Predictors and determinants of albuminuria in people with prediabetes and diabetes based on smoking status: A cross-sectional study using the UK Biobank data

Kar, Debasish; El-Wazir, Aya; Delanerolle, Gayathri; Forbes, Anna; Sheppard, James P; Nath, Mintu; Joy, Mark; Cole, Nicholas J.; Arnold, Jayanth R.; Lee, Andrew; Feher, Michael; Davies, Melanie J.; Khunti, Kamlesh; Lusignan, Simon de; Goyder, Elizabeth

doi:10.1016/j.eclinm.2022.101544

Cited by 7 publications

(6 citation statements)

References 43 publications

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“…Elevated UACR not only re ects glomerular injury and is a marker of renal dysfunction, but more importantly, it is a re ection of systemic vascular endothelial dysfunction and it has been well established as an independent risk factor for a number of diseases and adverse events, including metabolic syndrome, transition from prediabetes to diabetes, heart failure, cardiovascular death, and all-cause mortality [7][8][9][10][11][12].…”

Section: Discussionmentioning

confidence: 99%

“…Albuminuria, de ned as UACR > 30 mg/g, indicates increased urinary albumin excretion, and is a marker of kidney damage and an important diagnostic indicator for chronic kidney disease (CKD). Albuminuria is identi ed to be an independent predictor for metabolic syndrome, heart failure, cardiovascular death, and all-cause mortality [7][8][9][10][11][12]. Recently, an increasing evidence has revealed that UACR, even within the normal range, is signi cantly associated with incident hypertension, arterial stiffness, cardiovascular death and all-cause mortality [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

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Association between urinary albumin-to-creatinine ratio within the normal range and insulin resistance and prediabetes among US adults: a population-based study

Wu,

Yang,

Zhu

et al. 2024

Preprint

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Background Recent studies have shown that urine albumin-to-creatinine ratio (UACR) within the normal range is associated with increased risk of hypertension, diabetes, cardiovascular death and all-cause death. However, the relationship between normal range UACR and the prevalence of insulin resistance (IR) and prediabetes has not been explored. Methods The study included 14,208 US adults with normal range UACR values and without diabetes from the National Health and Nutrition Survey (1999-2018). The outcome variables included IR and prediabetes, as defined by the 2013 American Diabetes Association guidelines. The weighted multivariate linear regression, weighted multivariate logistic regression, restricted cubic spline (RCS) regression, and subgroup analysis were conducted to examine the relationship of UACR with IR and prediabetes. Results The weighted multivariate linear regression analysis showed that a 1-standard deviation (SD) increment in ln (UACR) was positively associated with fasting plasma glucose (FPG) (β = 0.02, 95% CI: 0.01, 0.04), glycosylated hemoglobin (β = 0.01, 95% CI: 0.00, 0.02), fasting serum insulin (FSI) (β = 0.50, 95% CI: 0.31, 0.68), and homeostasis model assessment of insulin resistance (HOMA-IR) (β = 0.14, 95% CI: 0.09, 0.19). The weighted multivariate logistic regression analysis revealed that a 1-SD increment in ln (UACR) was significantly associated with an increased prevalence of prediabetes (OR = 1.10, 95% CI: 1.04-1.15), but not with IR (OR = 1.05, 95% CI: 0.99-1.12). With the lowest quartile of UACR as a reference, ORs (95% CIs)for IR in the second, third, and fourth quartiles were 1.10 (0.86, 1.15), 1.15 (0.98, 1.33), and 1.12 (0.95, 1.32), respectively, and ORs (95% CIs) for prediabetes were 1.35 (1.19, 1.52), 1.32 (1.14, 1.53), and 1.44 (1.24, 1.66), respectively. Subgroup analysis indicated that smoking had a significant impact on the association between UACR and prediabetes. The association between UACR and prediabetes was more significant in smokers than in non-smokers (P for interaction = 0.03). RCS regression analysis revealed a non-linear positive dose-response association between UACR and indicators of diabetes. Conclusion Elevated UACR, even within the normal range, was positively associated with indicators of diabetes and increased prevalence of prediabetes among US adults. Smoking had a significant impact on the association between UACR and prediabetes, with a more pronounced association observed among smokers.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association between urinary albumin-to-creatinine ratio within the normal range and insulin resistance and prediabetes among US adults: a population-based study

Wu,

Yang,

Zhu

et al. 2024

Preprint

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“…In our recent cross-sectional study, we have demonstrated that almost 35% of smokers with pre-diabetes had already developed albuminuria. 73 A recent cohort study reported that between 2009 and 2018, in the UK, the incidence rate of T2DM declined by a third, compared with its peak in 2013-2014, but the incidence of pre-diabetes had tripled. 74 In 2022, one in three adults in the UK had pre-diabetes.…”

Section: Discussionmentioning

confidence: 99%

Relationship of cardiorenal risk factors with albuminuria based on age, smoking, glycaemic status and BMI: a retrospective cohort study of the UK Biobank data

Kar,

El-Wazir,

Nath

et al. 2023

bmjph

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IntroductionSmoking is harmful, and its cessation is recommended to prevent chronic kidney disease, which often begins with abnormal leakage of albumin in the urine, called albuminuria. Smoking cessation’s effect on albuminuria depends on the pack-years smoked, length of abstinence, body mass index (BMI) and glycosylated haemoglobin (HbA1c). Using the UK Biobank data, we examined the relationship between these cardiorenal variables and albuminuria.MethodsFor this study, we selected a UK Biobank cohort with urinary albumin concentration (UAC) in the first and second visits. Participants were divided into progressor and regressor groups, where progressors were defined as those with increased UAC value, and regressors were those with decreased UAC value. Three different logistic regression models were fitted. In model 1, with a cohort design, we explored the impact of a change in age, HbA1c and BMI between the first and second visits and the UAC. In model 2 and 3, in a cross-sectional design, we explored which cardiorenal risk factors were associated with a rise or fall of UAC at the time point of the second visit. Results are expressed in OR and 95% CI.ResultsThe prevalence of albuminuria was highest in ex-smokers who started smoking between the ages of 13 and 18. With a mean duration of 51 months, there was no statistically significant relationship between smoking status and BMI with albuminuria. Each year of ageing and each unit of increase in HbA1c (mmol/mol) increased the odds of progression of albuminuria by 20% and 3%, respectively. In ex-smokers, at the time point of the second visit, each year of smoking increased, and each year of abstinence decreased the odds by 4% and 6%, respectively.ConclusionSmokers should be supported to stop smoking and remain abstinent despite short-term weight gain. Childhood smoking should be actively discouraged.

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“…[8][9][10] Of note, previous observational studies have found favourable lifestyle behaviours including normal weight, no smoking and moderate alcohol consumption were associated with decreased risk of impaired fasting glucose (IFG). 11,12 These behaviours tend to cluster and work together within a population. However, the combined associations of these lifestyle behaviours on long-term risk of prediabetes-related adverse outcomes are not well understood.…”

Section: Introductionmentioning

confidence: 99%

“…Of note, previous observational studies have found favourable lifestyle behaviours including normal weight, no smoking and moderate alcohol consumption were associated with decreased risk of impaired fasting glucose (IFG) 11,12 . These behaviours tend to cluster and work together within a population.…”

Section: Introductionmentioning

confidence: 99%

Association of combined healthy lifestyle with risk of adverse outcomes in patients with prediabetes

Xu,

Li,

et al. 2024

Diabetes Metabolism Res

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ObjectivePrediabetes and lifestyle factors have been associated with the risks of multiple adverse outcomes, but the effect of a healthy lifestyle on prediabetes‐related complications remains unknown. We aimed to investigate whether the risks of multiple adverse outcomes including incident type 2 diabetes mellitus (T2DM), cardiovascular disease (CVD), and chronic kidney disease (CKD) among individuals with prediabetes can be offset by a broad combination of healthy lifestyle factors.MethodsThis prospective study used data from the UK Biobank cohort. An overall lifestyle score ranging from 0 to 6 was created with 1 point for each of the 6 healthy lifestyle factors: no current smoking, moderate alcohol consumption, regular physical activity, healthy diet, no overweight or obese, and adequate sleep duration. T2DM, CVD, and CKD were ascertained during a median follow‐up of 14 years. Cox proportional hazard regression models were used to estimate the associations. Sensitivity analyses were performed to test the robustness of the results.ResultsWe included 202,993 participants without T2DM, CVD, and CKD at baseline (mean age 55.5 years [SD 8.1]; 54.7% were women). Among these participants, 6,745, 16,961, and 6,260 participants eventually developed T2DM, CVD, and CKD, respectively. Compared with the participants with normoglycaemia, those with prediabetes showed a higher risk of these adverse outcomes. In addition, those prediabetic participants with a lifestyle score of 0‐1 had a significantly higher risk of T2DM (hazard ratio [HR] 16.73, 95% CI 14.24, 19.65), CVD (HR 1.96, 95% CI 1.74, 2.21), and CKD (HR 1.92, 95% CI 1.58, 2.34) compared with those with no prediabetes and a score of 5–6. Moreover, among the participants with prediabetes, the HRs for T2DM, CVD, and CKD comparing a lifestyle score of 5–6 versus 0‐1 decreased to 0.43 (95% CI 0.36, 0.51), 0.52 (95% CI 0.44, 0.62), and 0.60 (95% CI 0.46, 0.79), respectively.ConclusionsCombined healthy lifestyle factors were associated with a significantly lower risk of multiple adverse outcomes, including T2DM, CVD, and CKD. This indicates that prioritising multifactorial approaches to behavioural lifestyle modification is crucial for preventing and postponing the development of complications related to prediabetes.

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Predictors and determinants of albuminuria in people with prediabetes and diabetes based on smoking status: A cross-sectional study using the UK Biobank data

Cited by 7 publications

References 43 publications

Association between urinary albumin-to-creatinine ratio within the normal range and insulin resistance and prediabetes among US adults: a population-based study

Association between urinary albumin-to-creatinine ratio within the normal range and insulin resistance and prediabetes among US adults: a population-based study

Relationship of cardiorenal risk factors with albuminuria based on age, smoking, glycaemic status and BMI: a retrospective cohort study of the UK Biobank data

Association of combined healthy lifestyle with risk of adverse outcomes in patients with prediabetes

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