Metals in urine in relation to the prevalence of pre-diabetes, diabetes and atherosclerosis in rural India

Velmurugan, Ganesan; Swaminathan, Krishnan; Veerasekar, Ganesh; Purnell, Jonathan Q.; Mohanraj, Sundaresan; Dhivakar, Mani; Avula, Anil Kumar; Cherian, Mathew; Palaniswami, Nalla G; Alexander, Thomas; Pradeep, Thalappil

doi:10.1136/oemed-2018-104996

Cited by 30 publications

(26 citation statements)

References 30 publications

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“…As for urinary Cr, the sum that T2D patients have higher levels of urinary Cr was the same as the proposition of Kazi et al [7] who proved no statistically significant difference as well but deemed the tendency existed; it elevated visibly in T1D; considering the severity of illness and thus selection being incomprehensive, prediabetes showed no significant difference comparing with the control group on urinary Cr level; the Cr/UCr in diabetic groups was lower than those of the prediabetic and control group, indicating diabetic patients were all under low Cr state. It is already proved in a research launching in Indian rural areas that elevated urinary Cr is strongly correlated to diabetes [29]; our experiment adopted a random urine specimen, which might have varied greatly due to physical and chemical factors; thus the statistical difference could not be that obvious. Besides, it is noticeable that the excretion rate of Cr and Fe changed mildly in DN patients, which was opposite to our expectation that severe renal function damaged influenced elements in urine.…”

Section: Discussionmentioning

confidence: 99%

“…We assumed that diabetes affected absorption, transportation, and utilization of Cr and Fe. The limitations of this experiment are that the number of enrolled cases was not enough and the prediabetic group consisted of outpatients; therefore it would be difficult to follow up; there is no more detailed research, such as disease-staging patients; in a way, a 24 h urine sample may be better than a random urine specimen, which reflects cumulative exposure, exposure approaches, and different forms of elements [29]; metabolism, lifestyle, or drugs may not be excluded from impact of exposure, absorption, or excretion of certain elements.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Chromium and Iron Distribution in Serum and Urine among Healthy People and Prediabetes and Diabetes Patients

Zhou

Guo

Jia

et al. 2019

BioMed Research International

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The effect of chromium (Cr) and iron (Fe) on prevalence of diabetes has received great attention. This study investigated serum and urinary Cr and Fe levels among patients with impaired fasting glucose (IFG), impaired glucose tolerance (IGT), type 1 diabetes (T1D), and type 2 diabetes (T2D) in the Northeast Chinese population. From January 2010 to October 2011, patients with IFG (n=12), IGT (n=15), T1D (n=25), T2D (n=137) and healthy controls (n=50) were enrolled in the First Hospital of Jilin University. Trace elements were detected using an inductively coupled plasma spectrometer. Serum Cr levels decreased in T2D without complications, diabetic retinopathy (DR), diabetic peripheral neuropathy (DPN), and diabetic nephropathy (DN) (P<0.05). The urinary Cr level in T1D was the highest of all, which significantly exceeded those of the T2D groups with and without complications. No significant differences of serum Fe levels were found among all groups. The urinary Fe level of T1D was significantly increased (P<0.05). The correlation between serum Cr and serum Fe in T2D was obviously positive (P<0.05). One month of simvastatin therapy exerted no effects on serum or urinary Cr and Fe levels. These results suggest the potential role of Cr and Fe in diabetes should receive attention.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of Chromium and Iron Distribution in Serum and Urine among Healthy People and Prediabetes and Diabetes Patients

Zhou

Guo

Jia

et al. 2019

BioMed Research International

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“…[4] Very recently, Velmurugan et al revealed a strong association between diabetes and urinary levels of certain metals such as chromium and arsenic. [27] Such evidence indicates that diabetes mellitus may lead to increased urinary loss of chromium ions (Cr +3 ), which can lead over time to chromium deficiency. [25] Otherwise, a sequential randomized controlled cross-over study revealed that the loss of urinary chromium following the high glycemic-index diets, for 6 days, have not been observed in normal individuals.…”

Section: Discussionmentioning

confidence: 99%

Serum chromium level is increased in Jordanian smokers, decreased in jordanians with prediabetes and type 2 diabetes, but not altered in jordanians with hypertension, with obesity, or with family history of diabetes

2019

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Background:Chromium was found to be crucial for several biochemical processes in the human body, including, in particular, carbohydrate and lipid metabolism whereas the exact mechanisms of its actions have yet to be explored. Here, we asked whether low serum chromium levels are present in Jordanian smokers and Jordanians with prediabetes and type 2 diabetes (T2D), with hypertension, with overweight and obesity, and with a family history of diabetes.Methods:A total of 360 patients (120 with T2D, 120 with prediabetes, and 120 healthy controls) were recruited randomly based on the American Diabetes Association criteria. Smokers (n = 26), and patients with hypertension (n = 46), with overweight (n = 47) and obesity (n = 57), and with family history of diabetes (n = 63) were included in the tested population. Serum chromium concentration was measured using the graphite furnace atomic absorption spectrometry.Results:The results from this study revealed significant increase (P = 0.001 univariate, P = 0.038 multivariate) and significant decrease (P = 0.046 univariate,P = 0.038 multivariate) in serum chromium concentrations in smokers and people with T2D and prediabetes, respectively. In addition, serum chromium insignificantly altered (P > 0.05) in people with hypertension, with a family history of diabetes, and with overweight or obesity.Conclusions:Higher levels of serum chromium were observed in smokers, whereas lower levels were found to be present in patients with T2D and patients with prediabetes. In addition, serum chromium level may not be affected by hypertension, overweight and obesity, and family history of diabetes.

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“…The geographic location of the study areas is provided in Figure 1. Nallampatti is a typical farming village located around 60 km from Coimbatore 15,16 chosen as a representative rural area. Thadagam, a brick kiln rich area located 15 km from Coimbatore and Kalapatti, located within Coimbatore city, were chosen as representative sub‐urban and urban areas respectively.…”

Section: Methodsmentioning

confidence: 99%

“…Recent studies from rural India indicated the huge burden of diabetes and its complications with association of environmental factors like heavy metals and pesticide exposure. 13‐18 However, it remains vital to understand disease patterns in different communities, as wide geographic variations in disease patterns are likely in a vast country like India. Such studies will have implications in redefining health policy specific to those regions and may also provide insights into novel pathophysiological mechanisms, as well as regional socio‐cultural factors that may be at play.…”

Section: Introductionmentioning

confidence: 99%

Differential risk factor profile of diabetes and atherosclerosis in rural, sub‐urban and urban regions of South India: The KMCH‐Non‐communicable disease studies

et al. 2020

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Aims South Asia has emerged rapidly as an epicentre of non‐communicable diseases (NCDs) specifically diabetes and cardiovascular diseases. The prevalence rate, risk factors and aetiology of NCDs in different socio‐demographic settings are not clearly understood. This study was performed to assess the prevalence of diabetes and atherosclerosis and their risk factors in urban, sub‐urban and rural communities of South India. Methods Three communities [Nallampatti (rural), Thadagam (sub‐urban) and Kalapatti (urban)] in South India were selected for participation in the KMCH‐NCD Studies. Study volunteers were administered a detailed questionnaire, underwent anthropometric measurements, clinical measurements including blood pressure, glycated haemoglobin (HbA1c), non‐fasting lipid profile and serum creatinine. Carotid intima‐media thickness was measured using B‐mode ultrasound. Multiple logistic regression analyses were performed to understand the association of risk factors with diabetes and atherosclerosis. Results A total of 2976 native participants, ≥20 years of age were screened. The prevalence of diabetes was 16%, 26% and 23% respectively in the rural, sub‐urban and urban study populations. Association of obesity with diabetes was observed in only urban population while hypertension and dyslipidaemia showed association in both urban and semi‐urban populations. Association of diabetes with atherosclerosis was observed in urban and semi‐urban populations. Hypertension in semi‐urban and obesity and dyslipidaemia in urban population showed association with atherosclerosis. Conclusions Diabetes and atherosclerosis burden reported in the three different communities were higher than previous reports, especially in rural and sub‐urban regions. No traditional risk factor is identified to be associated with prevalence of diabetes and atherosclerosis in rural population. These findings suggest an urgent need for investigation into the role of non‐traditional risk factors like environmental or occupational exposures may help to better understand the aetiology of diseases in non‐urbanized communities.

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Metals in urine in relation to the prevalence of pre-diabetes, diabetes and atherosclerosis in rural India

Cited by 30 publications

References 30 publications

Comparison of Chromium and Iron Distribution in Serum and Urine among Healthy People and Prediabetes and Diabetes Patients

Comparison of Chromium and Iron Distribution in Serum and Urine among Healthy People and Prediabetes and Diabetes Patients

Serum chromium level is increased in Jordanian smokers, decreased in jordanians with prediabetes and type 2 diabetes, but not altered in jordanians with hypertension, with obesity, or with family history of diabetes

Differential risk factor profile of diabetes and atherosclerosis in rural, sub‐urban and urban regions of South India: The KMCH‐Non‐communicable disease studies

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