.1 to 23.0). For homocysteine levels of 9.1 to 14.0 mol/L and 14.1 to 19.0 mol/L, the values were OR 1.2 (95% CI 0.5 to 3.0) and OR 1.8 (95% CI 0.6 to 5.3), respectively. Additional adjustment for baseline insulin resistance, blood pressure, body mass index, presence of cardiovascular disease and retinopathy, current smoking, or estimates of glomerular filtration rate did not materially affect the results. Substituting homocysteine levels as a continuous variable for categories of homocysteine levels showed that a 5-mol/L increase of the homocysteine level was associated with an increased risk of developing (micro)albuminuria (OR 1.38, 95% CI 0.97 to 1.95) . Analyses performed in nondiabetic and diabetic subjects separately gave similar results among nondiabetic subjects. Among diabetic subjects, the association between homocysteine level and (micro)albuminuria could not be estimated, because there was an insufficient number of diabetic subjects with high homocysteine levels. Hyperhomocysteinemia is an independent determinant of the development of (micro)albuminuria among nondiabetic subjects, even after adjustment for estimates of glomerular filtration rate. We could neither confirm nor reject an association between homocysteine levels and the development of (micro)albuminuria among NIDDM subjects. These data suggest that homocysteine may play a pathophysiological role in the development of (micro)albuminuria.

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Section: Discussionmentioning

confidence: 99%

“…Microalbuminuria has been proposed to be part of the insulin resistance syndrome, 12,13 but not all studies concur. 20,34,35 Previous prospective studies 4 have not demonstrated a high insulin level or insulin resistance to be associated with an increased risk of developing microalbuminuria, which is in accordance with the present data.…”

Section: Discussionmentioning

confidence: 99%

Serum Homocysteine Levels Are Associated With the Development of (Micro)albuminuria

Jager

Kostense

Nijpels

et al. 2001

ATVB

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“…Based on the ®ndings of microalbuminuria in newly diagnosed NIDDM and impaired glucose tolerance, Haffner 16 proposed that microalbuminuria in nondiabetic subjects represents part of a pre-diabetic state. In the current study, participants with diabetes mellitus and impaired glucose tolerance were excluded, yet 2 h post 75 g Polycose load plasma glucose concentrations were weakly associated with degree of albuminuria in all participants as a group (Table 6), but did not reach statistical signi®cance in each ethnic group.…”

Section: Discussionmentioning

confidence: 99%

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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“…To facilitate comparisons, we roughly approximate the conventional boundaries of microalbuminuria (20 Use of semi-quantitative tests, which tend to overestimate urine albumin concentration, 7,8 may, to some extent, explain the unusually high prevalence of microalbuminuria reported in some large-scale studies. [9][10][11][12] Urine albumin concentrations measured in 'spot' morning collections are frequently standardised for concurrent creatinine excretion to derive ACRs. This procedure corrects for unknown urine volumes but needs differentiation of males from females in whom creatininuria is lower because of reduced muscle mass, a fact not always taken into account.…”

Section: Populations At Largementioning

confidence: 99%

Microalbuminuria, an integrated marker of cardiovascular risk in essential hypertension

et al. 2002

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This paper reviews the existing epidemiological and clinical evidence about the relationships of non-diabetic microalbuminuria with cardiovascular risk factors such as elevated blood pressure (BP), systolic particularly, cardiac hypertrophy, adverse metabolic status, smoking habits, elevated angiotensin II levels, endothelial dysfunction, acute and perhaps subclinical inflammation. Because of that unique property of reflecting the influence of so many clinically relevant parameters, microalbuminuria may legitimately be defined as an integrated marker of cardiovascular risk, an unique profile among the several prognostic predictors available to

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Is microalbuminuria part of the prediabetic state? The Mexico City Diabetes Study

Cited by 73 publications

References 45 publications

Serum Homocysteine Levels Are Associated With the Development of (Micro)albuminuria

Serum Homocysteine Levels Are Associated With the Development of (Micro)albuminuria

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

Microalbuminuria, an integrated marker of cardiovascular risk in essential hypertension

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