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Jones S, Tillin T, Williams S, Eastwood SV, Hughes AD, Chaturvedi N. Type 2 diabetes does not account for ethnic differences in exercise capacity or skeletal muscle function in older adults. Diabetologia 2020; 63:624-635. [PMID: 31820039 PMCID: PMC6997264 DOI: 10.1007/s00125-019-05055-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/29/2019] [Indexed: 01/14/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to compare exercise capacity, strength and skeletal muscle perfusion during exercise, and oxidative capacity between South Asians, African Caribbeans and Europeans, and determine what effect ethnic differences in the prevalence of type 2 diabetes has on these functional outcomes. METHODS In total, 708 participants (aged [mean±SD] 73 ± 7 years, 56% male) were recruited from the Southall and Brent Revisited (SABRE) study, a UK population-based cohort comprised of Europeans (n = 311) and South Asian (n = 232) and African Caribbean (n = 165) migrants. Measurements of exercise capacity using a 6 min stepper test (6MST), including measurement of oxygen consumption ([Formula: see text]) and grip strength, were performed. Skeletal muscle was assessed using near infrared spectroscopy (NIRS); measures included changes in tissue saturation index (∆TSI%) with exercise and oxidative capacity (muscle oxygen consumption recovery, represented by a time constant [τ]). Analysis was by multiple linear regression. RESULTS When adjusted for age and sex, in South Asians and African Caribbeans, exercise capacity was reduced compared with Europeans ([Formula: see text] [ml min-1 kg-1]: β = -1.2 [95% CI -1.9, -0.4], p = 0.002, and β -1.7 [95% CI -2.5, -0.8], p < 0.001, respectively). South Asians had lower and African Caribbeans had higher strength compared with Europeans (strength [kPa]: β = -9 [95% CI -12, -6), p < 0.001, and β = 6 [95% CI 3, 9], p < 0.001, respectively). South Asians had greater decreases in TSI% and longer τ compared with Europeans (∆TSI% [%]: β = -0.9 [95% CI -1.7, -0.1), p = 0.024; τ [s]: β = 11 [95% CI 3, 18], p = 0.006). Ethnic differences in [Formula: see text] and grip strength remained despite adjustment for type 2 diabetes or HbA1c (and fat-free mass for grip strength). However, the differences between Europeans and South Asians were no longer statistically significant after adjustment for other possible mediators or confounders (including physical activity, waist-to-hip ratio, cardiovascular disease or hypertension, smoking, haemoglobin levels or β-blocker use). The difference in ∆TSI% between Europeans and South Asians was marginally attenuated after adjustment for type 2 diabetes or HbA1c and was also no longer statistically significant after adjusting for other confounders; however, τ remained significantly longer in South Asians vs Europeans despite adjustment for all confounders. CONCLUSIONS/INTERPRETATION Reduced exercise capacity in South Asians and African Caribbeans is unexplained by higher rates of type 2 diabetes. Poorer exercise tolerance in these populations, and impaired muscle function and perfusion in South Asians, may contribute to the higher morbidity burden of UK ethnic minority groups in older age.
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Affiliation(s)
- Siana Jones
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Therese Tillin
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK
| | - Suzanne Williams
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK
| | - Sophie V Eastwood
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK
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Goloba M, Raghuraman R, Botros N, Khan U, Klein M, Brown A, Duffy D, Anim-Nyame N, Wang D, Manyonda I, Antonios TF. Early Life Microcirculatory Plasticity and Blood Pressure Changes in Low Birth Weight Infants Born to Normotensive Mothers: A Cohort Study. Am J Hypertens 2019; 32:570-578. [PMID: 30821323 PMCID: PMC6508166 DOI: 10.1093/ajh/hpz034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/20/2019] [Accepted: 02/27/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Capillary rarefaction (CR) is an established hallmark of essential hypertension (EH). The aim of this study was to examine early changes in capillary density (CD) and blood pressure (BP) in low birth weight (LBW) infants who are at risk of developing EH in later life. METHODS We studied 77 LBW infants and 284 normal birth weight (NBW) infants, all born to mothers with normotension, in a longitudinal multicenter study. Intravital capillaroscopy was used to measure functional basal capillary density (BCD) and maximal capillary density (MCD) at birth, 3, 6, and 12 months. RESULTS We found that LBW infants, born preterm and at term, had a significantly higher CD at birth, then underwent significant CR in the 1st 3 months culminating in a CD similar to that seen in NBW infants. NBW infants showed a gradual reduction in CD between birth and 12 months. Non-Caucasian ethnicity and preterm birth were significant predictors of a higher CD at birth. Systolic BP in NBW infants increased significantly from birth to 3 months, and we identified a significant negative correlation between systolic BP and MCD. CONCLUSIONS This study has identified a process of early “accelerated capillary remodeling” in LBW infants, which corrects their higher CD at birth. This remodeling is unlikely to explain the CR seen in adult individuals with, or at risk of developing EH. Further follow-up studies are required to determine the timing and mechanisms involved in CR, which is likely to occur after the 1st year of life but before early adulthood.
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Affiliation(s)
- Muti Goloba
- Molecular and Clinical Sciences Research Institute, St George’s, University of London, London, UK
- Blood Pressure Unit, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Rajendra Raghuraman
- Molecular and Clinical Sciences Research Institute, St George’s, University of London, London, UK
| | - Nansi Botros
- Molecular and Clinical Sciences Research Institute, St George’s, University of London, London, UK
| | - Uzma Khan
- Molecular and Clinical Sciences Research Institute, St George’s, University of London, London, UK
| | - Monique Klein
- Molecular and Clinical Sciences Research Institute, St George’s, University of London, London, UK
| | - Amelia Brown
- Molecular and Clinical Sciences Research Institute, St George’s, University of London, London, UK
| | - Donovan Duffy
- Neonatal Unit, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Nick Anim-Nyame
- Obstetrics and Gynaecology Department, Kingston Hospital NHS Foundation Trust, London, UK
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Isaac Manyonda
- Obstetrics and Gynaecology Department, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Tarek F Antonios
- Molecular and Clinical Sciences Research Institute, St George’s, University of London, London, UK
- Blood Pressure Unit, St George’s University Hospitals NHS Foundation Trust, London, UK
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Feng L, Naheed A, de Silva HA, Jehan I, Raqib R, Islam MT, Luke N, Kasturiratne A, Farazdaq H, Senan S, Jafar TH. Regional Variation in Comorbid Prediabetes and Diabetes and Associated Factors among Hypertensive Individuals in Rural Bangladesh, Pakistan, and Sri Lanka. J Obes 2019; 2019:4914158. [PMID: 31183214 PMCID: PMC6515018 DOI: 10.1155/2019/4914158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/16/2019] [Indexed: 11/17/2022] Open
Abstract
We aimed to explore the cross-country variation in the prevalence of comorbid prediabetes or diabetes and determine the sociodemographic, lifestyle, and clinical factors, especially body mass index (BMI) and waist circumference, associated with comorbid diabetes in individuals with hypertension in rural South Asia. We analyzed cross-sectional data of 2426 hypertensive individuals of ≥40 years from 30 randomly selected rural communities in Bangladesh, Pakistan, and Sri Lanka. Prediabetes was defined as fasting plasma glucose (FPG) between 100 and 125 mg/dL without use of antidiabetic treatment and diabetes as FPG ≥126 mg/dL or use of antidiabetic medication. The prevalence (95% CI) of prediabetes or diabetes (53.5% (51.5%, 55.5%)) and diabetes (27.7% (25.9%, 29.5%)) was high in the overall hypertensive study population in rural communities in 3 countries. Rural communities in Sri Lanka had the highest crude prevalence of prediabetes or diabetes and diabetes (73.1% and 39.3%) with hypertension, followed by those in Bangladesh (47.4% and 23.1%) and Pakistan (39.2% and 20.5%). The factors independently associated with comorbid diabetes and hypertension were residing in rural communities in Sri Lanka, higher education, international wealth index, waist circumference, pulse pressure, triglyceride, and lower high-density lipoprotein. The association of diabetes with waist circumference was stronger than with BMI in hypertensive individuals. Prediabetes or diabetes are alarmingly common among adults with hypertension and vary among countries in rural South Asia. The high prevalence of comorbid diabetes in Sri Lanka among hypertensives is not fully explained by conventional risk factors and needs further etiological research. Urgent public health efforts are needed to integrate diabetes control within hypertension management programs in rural South Asia, including screening waist circumference.
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Affiliation(s)
- Liang Feng
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Aliya Naheed
- Initiative for Non-Communicable Diseases, Health Systems and Population Studies Division, icddr, b, Dhaka, Bangladesh
| | - H. Asita de Silva
- Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Imtiaz Jehan
- Department of Community Health Science, Aga Khan University, Karachi, Pakistan
| | - Rubhana Raqib
- Immunobiology, Nutrition and Toxicology Laboratory, Infectious Diseases Division, icddr, b, Dhaka, Bangladesh
| | - Md Tauhidul Islam
- Initiative for Non-Communicable Diseases, Health Systems and Population Studies Division, icddr, b, Dhaka, Bangladesh
| | - Nathasha Luke
- Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Anuradhani Kasturiratne
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Hamida Farazdaq
- Department of Family Medicine, Aga Khan University, Karachi, Pakistan
| | - Sahar Senan
- Department of Community Health Science, Aga Khan University, Karachi, Pakistan
| | - Tazeen H. Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Department of Renal Medicine, Singapore General Hospital, Singapore
- Duke Global Health Institute, Duke University, Durham, NC, USA
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Singh H, Panta OB, Khanal U, Ghimire RK. Renal Cortical Elastography: Normal Values and Variations. J Med Ultrasound 2017; 25:215-220. [PMID: 30065495 PMCID: PMC6029337 DOI: 10.1016/j.jmu.2017.04.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/22/2017] [Indexed: 12/20/2022] Open
Abstract
Introduction Renal cortical elastography has shown conflicting but promising results in evaluation of chronic kidney disease and other renal disorders. The purpose of this study was to establish a normogram of renal cortical elasticity values and assess their variation between right and left kidney and their relation with age, gender, body mass index, renal dimensions and skin to cortex distance. Methods The study was a hospital based cross sectional study performed at Tribhuvan University Teaching Hospital, a tertiary care center in Kathmandu, Nepal. All individuals referred for Ultrasound from General Health Check up clinic were included in the study. Patient with abnormal ultrasound findings and abnormal renal function test were excluded from the study. Renal morphometry including length, cortical thickness, and skin to cortex distance were measured in B mode imaging and renal cortical elastography was measured with region of interest box of 1 × 0.5 cm. All analyses were done using Statistical Package for Social Sciences 20.0 soft ware. Results A total of 95 individuals who met the inclusion criteria were included in the study. The mean values of right and left renal cortical shear wave velocity were 1.49 ± 0.19 m/s and 1.54 ± 0.19 m/s respectively. Statistical significant difference was observed between the renal cortical shear wave velocity of right and left kidney. The renal shear wave velocity was seen to decrease with age, however the correlation was not statistically significant. No significant difference was also noted in renal shear wave velocity among various sex or Body mass index groups. Statistically significant negative correlation was noted between skin to cortex distance and renal cortical shear wave velocities. However no statistically significant correlation was noted between renal dimensions and renal cortical shear wave velocities. Conclusions The normal cortical elasticity values in terms of shear wave velocity of right and left kidney were established. Renal elasticity is independent of the age, gender, Body mass index and renal dimensions.
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Affiliation(s)
- Harsh Singh
- Department of Radiodiagnosis, King George Medical University, Lucknow, India
| | - Om Biju Panta
- Department of Intervention Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand
| | - Umesh Khanal
- Department of Radiology and Imaging, Tribhuvan University Teaching Hospital, Nepal
| | - Ram Kumar Ghimire
- Department of Radiology and Imaging, Tribhuvan University Teaching Hospital, Nepal
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Eastwood SV, Tillin T, Sattar N, Forouhi NG, Hughes AD, Chaturvedi N. Associations Between Prediabetes, by Three Different Diagnostic Criteria, and Incident CVD Differ in South Asians and Europeans. Diabetes Care 2015; 38:2325-32. [PMID: 26486189 PMCID: PMC4868252 DOI: 10.2337/dc15-1078] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 09/21/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We examined longitudinal associations between prediabetes and cardiovascular disease (CVD) (coronary heart disease [CHD] and stroke) in Europeans and South Asians. RESEARCH DESIGN AND METHODS This was a U.K. cohort study of 1,336 Europeans and 1,139 South Asians, aged 40-69 years at baseline (1988-1991). Assessment included blood pressure, blood tests, anthropometry, and questionnaires. Prediabetes was determined by OGTT or HbA1c, using either International Expert Committee (IEC) (HbA1c 6.0-6.5% [42-48 mmol/mol]) or American Diabetes Association (ADA) (HbA1c 5.7-6.5% [39-48 mmol/mol]) cut points. Incident CHD and stroke were established at 20 years from death certification, hospital admission, primary care record review, and participant report. RESULTS Compared with normoglycemic individuals, IEC-defined prediabetes was related to both CHD and CVD risk in Europeans but not South Asians (subhazard ratio for CHD 1.68 [95% CI 1.19, 2.38] vs. 1.00 [0.75, 1.33], ethnicity interaction P = 0.008, and for CVD 1.49 [1.08, 2.07] vs. 1.03 [0.78, 1.36], ethnicity interaction P = 0.04). Conversely, IEC-defined prediabetes was associated with stroke risk in South Asians but not Europeans (1.73 [1.03, 2.90] vs. 0.85 [0.44, 1.64], ethnicity interaction P = 0.11). Risks were adjusted for age, sex, smoking, total-to-HDL cholesterol ratio, waist-to-hip ratio, systolic blood pressure, and antihypertensive use. Associations were weaker for OGTT or ADA-defined prediabetes. Conversion from prediabetes to diabetes was greater in South Asians, but accounting for time to conversion did not account for these ethnic differences. CONCLUSIONS Associations between prediabetes and CVD differed by prediabetes diagnostic criterion, type of CVD, and ethnicity, with associations being present for overall CVD in Europeans but not South Asians. Substantiation of these findings and investigation of potential explanations are required.
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Affiliation(s)
- Sophie V Eastwood
- Institute of Cardiovascular Science, University College London, London, U.K.
| | - Therese Tillin
- Institute of Cardiovascular Science, University College London, London, U.K
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
| | - Nita G Forouhi
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, U.K
| | - Alun D Hughes
- Institute of Cardiovascular Science, University College London, London, U.K
| | - Nish Chaturvedi
- Institute of Cardiovascular Science, University College London, London, U.K
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Cubbon RM, Yuldasheva NY, Viswambharan H, Mercer BN, Baliga V, Stephen SL, Askham J, Sukumar P, Skromna A, Mughal RS, Walker AMN, Bruns A, Bailey MA, Galloway S, Imrie H, Gage MC, Rakobowchuk M, Li J, Porter KE, Ponnambalam S, Wheatcroft SB, Beech DJ, Kearney MT. Restoring Akt1 activity in outgrowth endothelial cells from South Asian men rescues vascular reparative potential. Stem Cells 2015; 32:2714-23. [PMID: 24916783 DOI: 10.1002/stem.1766] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 05/09/2014] [Accepted: 05/12/2014] [Indexed: 01/09/2023]
Abstract
Recent data suggest reduced indices of vascular repair in South Asian men, a group at increased risk of cardiovascular events. Outgrowth endothelial cells (OEC) represent an attractive tool to study vascular repair in humans and may offer potential in cell-based repair therapies. We aimed to define and manipulate potential mechanisms of impaired vascular repair in South Asian (SA) men. In vitro and in vivo assays of vascular repair and angiogenesis were performed using OEC derived from SA men and matched European controls, prior defining potentially causal molecular mechanisms. SA OEC exhibited impaired colony formation, migration, and in vitro angiogenesis, associated with decreased expression of the proangiogenic molecules Akt1 and endothelial nitric oxide synthase (eNOS). Transfusion of European OEC into immunodeficient mice after wire-induced femoral artery injury augmented re-endothelialization, in contrast with SA OEC and vehicle; SA OEC also failed to promote angiogenesis after induction of hind limb ischemia. Expression of constitutively active Akt1 (E17KAkt), but not green fluorescent protein control, in SA OEC increased in vitro angiogenesis, which was abrogated by a NOS antagonist. Moreover, E17KAkt expressing SA OEC promoted re-endothelialization of wire-injured femoral arteries, and perfusion recovery of ischemic limbs, to a magnitude comparable with nonmanipulated European OEC. Silencing Akt1 in European OEC recapitulated the functional deficits noted in SA OEC. Reduced signaling via the Akt/eNOS axis is causally linked with impaired OEC-mediated vascular repair in South Asian men. These data prove the principle of rescuing marked reparative dysfunction in OEC derived from these men.
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Affiliation(s)
- Richard M Cubbon
- Leeds Multidisciplinary Cardiovascular Research Centre, LIGHT Laboratories, The University of Leeds, Clarendon Way, Leeds, United Kingdom
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