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Maldonado-Hernández J, Martínez-Basila A, Rendón-Macías ME, López-Alarcón M. Accuracy of the 13C-glucose breath test to identify insulin resistance in non-diabetic adults. Acta Diabetol 2019; 56:923-929. [PMID: 30955127 DOI: 10.1007/s00592-019-01318-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/01/2019] [Indexed: 01/02/2023]
Abstract
AIMS To assess the validity of the 13C-glucose breath test (13C-GBT) to identify insulin resistance (IR) in non-diabetic individuals, using hyperinsulinemic-euglycemic clamps as gold standard. This validity was compared with that of other IR surrogates. METHODOLOGY Non-diabetic adults were studied in a cross-sectional design. In a first appointment, oral glucose tolerance tests were conducted simultaneously with 13C-GBTs. Oral 75 g glucose dissolved in 150 ml water, followed by 1.5 mg/Kg body weight U-13C-glucose dissolved in 50 ml water, was administered. Breath and blood samples were collected at baseline and at 30-min intervals. The percentages of glucose-oxidized dose at given periods were calculated. Clamps were conducted a week later. A clamp-derived M value ≤ 6.0 mg/kg*min was used as cut-off. ROC curves were constructed for 13C-GBT, fasting insulin, HOMA, and ISI-composite. RESULTS Thirty-eight subjects completed the study protocol. The correlation coefficient between the 13C-GBT derived glucose-oxidized dose at 180 min and M values was 0.524 (p = 0.001). The optimal value to identify IR with the 13C-GBT was 4.23% (AUC 0.81; 95CI 0.66, 0.96; accuracy 0.82, 95CI 0.66, 0.92). The 13C-GBT sensitivity (0.88) was higher than HOMA and fasting insulin sensitivities (0.83 and 0.75 respectively), while their specificities were comparable (0.71, 0.71, and 0.79, respectively). The sensitivity of ISI-C was higher (0.92) than that of the 13C-GBT, but its specificity was poor (0.36). The accuracy of the 13C-GBT was superior to that of the other studied surrogates. CONCLUSIONS The 13C-GBT is a valid and accurate method to detect IR in non-diabetic adults. Therefore, it is potentially useful in clinical and community settings.
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Affiliation(s)
- Jorge Maldonado-Hernández
- Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, 06720, México City, Mexico
| | - Azucena Martínez-Basila
- Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, 06720, México City, Mexico
| | - Mario Enrique Rendón-Macías
- Unit of Research in Clinical Epidemiology, Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Mardia López-Alarcón
- Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, 06720, México City, Mexico.
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Piña-Aguero MI, Zaldivar-Delgado A, Salas-Fernández A, Martínez-Basila A, Bernabe-Garcia M, Maldonado-Hernández J. Optimal Cut-off Points of Fasting and Post-Glucose Stimulus Surrogates of Insulin Resistance as Predictors of Metabolic Syndrome in Adolescents According to Several Definitions. J Clin Res Pediatr Endocrinol 2018; 10:139-146. [PMID: 29082896 PMCID: PMC5985383 DOI: 10.4274/jcrpe.4873] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The aim of this study was to determine optimal cut-off points for fasting and post-glucose stimulus surrogates of insulin resistance to predict metabolic syndrome in adolescents according to several definitions. METHODS One hundred fifty-five adolescents living in Mexico City were enrolled during 2011 and 2012. Waist circumference and blood pressure were recorded. Subjects received an oral glucose load of 1.75 g per kg up to a maximum dose of 75 g. Blood samples were drawn at baseline and 120 minutes. Concentrations of plasma glucose, triglycerides, high-density lipoprotein cholesterol and insulin were determined. RESULTS The frequency of metabolic syndrome showed a large variability when using a variety of published definitions; in contrast, the optimal cut-off points for fasting insulin, homeostatic model assessment of insulin resistance and two-hour oral glucose tolerance test insulin were very similar in almost all the definitions considered and had adequate diagnostic performance: area under the curve >0.869, sensitivity >0.835 and specificity >0.755. Insulin resistance surrogates had substantial agreements with Ford, Cook and Salas definitions (Kappa~0.62; agreement~82%); moderate agreement was observed for International Diabetes Federation, Cruz and Ferranti definitions (Kappa~0.41–0.59; agreement~77%). CONCLUSION Insulin resistance surrogates may be a better approach for metabolic syndrome assessment in an adolescent population because of reduced variability and a higher predictive value.
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Affiliation(s)
- Mónica Ivette Piña-Aguero
- Instituto Mexicano del Seguro Social (IMSS), National Medical Center Siglo XXI, Pediatrics Hospital, Unit of Medical Research in Nutrition, Mexico City, Mexico
| | - Aranza Zaldivar-Delgado
- Instituto Mexicano del Seguro Social (IMSS), National Medical Center Siglo XXI, Pediatrics Hospital, Unit of Medical Research in Nutrition, Mexico City, Mexico
| | - Alejandra Salas-Fernández
- Instituto Mexicano del Seguro Social (IMSS), National Medical Center Siglo XXI, Pediatrics Hospital, Unit of Medical Research in Nutrition, Mexico City, Mexico
| | - Azucena Martínez-Basila
- Instituto Mexicano del Seguro Social (IMSS), National Medical Center Siglo XXI, Pediatrics Hospital, Unit of Medical Research in Nutrition, Mexico City, Mexico
| | - Mariela Bernabe-Garcia
- Instituto Mexicano del Seguro Social (IMSS), National Medical Center Siglo XXI, Pediatrics Hospital, Unit of Medical Research in Nutrition, Mexico City, Mexico
| | - Jorge Maldonado-Hernández
- Instituto Mexicano del Seguro Social (IMSS), National Medical Center Siglo XXI, Pediatrics Hospital, Unit of Medical Research in Nutrition, Mexico City, Mexico,* Address for Correspondence: Instituto Mexicano del Seguro Social (IMSS), National Medical Center Siglo XXI, Pediatrics Hospital, Unit of Medical Research in Nutrition, Mexico City, Mexico Phone: +52 55 56 27 69 44 E-mail:
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Maldonado-Hernández J, Martínez-Basila A, Salas-Fernández A, Navarro-Betancourt JR, Piña-Aguero MI, Bernabe-García M. The 13C-Glucose Breath Test for Insulin Resistance Assessment in Adolescents: Comparison with Fasting and Post-Glucose Stimulus Surrogate Markers of Insulin Resistance. J Clin Res Pediatr Endocrinol 2016; 8:419-424. [PMID: 27354200 PMCID: PMC5198000 DOI: 10.4274/jcrpe.3260] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To evaluate the use of the 13C-glucose breath test (13C-GBT) for insulin resistance (IR) detection in adolescents through comparison with fasting and post-glucose stimulus surrogates. METHODS One hundred thirty-three adolescents aged between 10 and 16 years received an oral glucose load of 1.75 g per kg of body weight dissolved in 150 mL of water followed by an oral dose of 1.5 mg/kg of U-13C-Glucose, without a specific maximum dose. Blood samples were drawn at baseline and 120 minutes, while breath samples were obtained at baseline and at 30, 60, 90, 120, 150, and 180 minutes. The 13C-GBT was compared to homeostasis model assessment (HOMA) IR (≥p95 adjusted by gender and age), fasting plasma insulin (≥p90 adjusted by gender and Tanner stage), results of 2-h oral glucose tolerance test (OGTT), insulin levels (≥65 μU/mL) in order to determine the optimal cut-off point for IR diagnosis. RESULTS 13C-GBT data, expressed as adjusted cumulative percentage of oxidized dose (A% OD), correlated inversely with fasting and post-load IR surrogates. Sexual development alters A% OD results, therefore individuals were stratified into pubescent and post-pubescent. The optimal cut-off point for the 13C-GBT in pubescent individuals was 16.3% (sensitivity=82.8% & specificity=60.6%) and 13.0% in post-pubescents (sensitivity=87.5% & specificity=63.6%), when compared to fasting plasma insulin. Similar results were observed against HOMA and 2-h OGTT insulin. CONCLUSION The 13C-GBT is a practical and non-invasive method to screen for IR in adolescents with reasonable sensitivity and specificity.
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Affiliation(s)
- Jorge Maldonado-Hernández
- National Medical Center "Siglo XXI", Mexican Social Security Institute, Medical Nutrition Research Unit, Mexico City, Mexico, Phone: 52 (55) 56 27 69 44 E-mail:
| | - Azucena Martínez-Basila
- National Medical Center “Siglo XXI”, Mexican Social Security Institute, Medical Nutrition Research Unit, Mexico City, Mexico
| | - Alejandra Salas-Fernández
- National Medical Center “Siglo XXI”, Mexican Social Security Institute, Medical Nutrition Research Unit, Mexico City, Mexico
| | - José R. Navarro-Betancourt
- National Medical Center “Siglo XXI”, Mexican Social Security Institute, Medical Nutrition Research Unit, Mexico City, Mexico
| | - Mónica I. Piña-Aguero
- National Medical Center “Siglo XXI”, Mexican Social Security Institute, Medical Nutrition Research Unit, Mexico City, Mexico
| | - Mariela Bernabe-García
- National Medical Center “Siglo XXI”, Mexican Social Security Institute, Medical Nutrition Research Unit, Mexico City, Mexico
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Salas-Fernández A, Maldonado-Hernández J, Martínez-Basila A, Martínez-Razo G, Jasso-Saavedra F. The 13C-glucose breath test is a valid non-invasive screening tool to identify metabolic syndrome in adolescents. Clin Chem Lab Med 2015; 53:133-8. [PMID: 25153397 DOI: 10.1515/cclm-2014-0412] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 06/25/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Metabolic syndrome (MS) is an important risk factor in pediatric population for the early onset of type 2 diabetes mellitus and cardiovascular disease. New non-invasive tools are required to identify MS in at risk populations; the aim of this study was to determine an optimal cut-off point for the 13C-glucose breath test (13C-GBT) for the diagnosis of MS in adolescents. METHODS A total of 136 adolescents between 10 and 16 years old were recruited. MS was defined as: waist circumference >90th percentile and at least two of the following; high density lipoprotein-cholesterol (HDL-C) <50 mg/dL, triglycerides >110 mg/dL, diastolic and/or systolic blood pressure >90th percentile adjusted by age, gender and height, and/or fasting glucose >100 mg/dL. After the ingestion of a glucose load of 1.75 g/kg of body weight (up to 75 g) and an oral dose of 1.5 mg of universally labeled 13C-glucose/kg dissolved in water, breath samples were taken at baseline, 30, 60, 90, 120, 150 and 180 min. Exhaled 13CO2 in breath samples was measured by isotope ratio mass spectrometry. RESULTS 13C-GBT data, expressed as adjusted cumulative percentage of oxidized dose (A% OD) at 180 min, was significantly higher in the healthy subjects group (17.72%±4.9%) in comparison with subjects with ≥3, 2 or 1 components of the MS (9.95%±4.73%, 14.3%±4.47% and 14.62%±4.62%, respectively). The optimal cut-off point for the A% OD was 16.09, with a sensitivity of 81.5% and a specificity of 66.7%. CONCLUSIONS Our results demonstrate that the 13C-glucose breath test could be a valid screening method to identify MS in adolescents.
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López-Alarcón M, Montalvo-Velarde I, Vital-Reyes VS, Hinojosa-Cruz JC, Leaños-Miranda A, Martínez-Basila A. Serial determinations of asymmetric dimethylarginine and homocysteine during pregnancy to predict pre-eclampsia: a longitudinal study. BJOG 2015. [PMID: 26213116 DOI: 10.1111/14 71-0528.13516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the usefulness of serial determinations of asymmetric dimethylarginine (ADMA) and homocysteine (Hcy) concentrations during pregnancy to predict pre-eclampsia, taking into account maternal obesity and B vitamin status. DESIGN Longitudinal study. SETTING Two obstetric referral hospitals. SAMPLE Two hundred and fifty-two of 411 women invited to participate in the study. METHODS The women made monthly visits from ≤20 weeks of gestation until delivery for measurements of plasma ADMA, Hcy, and vitamins B6 , B12, and folic acid, and for the recording of clinical information. MAIN OUTCOME MEASURE Early elevations in plasma ADMA and Hcy related to the development of pre-eclampsia. RESULTS Of the 252 women who completed the study, 179 had no complications, 49 developed pre-eclampsia, and 24 presented with complications other than pre-eclampsia. ADMA and Hcy increased gradually throughout pregnancy in the pre-eclampsia group, independent of maternal B-vitamin status and obesity, but remained constant in women with no complications. Relative to the preceding month, ADMA and Hcy levels increased 1 month prior to the onset of pre-eclampsia: 124 ± 27 nmol (P < 0.001) and 1177 ± 278 nmol (P = 0.001), respectively, in the pre-eclampsia group. The group of women with no complications did not show any significant changes. Increases of 80 nmol ADMA and 1000 nmol Hcy at 1 month prior to the onset of pre-eclampsia demonstrated the best potential for prediction. CONCLUSIONS Increased ADMA and Hcy levels precede clinical manifestations of pre-eclampsia. Therefore, serial determinations of their concentrations may be helpful in identifying women at risk. TWEETABLE ABSTRACT Increased ADMA and Hcy precede clinical pre-eclampsia and may identify women at risk.
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Affiliation(s)
- M López-Alarcón
- Unit of Research in Medical Nutrition, Centro Médico Nacional Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - I Montalvo-Velarde
- Unit of Research in Medical Nutrition, Centro Médico Nacional Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - V S Vital-Reyes
- Hospital of Obstetrics and Gynaecology #3, Centro Médico La Raza, Mexican Institute of Social Security, Mexico City, Mexico
| | - J C Hinojosa-Cruz
- Hospital of Obstetrics and Gynaecology #3, Centro Médico La Raza, Mexican Institute of Social Security, Mexico City, Mexico
| | - A Leaños-Miranda
- Hospital of Obstetrics and Gynaecology #4, Luis Castelazo Ayala, Mexican Institute of Social Security, Mexico City, Mexico
| | - A Martínez-Basila
- Unit of Research in Medical Nutrition, Centro Médico Nacional Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
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López-Alarcón M, Montalvo-Velarde I, Vital-Reyes VS, Hinojosa-Cruz JC, Leaños-Miranda A, Martínez-Basila A. Serial determinations of asymmetric dimethylarginine and homocysteine during pregnancy to predict pre-eclampsia: a longitudinal study. BJOG 2015. [DOI: 10.1111/1471-0528.13516] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M López-Alarcón
- Unit of Research in Medical Nutrition; Centro Médico Nacional Siglo XXI; Mexican Institute of Social Security; Mexico City Mexico
| | - I Montalvo-Velarde
- Unit of Research in Medical Nutrition; Centro Médico Nacional Siglo XXI; Mexican Institute of Social Security; Mexico City Mexico
| | - VS Vital-Reyes
- Hospital of Obstetrics and Gynaecology #3; Centro Médico La Raza; Mexican Institute of Social Security; Mexico City Mexico
| | - JC Hinojosa-Cruz
- Hospital of Obstetrics and Gynaecology #3; Centro Médico La Raza; Mexican Institute of Social Security; Mexico City Mexico
| | - A Leaños-Miranda
- Hospital of Obstetrics and Gynaecology #4; Luis Castelazo Ayala; Mexican Institute of Social Security; Mexico City Mexico
| | - A Martínez-Basila
- Unit of Research in Medical Nutrition; Centro Médico Nacional Siglo XXI; Mexican Institute of Social Security; Mexico City Mexico
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Maldonado-Hernández J, Martínez-Basila A, Matute-González MG, López-Alarcón M. The [(13)c]glucose breath test is a reliable method to identify insulin resistance in Mexican adults without diabetes: comparison with other insulin resistance surrogates. Diabetes Technol Ther 2014; 16:385-91. [PMID: 24716853 DOI: 10.1089/dia.2013.0263] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Insulin resistance (IR) precedes type 2 diabetes, but tests used to detect it in clinical settings reported poor reproducibility. We assessed the reliability of the [(13)C]glucose breath test ((13)C-GBT) in a sample of subjects without diabetes. Repeatability of the test was compared with that of other IR surrogates derived from the fasting or oral glucose tolerance test (OGTT). SUBJECTS AND METHODS Eighty-six healthy volunteers received an oral load of 75 g of glucose in 150 mL of water followed by 1.5 mg/kg of [U-(13)C]glucose in 50 mL of water. Breath and blood samples were collected at baseline and at 10, 20, 30, 60, 90, 120, 150, and 180 min following the glucose load; the same procedure was repeated within 1 week. The enrichment of breath (13)CO2 was measured by ratio mass spectrometry and expressed as percentage oxidized dose at a given time period. Intrasubject variability was assessed with Bland-Altman plots and coefficients of variation (CVs). RESULTS The overall CV of the (13)C-GBT was 12.99±11.61%, compared with 18.42% of fasting insulin, 19.44% for homeostasis model assessment, 17.06% of the composite insulin sensitivity index, and 29.99% for insulin in the 2-h oral glucose tolerance test. The variability of the (13)C-GBT tended to be higher in lean (17.40%) than in overweight (10.17%) and obese (12.61%) individuals. CONCLUSIONS The variability of the (13)C-GBT is lower than that of other IR surrogates, making it a reproducible method to estimate insulin sensitivity in overweight and obese adults without diabetes. Because the individuals did not have diabetes but were within a high range of insulin sensitivity, the test should have application in clinical and population-based studies, given the evidence for the utility and limitations of this surrogate.
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Affiliation(s)
- Jorge Maldonado-Hernández
- Unit of Research in Medical Nutrition, National Medical Center "Siglo XXI," Mexican Institute of Social Security , México Federal District, México
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