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Marquès M, Correig E, Ibarretxe D, Anoro E, Antonio Arroyo J, Jericó C, Borrallo RM, Miret ML, Näf S, Pardo A, Perea V, Pérez-Bernalte R, Ramírez-Montesinos R, Royuela M, Soler C, Urquizu-Padilla M, Zamora A, Pedro-Botet J, Masana L, Domingo JL. Long-term exposure to PM 10 above WHO guidelines exacerbates COVID-19 severity and mortality. Environ Int 2022; 158:106930. [PMID: 34678637 PMCID: PMC8519784 DOI: 10.1016/j.envint.2021.106930] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 09/28/2021] [Accepted: 10/07/2021] [Indexed: 05/04/2023]
Abstract
BACKGROUND Age, sex, race and comorbidities are insufficient to explain why some individuals remain asymptomatic after SARS-CoV-2 infection, while others die. In this sense, the increased risk caused by the long-term exposure to air pollution is being investigated to understand the high heterogeneity of the COVID-19 infection course. OBJECTIVES We aimed to assess the underlying effect of long-term exposure to NO2 and PM10 on the severity and mortality of COVID-19. METHODS A retrospective observational study was conducted with 2112 patients suffering COVID-19 infection. We built two sets of multivariate predictive models to assess the relationship between the long-term exposure to NO2 and PM10 and COVID-19 outcome. First, the probability of either death or severe COVID-19 outcome was predicted as a function of all the clinical variables together with the pollutants exposure by means of two regularized logistic regressions. Subsequently, two regularized linear regressions were constructed to predict the percentage of dead or severe patients. Finally, odds ratios and effects estimates were calculated. RESULTS We found that the long-term exposure to PM10 is a more important variable than some already stated comorbidities (i.e.: COPD/Asthma, diabetes, obesity) in the prediction of COVID-19 severity and mortality. PM10 showed the highest effects estimates (1.65, 95% CI 1.32-2.06) on COVID-19 severity. For mortality, the highest effect estimates corresponded to age (3.59, 95% CI 2.94-4.40), followed by PM10 (2.37, 95% CI 1.71-3.32). Finally, an increase of 1 µg/m3 in PM10 concentration causes an increase of 3.06% (95% CI 1.11%-4.25%) of patients suffering COVID-19 as a severe disease and an increase of 2.68% (95% CI 0.53%-5.58%) of deaths. DISCUSSION These results demonstrate that long-term PM10 burdens above WHO guidelines exacerbate COVID-19 health outcomes. Hence, WHO guidelines, the air quality standard established by the Directive 2008/50/EU, and that of the US-EPA should be updated accordingly to protect human health.
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Affiliation(s)
- Montse Marquès
- Universitat Rovira i Virgili, Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Sant Llorenç 21, 43201 Reus, Catalonia, Spain.
| | - Eudald Correig
- Universitat Rovira i Virgili, Department of Biostatistics, Sant Llorenç 21, 43201 Reus, Catalonia, Spain
| | - Daiana Ibarretxe
- Universitat Rovira i Virgili, LIPIDCAS, University Hospital Sant Joan IISPV, CIBERDEM, Reus, Spain
| | - Eva Anoro
- LIPIDCAS, Pius Hospital Valls, Valls, Spain
| | - Juan Antonio Arroyo
- Lipid Unit, University Hospital Santa Creu i Sant Pau, Barcelona Autonomous University, Barcelona, Spain
| | - Carlos Jericó
- Lipid Unit, Hospital Moises Broggi. Consorci Sanitari Integral. Sant Joan Despí, Spain
| | - Rosa M Borrallo
- Internal Medicine Department. Terrasa Hospital. Consorci Sanitari Terrassa, Spain
| | - Marcel la Miret
- LIPIDCAS, Endocrinology Department, Hospital Verge de la Cinta, Tortosa, Spain
| | - Silvia Näf
- LIPIDCAS, Endocrinology Department, University Hospital Joan XXIII, IISPV. CIBERDEM. Universitat Rovira i Virgili. Tarragona, Spain
| | - Anna Pardo
- Internal Medicine Department, Hospital Delfos, Barcelona, Spain
| | | | | | | | - Meritxell Royuela
- Lipid Unit, ALTHAIA, Xarxa Assistencial Universitària de Manresa, Spain
| | | | - Maria Urquizu-Padilla
- Lipid Unit, University Hospital Vall d'Hebron, Barcelona Autonomous University, Barcelona, Spain
| | - Alberto Zamora
- Lipid Unit, Corporació de Salut del Maresme i la Selva, Hospital de Blanes, Spain
| | - Juan Pedro-Botet
- Lipid Unit, University Hospital del Mar, Barcelona Autonomous University, Barcelona, Spain
| | - Lluís Masana
- Universitat Rovira i Virgili, LIPIDCAS, University Hospital Sant Joan IISPV, CIBERDEM, Reus, Spain
| | - José L Domingo
- Universitat Rovira i Virgili, Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Sant Llorenç 21, 43201 Reus, Catalonia, Spain
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Marquès M, Correig E, Ibarretxe D, Anoro E, Antonio Arroyo J, Jericó C, Borrallo RM, Miret ML, Näf S, Pardo A, Perea V, Pérez-Bernalte R, Ramírez-Montesinos R, Royuela M, Soler C, Urquizu-Padilla M, Zamora A, Pedro-Botet J, Masana L, Domingo JL. Long-term exposure to PM 10 above WHO guidelines exacerbates COVID-19 severity and mortality. Environ Int 2022; 158:106930. [PMID: 34678637 DOI: 10.21203/rs.3.rs-569549/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 09/28/2021] [Accepted: 10/07/2021] [Indexed: 05/20/2023]
Abstract
BACKGROUND Age, sex, race and comorbidities are insufficient to explain why some individuals remain asymptomatic after SARS-CoV-2 infection, while others die. In this sense, the increased risk caused by the long-term exposure to air pollution is being investigated to understand the high heterogeneity of the COVID-19 infection course. OBJECTIVES We aimed to assess the underlying effect of long-term exposure to NO2 and PM10 on the severity and mortality of COVID-19. METHODS A retrospective observational study was conducted with 2112 patients suffering COVID-19 infection. We built two sets of multivariate predictive models to assess the relationship between the long-term exposure to NO2 and PM10 and COVID-19 outcome. First, the probability of either death or severe COVID-19 outcome was predicted as a function of all the clinical variables together with the pollutants exposure by means of two regularized logistic regressions. Subsequently, two regularized linear regressions were constructed to predict the percentage of dead or severe patients. Finally, odds ratios and effects estimates were calculated. RESULTS We found that the long-term exposure to PM10 is a more important variable than some already stated comorbidities (i.e.: COPD/Asthma, diabetes, obesity) in the prediction of COVID-19 severity and mortality. PM10 showed the highest effects estimates (1.65, 95% CI 1.32-2.06) on COVID-19 severity. For mortality, the highest effect estimates corresponded to age (3.59, 95% CI 2.94-4.40), followed by PM10 (2.37, 95% CI 1.71-3.32). Finally, an increase of 1 µg/m3 in PM10 concentration causes an increase of 3.06% (95% CI 1.11%-4.25%) of patients suffering COVID-19 as a severe disease and an increase of 2.68% (95% CI 0.53%-5.58%) of deaths. DISCUSSION These results demonstrate that long-term PM10 burdens above WHO guidelines exacerbate COVID-19 health outcomes. Hence, WHO guidelines, the air quality standard established by the Directive 2008/50/EU, and that of the US-EPA should be updated accordingly to protect human health.
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Affiliation(s)
- Montse Marquès
- Universitat Rovira i Virgili, Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Sant Llorenç 21, 43201 Reus, Catalonia, Spain.
| | - Eudald Correig
- Universitat Rovira i Virgili, Department of Biostatistics, Sant Llorenç 21, 43201 Reus, Catalonia, Spain
| | - Daiana Ibarretxe
- Universitat Rovira i Virgili, LIPIDCAS, University Hospital Sant Joan IISPV, CIBERDEM, Reus, Spain
| | - Eva Anoro
- LIPIDCAS, Pius Hospital Valls, Valls, Spain
| | - Juan Antonio Arroyo
- Lipid Unit, University Hospital Santa Creu i Sant Pau, Barcelona Autonomous University, Barcelona, Spain
| | - Carlos Jericó
- Lipid Unit, Hospital Moises Broggi. Consorci Sanitari Integral. Sant Joan Despí, Spain
| | - Rosa M Borrallo
- Internal Medicine Department. Terrasa Hospital. Consorci Sanitari Terrassa, Spain
| | - Marcel la Miret
- LIPIDCAS, Endocrinology Department, Hospital Verge de la Cinta, Tortosa, Spain
| | - Silvia Näf
- LIPIDCAS, Endocrinology Department, University Hospital Joan XXIII, IISPV. CIBERDEM. Universitat Rovira i Virgili. Tarragona, Spain
| | - Anna Pardo
- Internal Medicine Department, Hospital Delfos, Barcelona, Spain
| | | | | | | | - Meritxell Royuela
- Lipid Unit, ALTHAIA, Xarxa Assistencial Universitària de Manresa, Spain
| | | | - Maria Urquizu-Padilla
- Lipid Unit, University Hospital Vall d'Hebron, Barcelona Autonomous University, Barcelona, Spain
| | - Alberto Zamora
- Lipid Unit, Corporació de Salut del Maresme i la Selva, Hospital de Blanes, Spain
| | - Juan Pedro-Botet
- Lipid Unit, University Hospital del Mar, Barcelona Autonomous University, Barcelona, Spain
| | - Lluís Masana
- Universitat Rovira i Virgili, LIPIDCAS, University Hospital Sant Joan IISPV, CIBERDEM, Reus, Spain
| | - José L Domingo
- Universitat Rovira i Virgili, Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Sant Llorenç 21, 43201 Reus, Catalonia, Spain
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Masana L, Correig E, Ibarretxe D, Anoro E, Arroyo JA, Jericó C, Guerrero C, Miret ML, Näf S, Pardo A, Perea V, Pérez-Bernalte R, Plana N, Ramírez-Montesinos R, Royuela M, Soler C, Urquizu-Padilla M, Zamora A, Pedro-Botet J. Low HDL and high triglycerides predict COVID-19 severity. Sci Rep 2021; 11:7217. [PMID: 33785815 PMCID: PMC8010012 DOI: 10.1038/s41598-021-86747-5] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/15/2021] [Indexed: 12/13/2022] Open
Abstract
Lipids are indispensable in the SARS-CoV-2 infection process. The clinical significance of plasma lipid profile during COVID-19 has not been rigorously evaluated. We aim to ascertain the association of the plasma lipid profile with SARS-CoV-2 infection clinical evolution. Observational cross-sectional study including 1411 hospitalized patients with COVID-19 and an available standard lipid profile prior (n: 1305) or during hospitalization (n: 297). The usefulness of serum total, LDL, non-HDL and HDL cholesterol to predict the COVID-19 prognosis (severe vs mild) was analysed. Patients with severe COVID-19 evolution had lower HDL cholesterol and higher triglyceride levels before the infection. The lipid profile measured during hospitalization also showed that a severe outcome was associated with lower HDL cholesterol levels and higher triglycerides. HDL cholesterol and triglyceride concentrations were correlated with ferritin and D-dimer levels but not with CRP levels. The presence of atherogenic dyslipidaemia during the infection was strongly and independently associated with a worse COVID-19 infection prognosis. The low HDL cholesterol and high triglyceride concentrations measured before or during hospitalization are strong predictors of a severe course of the disease. The lipid profile should be considered as a sensitive marker of inflammation and should be measured in patients with COVID-19.
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Affiliation(s)
- Lluís Masana
- Facultat de Medicina, Universitat Rovira I Virgili, LIPIDCAS, University Hospital Sant Joan, IISPV, CIBERDEM, C/. Sant Llorenç, 21, 43201, Reus, Spain.
| | - Eudald Correig
- Statistics Department, Institut Investigació Sanitaria Pere Virgili, Universitat Rovira I Virgili, Reus, Spain
| | - Daiana Ibarretxe
- Facultat de Medicina, Universitat Rovira I Virgili, LIPIDCAS, University Hospital Sant Joan, IISPV, CIBERDEM, C/. Sant Llorenç, 21, 43201, Reus, Spain
| | - Eva Anoro
- LIPIDCAS, Pius Hospital Valls, Valls, Spain
| | - Juan Antonio Arroyo
- Lipid Unit, University Hospital Santa Creu I Sant Pau, Barcelona Autonomous University, Barcelona, Spain
| | - Carlos Jericó
- Lipid Unit, Hospital Moises Broggi, Consorci Sanitari Integral, Sant Joan Despí, Spain
| | - Carolina Guerrero
- Internal Medicine Department, Terrasa Hospital, Consorci Sanitari Terrassa, Barcelona, Spain
| | - Marcel la Miret
- LIPIDCAS, Endocrinology Department, Hospital Verge de La Cinta, Tortosa, Spain
| | - Silvia Näf
- LIPIDCAS, Endocrinology Department, University Hospital Joan XXIII, IISPV. CIBERDEM, Universitat Rovira I Virgili, Tarragona, Spain
| | - Anna Pardo
- Internal Medicine Department, Hospital Delfos, Barcelona, Spain
| | | | | | - Núria Plana
- Facultat de Medicina, Universitat Rovira I Virgili, LIPIDCAS, University Hospital Sant Joan, IISPV, CIBERDEM, C/. Sant Llorenç, 21, 43201, Reus, Spain
| | | | - Meritxell Royuela
- Lipid Unit, ALTHAIA, Xarxa Assistencial Universitària de Manresa, Barcelona, Spain
| | | | - Maria Urquizu-Padilla
- Lipid Unit, University Hospital Vall d'Hebron, Barcelona Autonomous University, Barcelona, Spain
| | - Alberto Zamora
- Lipid Unit, Corporació de Salut del Maresme I La Selva, Hospital de Blanes, Blanes, Spain
| | - Juan Pedro-Botet
- Lipid Unit, University Hospital del Mar, Barcelona Autonomous University, Barcelona, Spain
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Masana L, Correig E, Rodríguez-Borjabad C, Anoro E, Arroyo JA, Jericó C, Pedragosa A, Miret ML, Näf S, Pardo A, Perea V, Pérez-Bernalte R, Plana N, Ramírez-Montesinos R, Royuela M, Soler C, Urquizu-Padilla M, Zamora A, Pedro-Botet J, Group OBOTSXR. EFFECT oF STATIN THERAPY oN SARS-CoV-2 INFECTION-RELATED. Eur Heart J Cardiovasc Pharmacother 2020; 8:157-164. [PMID: 33135047 PMCID: PMC7665420 DOI: 10.1093/ehjcvp/pvaa128] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/03/2020] [Accepted: 10/22/2020] [Indexed: 12/18/2022]
Abstract
Aim Assessing the effect of statin therapy at hospital admission for COVID-19 on in-hospital mortality. Methods and Results Retrospective observational study. Patients taking statins were 11 years older and had significantly more comorbidities than patients who were not taking statins. A genetic matching (GM) procedure was performed prior to analysis of the mortality risk. A Cox proportional hazards model was used for the cause-specific hazard (CSH) function, and a competing-risks Fine and Gray (FG) model was also used to study the direct effects of statins on risk. Data from reverse transcription-polymerase chain reaction-confirmed 2157 SARS-CoV-2-infected patients (1234 men, 923 women; age: 67 y/o (IQR 54-78)) admitted to the hospital were retrieved from the clinical records in anonymized manner. 353 deaths occurred. 581 patients were taking statins. Univariate test after GM showed a significantly lower mortality rate in patients on statin therapy than the matched non-statin group (19.8% vs. 25.4%, χ2 with Yates continuity correction: p = 0.027). The mortality rate was even lower in patients (n = 336) who maintained their statin treatments during hospitalization compared to the GM non-statin group (17.4%; p = 0.045). The Cox model applied to the CSH function (HR = 0.58(CI: 0.39-0.89); p = 0.01) and the competing risks FG model (HR = 0.60(CI: 0.39-0.92); p = 0.02) suggest that statins are associated with reduced COVID-19-related mortality. Conclusions A lower SARS-CoV-2 infection-related mortality was observed in patients treated with statin therapy prior to hospitalization. Statin therapy should not be discontinued due to the global concern of the pandemic or in patients hospitalized for COVID-19.
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Affiliation(s)
- Lluís Masana
- CIBERDEM, Universitat Rovira i Virgili, LIPIDCAS, University Hospital Sant Joan IISPV, Reus, Spain
| | - Eudald Correig
- Statistics Department, Institut Investigació Sanitaria Pere Virgili, Reus, Spain
| | - Cèlia Rodríguez-Borjabad
- CIBERDEM, Universitat Rovira i Virgili, LIPIDCAS, University Hospital Sant Joan IISPV, Reus, Spain
| | - Eva Anoro
- LIPIDCAS, Pius Hospital Valls, Valls, Spain
| | - Juan Antonio Arroyo
- Lipid Unit, University Hospital Santa Creu i Sant Pau, Barcelona Autonomous University, Barcelona, Spain
| | - Carlos Jericó
- Lipid Unit, Hospital Moises Broggi. Consorci Sanitari Integral. Sant Joan Despí, Spain
| | | | - Marcel la Miret
- LIPIDCAS, Endocrinology Department, Hospital Verge de la Cinta, Tortosa, Spain
| | - Silvia Näf
- LIPIDCAS, Endocrinology Department, University Hospital Joan XXIII, IISPV. CIBERDEM. Universitat Rovira i Virgili., Tarragona, Spain
| | - Anna Pardo
- Internal Medicine Department, Hospital Delfos, Barcelona, Spain
| | | | | | - Núria Plana
- CIBERDEM, Universitat Rovira i Virgili, LIPIDCAS, University Hospital Sant Joan IISPV, Reus, Spain
| | | | - Meritxell Royuela
- Lipid Unit, ALTHAIA, Xarxa Assistencial Universitària de Manresa, Spain
| | | | - Maria Urquizu-Padilla
- Lipid Unit, University Hospital Vall d'Hebron, Barcelona Autonomous University, Barcelona, Spain
| | - Alberto Zamora
- Lipid Unit, Corporació de Salut del Maresme i la Selva, Hospital de Blanes, Spain
| | - Juan Pedro-Botet
- Lipid Unit, University Hospital del Mar, Barcelona Autonomous University, Barcelona, Spain
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Ruiz A, Michalopoulou T, Megia A, Näf S, Simón-Muela I, Solano E, Martínez L, Vendrell J. Accuracy of new recommendations for adrenal incidentalomas in the evaluation of excessive cortisol secretion and follow-up. Eur J Clin Invest 2019; 49:e13048. [PMID: 30412278 DOI: 10.1111/eci.13048] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/28/2018] [Accepted: 11/02/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate whether the 2016 European Society of Endocrinology (ESE) recommendations for the management of adrenal incidentalomas accurately classifies those patients who do not require further follow-up. DESIGN AND METHODS Single centre retrospective study. From 2010 to 2015, 130 patients with adrenal incidentaloma were evaluated and followed-up. Clinical, analytical and radiological data were recorded and the presence of comorbidities was assessed. Patients were grouped as nonfunctional or subclinical Cushing syndrome according to American guidelines; and nonfunctional, possible autonomous cortisol secretion and autonomous cortisol secretion, according to ESE guidelines. RESULTS Based on American guidelines, 94% of patients had nonfunctional adrenal incidentalomas and 6% had subclinical Cushing syndrome. Based on ESE guidelines, patients were classified into nonfunctional (54%), possible autonomous cortisol secretion (40%) and autonomous cortisol secretion (6%) groups. No differences were observed in demographic characteristics and comorbidities between groups in either classification. Following ESE guidelines, no patient in the nonfunctional group was reclassified into the possible autonomous or autonomous cortisol secretion groups during follow-up, but one patient in the possible autonomous cortisol secretion group was reclassified into the autonomous cortisol secretion group. Also, 30 patients included in the groups of possible autonomous or autonomous cortisol secretion experienced progression of a comorbidity associated with cortisol excess, with diabetes mellitus as the most frequent comorbidity observed. CONCLUSION Although adrenal incidentalomas with an excess of cortisol secretion were more frequently diagnosed with the new ESE recommendations, patients who did not require longer follow-up after first evaluation were accurately classified.
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Affiliation(s)
- Ana Ruiz
- Department of Endocrinology and Nutrition, Joan XXIII University Hospital, Tarragona, Spain
| | - Theodora Michalopoulou
- Department of Endocrinology and Nutrition, Joan XXIII University Hospital, Tarragona, Spain.,IISPV, Ciberdem, Rovira i Virgili University, Tarragona, Spain
| | - Ana Megia
- Department of Endocrinology and Nutrition, Joan XXIII University Hospital, Tarragona, Spain.,IISPV, Ciberdem, Rovira i Virgili University, Tarragona, Spain
| | - Silvia Näf
- Department of Endocrinology and Nutrition, Joan XXIII University Hospital, Tarragona, Spain.,IISPV, Ciberdem, Rovira i Virgili University, Tarragona, Spain
| | - Inmaculada Simón-Muela
- Department of Endocrinology and Nutrition, Joan XXIII University Hospital, Tarragona, Spain.,IISPV, Ciberdem, Rovira i Virgili University, Tarragona, Spain
| | - Esther Solano
- Department of Endocrinology and Nutrition, Joan XXIII University Hospital, Tarragona, Spain.,IISPV, Ciberdem, Rovira i Virgili University, Tarragona, Spain
| | - Laia Martínez
- Department of Endocrinology and Nutrition, Joan XXIII University Hospital, Tarragona, Spain.,IISPV, Ciberdem, Rovira i Virgili University, Tarragona, Spain
| | - Joan Vendrell
- Department of Endocrinology and Nutrition, Joan XXIII University Hospital, Tarragona, Spain.,IISPV, Ciberdem, Rovira i Virgili University, Tarragona, Spain
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Megia A, Gil-Lluis P, Näf S, Ceperuelo-Mallafré V, Gonzalez-Clemente JM, Llauradó G, Nuñez-Roa C, Roche K, Ballesteros M, Yañez RE, Fernández-Veledo S, Vendrell J. Cord blood FGF21 in gestational diabetes and its relationship with postnatal growth. Acta Diabetol 2015; 52:693-700. [PMID: 25604041 DOI: 10.1007/s00592-014-0705-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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] [Received: 07/29/2014] [Accepted: 12/19/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND/OBJECTIVES To study whether FGF21 was present in cord blood and explore its relationship with maternal variables and postnatal growth. SUBJECTS AND METHODS The study included 157 pregnant women at the beginning of the third trimester; 79 with gestational diabetes (GDM), 78 with normal glucose tolerance (NGT), and their offspring. Glucose metabolism was assessed by oral glucose tolerance test. Insulin resistance was assessed by homeostasis model assessment index-insulin resistance (HOMA-IR). FGF21 was determined in maternal plasma drawn at recruitment and in cord blood obtained at delivery. Offspring weight and height was assessed at birth and at 12, 24 and 48 months. RESULTS Maternal FGF21 was higher in gestational diabetes than in the normal glucose-tolerant group, whereas similar cord blood FGF21 levels were observed in both groups. Lower cord blood FGF21 was strongly positively correlated with maternal circulating levels. This relationship was independent of mother's prepregnancy body mass index (BMI), glucose levels and HOMA-IR. Although maternal FGF21 levels were correlated with prepregnancy BMI and HOMA-IR index, no relationship was observed between FGF21 and birth weight. However, cord blood FGF21 levels were correlated with BMI Zeta Score at 12 and 24 months, and this relationship became stronger when only the NGT group was analyzed. CONCLUSION FGF21 is present in human cord blood, and its levels are closely correlated with maternal levels. The association observed between cord blood FGF21 and postnatal BMI may suggest a potential role during intrauterine life that may influence future metabolic imbalance.
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Affiliation(s)
- Ana Megia
- Endocrinology and Nutrition Section, Hospital Universitari de Tarragona Joan XXIII, Institut Investigació Sanitaria Pere Virgili, Universitat Rovira i Virgili, C/Dr. Mallafré Guasch, 4, 43007, Tarragona, Spain,
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Simón-Muela I, Llauradó G, Chacón MR, Olona M, Näf S, Maymó-Masip E, Gil P, de la Flor M, Gonzalez Clemente JM, Vendrell J, Megía A. Reduced circulating levels of TWEAK are associated with gestational diabetes mellitus. Eur J Clin Invest 2015; 45:27-35. [PMID: 25443800 DOI: 10.1111/eci.12375] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 11/10/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND To evaluate the inflammatory axis mediated by tumour necrosis factor-like weak inducer of apoptosis (TWEAK) and its scavenger receptor CD163 during pregnancy and their influence on insulin sensitivity in normal pregnancy and in gestational diabetes mellitus (GDM). MATERIALS AND METHODS One hundred and thirty seven women with one singleton pregnancy, 71 with normal glucose tolerance (NGT) and 66 with GDM were studied. Glucose metabolism was assessed by oral glucose tolerance test. Serum concentrations of soluble TWEAK (sTWEAK) and CD163 (sCD163) and insulin resistance (HOMA-IR index) were determined in maternal blood drawn at recruitment, in the early third trimester. Offspring weight and height were assessed at birth. RESULTS Women with GDM had lower circulating sTWEAK concentrations than control NGT group (237·8 (192·1-301·0) pg/mL vs. 277·2 (206·4-355·7) pg/mL; P = 0·013). sTWEAK was negatively associated with the presence of GDM (r = -0·212; P = 0·013), HOMA-IR index (r = -0·197; P = 0·021) and ponderal index of the newborn (r = -0·196; P = 0·025), but positively with HDL cholesterol (r = 0·283; P = 0·001). In multiple regression analysis, sTWEAK concentration emerged as one of the main predictors of insulin resistance, along with BMI, triglycerides and low concentrations of HDL cholesterol (R(2) = 0·486; P < 0·001). No relationship was found between HOMA-IR index and sCD163 or sCD163/sTWEAK ratio. CONCLUSIONS sTWEAK concentrations are lower in patients with GDM compared with healthy pregnant women, and low concentrations of sTWEAK are associated with insulin resistance. These findings suggest that insulin resistance during pregnancy is closely linked to inflammatory imbalance and sTWEAK may represent a new candidate associated with GDM.
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Affiliation(s)
- Inmaculada Simón-Muela
- Endocrinology, Diabetes and Nutrition Section, Hospital Universitari de Tarragona Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain; Institut d'Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
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8
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Näf S, Escote X, Ballesteros M, Yañez RE, Simón-Muela I, Gil P, Albaiges G, Vendrell J, Megia A. Serum activin A and follistatin levels in gestational diabetes and the association of the Activin A-Follistatin system with anthropometric parameters in offspring. PLoS One 2014; 9:e92175. [PMID: 24763182 PMCID: PMC3998926 DOI: 10.1371/journal.pone.0092175] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 02/19/2014] [Indexed: 11/18/2022] Open
Abstract
CONTEXT The Activin A-Follistatin system has emerged as an important regulator of lipid and glucose metabolism with possible repercussions on fetal growth. OBJECTIVE To analyze circulating activin A, follistatin and follistatin-like-3 (FSTL3) levels and their relationship with glucose metabolism in pregnant women and their influence on fetal growth and neonatal adiposity. DESIGN AND METHODS A prospective cohort was studied comprising 207 pregnant women, 129 with normal glucose tolerance (NGT) and 78 with gestational diabetes mellitus (GDM) and their offspring. Activin A, follistatin and FSTL3 levels were measured in maternal serum collected in the early third trimester of pregnancy. Serial fetal ultrasounds were performed during the third trimester to evaluate fetal growth. Neonatal anthropometry was measured to assess neonatal adiposity. RESULTS Serum follistatin levels were significantly lower in GDM than in NGT pregnant women (8.21±2.32 ng/mL vs 9.22±3.41, P = 0.012) whereas serum FSTL3 and activin A levels were comparable between the two groups. Serum follistatin concentrations were negatively correlated with HOMA-IR and positively with ultrasound growth parameters such as fractional thigh volume estimation in the middle of the third trimester and percent fat mass at birth. Also, in the stepwise multiple linear regression analysis serum follistatin levels were negatively associated with HOMA-IR (β = -0.199, P = 0.008) and the diagnosis of gestational diabetes (β = -0.138, P = 0.049). Likewise, fractional thigh volume estimation in the middle of third trimester and percent fat mass at birth were positively determined by serum follistatin levels (β = 0.214, P = 0.005 and β = 0.231, P = 0.002, respectively). CONCLUSIONS Circulating follistatin levels are reduced in GDM compared with NGT pregnant women and they are positively associated with fetal growth and neonatal adiposity. These data suggest a role of the Activin-Follistatin system in maternal and fetal metabolism during pregnancy.
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Affiliation(s)
- Silvia Näf
- Endocrinology and Diabetes Unit, Hospital Universitari Joan XXIII, Tarragona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, Tarragona, Spain
- * E-mail:
| | - Xavier Escote
- Endocrinology and Diabetes Unit, Hospital Universitari Joan XXIII, Tarragona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, Tarragona, Spain
| | - Mónica Ballesteros
- Obstetrics and Gynecology Service, Hospital Universitari Joan XXIII, Tarragona, Spain, IISPV, Universitat Rovira i Virgili, Tarragona, Spain
| | - Rosa Elena Yañez
- Endocrinology and Diabetes Unit, Hospital Universitari Joan XXIII, Tarragona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, Tarragona, Spain
| | - Inmaculada Simón-Muela
- Endocrinology and Diabetes Unit, Hospital Universitari Joan XXIII, Tarragona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, Tarragona, Spain
| | - Pilar Gil
- Endocrinology and Diabetes Unit, Hospital Universitari Joan XXIII, Tarragona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, Tarragona, Spain
| | - Gerard Albaiges
- Obstetrics and Gynecology Service, Hospital Universitari Joan XXIII, Tarragona, Spain, IISPV, Universitat Rovira i Virgili, Tarragona, Spain
| | - Joan Vendrell
- Endocrinology and Diabetes Unit, Hospital Universitari Joan XXIII, Tarragona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, Tarragona, Spain
| | - Ana Megia
- Endocrinology and Diabetes Unit, Hospital Universitari Joan XXIII, Tarragona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, Tarragona, Spain
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Simón-Muela I, Näf S, Ballesteros M, Vendrell J, Ceperuelo-Mallafre V, de la Flor M, Megia A. Gender determines the actions of adiponectin multimers on fetal growth and adiposity. Am J Obstet Gynecol 2013; 208:481.e1-7. [PMID: 23467049 DOI: 10.1016/j.ajog.2013.02.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 01/07/2013] [Accepted: 02/25/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE We sought to analyze the role of cord blood adiponectin and its multimeric forms in neonatal adiposity and fetal growth velocity (FGV) during the third trimester of pregnancy according to fetal gender. STUDY DESIGN This was a prospective analytical observational study conducted at the Diabetes and Pregnancy Unit, University Hospital Joan XXIII, Tarragona, Spain. In all, 96 healthy pregnant women were included in the early third trimester and were followed up until delivery. Maternal blood was obtained upon recruitment, and cord blood was obtained at delivery. Serial fetal ultrasounds were performed during the third trimester to assess FGV. Skinfolds were measured after birth to assess neonatal adiposity. Adiponectin multimers were determined in maternal and cord blood. RESULTS In female neonates, adiposity and FGV in the late third trimester were correlated positively with cord blood insulin (r = 0.343, P = .015 and r = 0.430, P = .002, respectively) and maternal pregravid body mass index (r = 597, P < .001 and r = 0.428, P = .002, respectively), and negatively with maternal high-molecular-weight (HMW)/total adiponectin ratio (r = -0.269, P = .035 and r = -0.387, P = .005, respectively), but in the stepwise multiple regression model, the main determinants were cord blood insulin, pregravid body mass index, and cord blood HMW adiponectin. Otherwise, in male neonates, adiposity and fetal growth were correlated with cord blood low-molecular-weight adiponectin (r = 0.486, P = .003 and r = 0.394, P = .020, respectively), and it was this multimeric form that emerged as an independent determinant in the stepwise regression model. CONCLUSION Adiponectin seems to determine fetal growth and adipose tissue accretion, and low molecular weight is more specifically implicated in males, whereas the HMW isoform may be more important in females.
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Näf S, Escote X, Yañez RE, Ballesteros M, Simón I, Gil P, Megia A, Vendrell J. Zinc-α2-glycoprotein is unrelated to gestational diabetes: anthropometric and metabolic determinants in pregnant women and their offspring. PLoS One 2012; 7:e47601. [PMID: 23272038 PMCID: PMC3525576 DOI: 10.1371/journal.pone.0047601] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 09/17/2012] [Indexed: 12/16/2022] Open
Abstract
Context Zinc-α2-Glycoprotein (ZAG) is an adipokine with lipolytic action and is positively associated with adiponectin in adipose tissue. We hypothesize that ZAG may be related with hydrocarbonate metabolism disturbances observed in gestational diabetes mellitus (GDM). Objective The aim of this study was to analyze serum ZAG concentration and its relationship with carbohydrate metabolism in pregnant women and its influence on fetal growth. Design 207 pregnant women (130 with normal glucose tolerance (NGT) and 77 with GDM) recruited in the early third trimester and their offspring were studied. Cord blood was obtained at delivery and neonatal anthropometry was assessed in the first 48 hours. ZAG was determined in maternal serum and cord blood. Results ZAG concentration was lower in cord blood than in maternal serum, but similar concentration was observed in NGT and GDM pregnant women. Also similar levels were found between offspring of NGT and GDM women. In the bivariate analysis, maternal ZAG (mZAG) was positively correlated with adiponectin and HDL cholesterol, and negatively correlated with insulin and triglyceride concentrations, and HOMA index. On the other hand, cord blood ZAG (cbZAG) was positively correlated with fat-free mass, birth weight and gestational age at delivery. After adjusting for confounding variables, gestational age at delivery and HDL cholesterol emerged as the sole determinants of cord blood ZAG and maternal ZAG concentrations, respectively. Conclusion mZAG was not associated with glucose metabolism during pregnancy. ZAG concentration was lower in cord blood compared with maternal serum. cbZAG was independently correlated with gestational age at delivery, suggesting a role during the accelerated fetal growth during latter pregnancy.
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Affiliation(s)
- Silvia Näf
- Endocrinology and Diabetes Unit, Hospital Universitari de Tarragona Joan XXIII, Institut d'Investigació Sanitària Pere Virgili IISPV, Universitat Rovira i Virgili, Tarragona, Spain.
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11
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Abstract
To investigate the role of HbA1c in postpartum reclassification of gestational diabetes (GDM) we studied 364 women with GDM attending the postpartum reclassification assessment of their glucose tolerance status. A 75-g oral glucose tolerance test (OGTT) was performed and HbA1c was determined. Diabetes was diagnosed in 12 (3.3%), 7 (1.9%) and 2 (0.6%) women according to the fasting plasma glucose (FPG) and/or the 2-hour OGTT, the FPG alone and HbA1c levels, respectively. The sensitivity and specificity for HbA1c to diagnose diabetes was 16.7% and 100%, respectively, for FPG and OGTT criteria. The combination of a cutoff value of 5.5% for HbA1c and FPG allowed us to identify 95.1% of women with any kind of glucose intolerance. We conclude that in the early postpartum period, the cutoff of 6.5% for HbA1c alone has low sensitivity for the diagnosis of diabetes compared with OGTT, but the combination of FPG and HbA1c at a lower cutoff value is very useful to identify women with any kind of glucose intolerance.
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Affiliation(s)
- A Megia
- University Hospital Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain.
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12
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Osorio-Conles O, Guitart M, Chacón MR, Maymo-Masip E, Moreno-Navarrete JM, Montori-Grau M, Näf S, Fernandez-Real JM, Vendrell J, Gómez-Foix AM. Plasma PTX3 protein levels inversely correlate with insulin secretion and obesity, whereas visceral adipose tissue PTX3 gene expression is increased in obesity. Am J Physiol Endocrinol Metab 2011; 301:E1254-61. [PMID: 21900125 DOI: 10.1152/ajpendo.00163.2011] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [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: 12/14/2022]
Abstract
Plasma acutephase protein pentraxin 3 (PTX3) concentration is dysregulated in human obesity and metabolic syndrome. Here, we explore its relationship with insulin secretion and sensitivity, obesity markers, and adipose tissue PTX3 gene expression. Plasma PTX3 protein levels were analyzed in a cohort composed of 27 lean [body mass index (BMI) ≤ 25 kg/m(2)] and 48 overweight (BMI 25-30 kg/m(2)) men (cohort 1). In this cohort, plasma PTX3 was negatively correlated with fasting triglyceride levels and insulin secretion after intravenous and oral glucose administration. Plasma PTX3 protein and PTX3 gene expression in visceral (VAT) and subcutaneous (SAT) whole adipose tissue and adipocyte and stromovascular fractions were analyzed in cohort 2, which was composed of 19 lean, 28 overweight, and 15 obese subjects (BMI >30 kg/m(2)). An inverse association with body weight and waist/hip ratio was observed in cohort 2. In VAT depots, PTX3 mRNA levels were higher in subjects with BMI >25 kg/m(2) than in lean subjects, positively correlated with IL-1β mRNA levels, and higher in the adipocyte than stromovascular fraction. Human preadipocyte SGBS cell line was used to study PTX3 production in response to factors that obesity entails. In SGBS adipocytes, PTX3 gene expression was enhanced by IL-1β and TNFα but not IL-6 or insulin. In conclusion, the negative correlation between PTX3 and glucose-stimulated insulin secretion suggests a role for PTX3 in metabolic control. PTX3 gene expression is upregulated in VAT depots in obesity, despite lower plasma PTX3 protein, and by some proinflammatory cytokines in cultured adipocytes.
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Affiliation(s)
- O Osorio-Conles
- Departament de Bioquímica i Biologia Molecular, Universitat de Barcelona, Diagonal, 645, E-08028-Barcelona, Spain.
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13
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Ceperuelo-Mallafré V, Näf S, Escoté X, Caubet E, Gomez JM, Miranda M, Chacon MR, Gonzalez-Clemente JM, Gallart L, Gutierrez C, Vendrell J. Circulating and adipose tissue gene expression of zinc-alpha2-glycoprotein in obesity: its relationship with adipokine and lipolytic gene markers in subcutaneous and visceral fat. J Clin Endocrinol Metab 2009; 94:5062-9. [PMID: 19846741 DOI: 10.1210/jc.2009-0764] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [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: 11/19/2022]
Abstract
CONTEXT Zinc-alpha2-glycoprotein (ZAG) is a soluble protein similar to the class I major histocompatibility complex heavy chain, which has been implicated in lipid catabolism. We hypothesized that ZAG mRNA expression in adipose tissue may be linked with lipolytic and adipokine gene expression and have a close relationship with clinical phenotype. OBJECTIVES The objective of the study was to analyze ZAG gene expression in human adipose tissue from lean and obese subjects. ZAG circulating plasma levels and its relationship with cardiometabolic risk factors were also studied. DESIGN Seventy-three Caucasian (43 male and 30 female) subjects were included. Plasma and adipose tissue [sc (SAT) and visceral (VAT)] from the same patient were studied. mRNA of PPARgamma, hormone-sensitive lipase (HSL), adipose triglyceride lipase, adiponectin, omentin, visfatin, and ZAG were quantified. Plasma concentrations of ZAG were determined with ELISA. RESULTS ZAG plasma levels showed a negative correlation with insulin (r = -0.39; P = 0.008) and the homeostasis model assessment for insulin resistance index (r = -0.36; P = 0.016). No differences in ZAG circulating levels according to body mass index classification were observed. ZAG expression in SAT was significantly reduced in overweight and obese individuals compared with lean subjects (P < 0.001 and P = 0.007, respectively). ZAG mRNA expression in both SAT and VAT depots were negatively correlated with many clinical and metabolic cardiovascular risk factors. After multiple linear regression analysis, SAT ZAG was mainly predicted by adiponectin mRNA expression (B = 0.993; P < 0.0001) and plasma triglyceride levels (B = -0.565; P = 0.006). VAT ZAG expression was predicted by adiponectin expression (B = 0.449; P < 0.0001), and HSL VAT expression (B = 0.180; P = 0.023). CONCLUSIONS The present study provides evidence of a role of ZAG gene in adipose tissue metabolism, with a close association with adiponectin gene expression in sc and visceral fat.
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Affiliation(s)
- V Ceperuelo-Mallafré
- Endocrinology and Nutrition Unit, Research Department, University Hospital of Tarragona Joan XXIII, Pere Virgili Institute, 43007 Tarragona, Spain
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14
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Conget I, Aguilera E, Pellitero S, Näf S, Bendtzen K, Casamitjana R, Gomis R, Nicoletti F. Lack of effect of intermittently administered sodium fusidate in patients with newly diagnosed type 1 diabetes mellitus: the FUSIDM trial. Diabetologia 2005; 48:1464-8. [PMID: 15995847 DOI: 10.1007/s00125-005-1823-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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] [Received: 01/04/2005] [Accepted: 03/30/2005] [Indexed: 10/25/2022]
Abstract
AIMS/HYPOTHESIS We evaluated in a double-blind study the effect of early treatment with the immunomodulatory drug fusidin in patients with newly diagnosed type 1 diabetes mellitus. METHODS Twenty-eight adults with newly diagnosed type 1 diabetes were included in the study. The patients were randomly assigned (computer-generated random number sequence) to two experimental groups. Patients allocated to the fusidin (FUS) group (n=15) received sodium fusidate (fusidin; 500 mg orally three times daily for 4 weeks). Subsequently the drug was given at the same dose and scheduled for two consecutive weeks a month followed by 2 weeks a month without the drug for 20 weeks. Subjects allocated to the placebo (PCB) group (n=13) received placebo according to the same schedule and conditions described for sodium fusidate in the FUS group. All patients received a diet adjusted to their age and BMI, and intensive insulin therapy. RESULTS There were no statistically significant differences between the FUS and PCB groups in beta cell function, evaluated by basal and glucagon-stimulated C-peptide values during the follow-up (24 and 48 weeks). There was also no difference between the two groups in insulin requirement after 48 weeks (0.4+/-0.2 and 0.4+/-0.2 U/kg body weight for the FUS and PCB groups, respectively). Antibody titres, including insulin autoantibodies, were similar in the two groups during the follow-up. CONCLUSIONS/INTERPRETATION Early treatment of newly diagnosed type 1 diabetes patients with intermittently administered fusidin failed to influence the natural course of the disease.
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Affiliation(s)
- I Conget
- Endocrinology and Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain.
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15
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Abstract
AIMS The aims of the study were to determine whether transforming growth factor beta1 TGF-beta1 levels are raised at diagnosis of Type 1 diabetes mellitus and are related to blood glucose. SUBJECTS AND METHODS Fourteen patients (mean age 24.3 +/- 4.9 years) admitted to hospital for onset of Type 1 diabetes were studied. On the first day of hospitalization, before insulin therapy, and at 1, 4 and 16 weeks, fasting blood glucose, HbA(1c), lipid profile and TGF-beta1 levels and TGF-beta1 levels in 24-h urine were determined. The control group included 14 non-diabetic subjects with similar characteristics to those of the diabetic group. RESULTS Plasma and urinary TGF-beta1 levels were significantly lower in controls (4.7 (1.6-6.8) ng/ml P < 0.001; 5.7 (1.5-8.5) ng/mg urinary creatinine, P < 0.01) than in patients with Type 1 diabetes mellitus [10.5 (1.8-24.9) ng/ml; 10.1 (4.2-29.8) ng/mg urinary creatinine]. On study completion, HbA(1c) fell from 11.6 +/- 2.0 to 5.4 +/- 0.6% (P < 0.001). Improved metabolic control was not associated with changes in plasma (9.4 (2.6-19.5)/5.9 (1.6-21.5)/7.0 (2.3-30.2)/10.5 (1.8-24.9) ng/ml at baseline, 1, 4 and 16 weeks, respectively) or urinary (12.0 (4.7-29.5)/10.9 (1.5-20.5)/8.7 (4.3-16.9)/10.1 (4.2-29.8) ng/mg urinary creatinine) TGF-beta1 levels. A statistically significant correlation was observed between plasma TGF-beta1 and insulin dosage (U/kg/day) (r = 0.52, P = 0.037). CONCLUSIONS The increased TGF-beta1 production observed herein was not modulated by glycaemic reduction and could be a response to immuno-inflammatory activation present at the onset of Type 1 diabetes.
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Affiliation(s)
- L Flores
- Diabetes Unit, Hospital Clínic, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, Barcelona, Spain
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Näf S, José Ricart M, Recasens M, Astudillo E, Fernández-Cruz L, Esmatjes E. Macrovascular events after kidney-pancreas transplantation in type 1 diabetic patients. Transplant Proc 2003; 35:2019-20. [PMID: 12962882 DOI: 10.1016/s0041-1345(03)00711-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND There are few studies concerning the effect of kidney-pancreas transplantation (KPTx) on the progression of macrovascular disease in type 1 diabetic patients. The aim of our study was to retrospectively evaluate the incidence of macrovascular events after functioning KPTx. MATERIALS AND METHODS We studied 146 patients (96 men and 50 women) who had undergone KPTx from February 1983 to September 2001, with more than 1 year of evolution of both grafts functioning normally. The mean follow-up of the patients after KPTx was 5+/-3 years. RESULTS Before KPTx, 29 patients displayed 42 macrovascular events. During the follow-up after transplantation, intermittent claudication remained in 25 patients (86.2%) with 11 new macrovascular events (1 stroke, 1 angina pectoris, 1 myocardial infarction, and 8 minor amputations) in 10 patients (34%). Among the 117 patients without antecedent macrovascular events prior to KPTx, 38 (32.5%) experienced a total of 63 macrovascular events (26 intermittent claudication, 4 stroke, 8 angina pectoris, 7 myocardial infarction, 11 minor amputations, and 7 major amputations). Before transplantation, 88.4% of the patients presented with hypertension, 42.5% a history of smoking, and 14.4% previous treatment for dyslipidmia. After transplantation, we observed an important reduction in the percentage of patients with hypertension (48.6%) and smoking (25.5%), without a change in the prevalence of dyslipemia (19.9%). Hypertension after transplantation was clearly associated with the appearance or persistence of macrovascular events. CONCLUSION In our experience, 43% of the transplant recipients present with macrovascular events. It is important to note the elevated prevalence of cardiovascular risk factors in the patients who underwent KPTx.
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Affiliation(s)
- S Näf
- Endocrinology and Diabetes Unit, Institut d'Investigacions Biomèèdiques August Pii Sunyer, Hospital Clínic i Univeritari, Barcelona, Spain
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Näf S, Esmatjes E, Recasens M, Valero A, Halperin I, Levy I, Gomis R. Continuous subcutaneous insulin infusion to resolve an allergy to human insulin. Diabetes Care 2002; 25:634-5. [PMID: 11874967 DOI: 10.2337/diacare.25.3.634-a] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Simó O, Näf S, Martínez de Osaba MJ, Halperin I. [Unexpected etiology of virilization in postmenopausal woman]. Med Clin (Barc) 2001; 117:599. [PMID: 11714462 DOI: 10.1016/s0025-7753(01)72191-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- O Simó
- Servicio de Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona
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