Clinical features of and risk factors for normoalbuminuric diabetic kidney disease in hospitalized patients with type 2 diabetes mellitus: a retrospective cross-sectional study.

BACKGROUND: Normoalbuminuric diabetic kidney disease (NADKD) is a newly defined DKD, the clinical features and pathogenesis for which are still being understood. This study aimed to investigate the features and risk factors for NADKD in patients with type 2 diabetes mellitus (T2DM). METHODS: A retrospective cross-sectional study was conducted. The related clinical and laboratory data of patients with T2DM hospitalized between August 2012 and January 2020 were collected for statistical analysis. We classified the patients with T2DM into four groups on the basis of the presence or absence of albuminuria and reduced estimated glomerular filtration rate (eGFR). Analysis of variance, the Kruskal-Wallis test, and the chi-square test were used to compare the groups. Binary logistic regression analyses with a forward stepwise method were performed to explore the risk factors for renal dysfunction in hospitalized patients with normoalbuminuric T2DM. RESULTS: Among the 1620 patients evaluated, 500 (30.9%) had DKD, of which 9% had NADKD. The prevalence of stroke, cardiovascular events, carotid plaque, and peripheral arterial disease in NADKD was significantly higher than in a non-DKD control group (normoalbuminuric T2DM patients with eGFR of ≥60 ml/min/1.73 m2). Regression analyses revealed that three significant independent factors were associated with NADKD: age (OR = 1.089, confidence interval [CI] 95% [1.055-1.123], p < 0.001), previous use of renin-angiotensin system inhibitors (RASIs; OR = 2.330, CI 95% [1.212-4.481], p = 0.011), and glycated hemoglobin (HbA1c; OR = 0.839, CI 95% [0.716-0.983], p = 0.03). CONCLUSIONS: NADKD is mainly associated with macrovascular rather than microvascular complications. NADKD is more common in patients with normoalbuminuric T2DM with older age, previous use of RASIs, and good glycemic control.

Serum alanine aminotransferase independently correlates with intrahepatic triglyceride contents in obese subjects.

BACKGROUND AND AIM: Liver enzymes including serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyltransferase (GGT) are well recognized as surrogate makers reflecting non-alcoholic fatty liver disease (NAFLD). However, the associations of serum ALT, AST and GGT with hepatic lipid contents are not well established. The aim of this study was to investigate the relationship between liver enzymes and intrahepatic triglyceride (IHTG) contents, and explore the feasibility in using liver enzymes to reflect accumulation of IHTG in obese subjects. METHODS: A cross-sectional analysis was conducted in 475 obese adults aged 40-65 years. Anthropometric parameters and blood biochemical indexes including liver enzymes, glucose and lipid profiles were measured. The liver triglyceride contents of subjects were determined by (1)H-MRS. RESULTS: Serum ALT, AST and GGT were positively correlated with IHTG contents (p < 0.01). Serum ALT, AST and GGT levels at the highest quartile of IHTG contents were significantly elevated as compared with those in the lowest quartile (p < 0.01). Multivariate linear regression analysis demonstrated that serum ALT, but not AST or GGT was independently associated with IHTG contents. By logistic regression analysis, the odds ratio for higher IHTG contents was increased by 1.464 times/1 SD increase in serum ALT level after adjusting for multiple confounding factors [OR (95% CI) 2.464 (1.584-3.834)]. However, these relationships could not be observed between serum AST or GGT with IHTG contents. CONCLUSIONS: Serum ALT level is independently correlated with the hepatic triglyceride contents in obese subjects and more appropriate to be used as a predictor for the degree of NAFLD rather than AST and GGT.

Irisin is inversely associated with intrahepatic triglyceride contents in obese adults.

BACKGROUND & AIMS: Obesity is closely related to non-alcoholic fatty liver disease (NAFLD), which has become an important public health problem because of its high prevalence and association with metabolic syndromes. Irisin was recently identified as a novel peptide to improve obesity and glucose homeostasis, and considered to be therapeutic for human metabolic diseases. The aim of this study was to examine the association of serum irisin concentration and liver triglyceride contents in obese Chinese adults. METHODS: Serum irisin levels were measured and liver fat contents determined by (1)H MRS in 296 obese adults. Anthropometric parameters and blood biochemical indexes including liver enzymes, glucose, and lipid profiles were detected. The liver triglyceride contents of subjects were measured by (1)H MRS. The protein levels of irisin were determined by quantitative ELISA. RESULTS: We found that serum irisin levels were reduced in obese adults with NAFLD. By dividing the distribution of intrahepatic triglyceride (IHTG) contents into quartiles, serum irisin levels were reduced gradually with the increase of IHTG contents (p<0.01). Higher serum irisin levels were associated with preferable TG levels. Serum ALT and AST concentrations were inversely correlated with serum irisin levels. Multivariate linear regression analysis demonstrated that serum irisin levels were independently associated with liver fat (p<0.01). By logistic regression analysis, the odds ratio for higher IHTG contents was reduced by 12.4% per 1 SD increase in serum irisin concentrations after adjustment for multivariate metabolic factors [OR (95% CI); 0.876 (0.777-0.987)]. CONCLUSIONS: These results demonstrated that serum irisin concentrations were inversely associated with the triglyceride contents in the liver and liver enzymes in obese Chinese adults.

Disease progression associated with low bone mass in axial spondyloarthropathy patients.

Through statistical analysis, we have found that inflammation and low femoral and lumbar spine BMD were strongly correlated with a high SIJ CT grade, and inflammation, low vitamin D levels, and a longer disease course within a certain time range influenced bone loss in axSpA. PURPOSE: We investigated the relationship between bone mineral density (BMD), vitamin D, and computed tomography (CT)-based progression of disease grades of the sacroiliac joint (SIJ), and sought to identify parameters predicting low BMD in patients with axial spondyloarthropathy (axSpA). METHODS: We collected the ankylosis spondylitis disease activity score (ASDAS), the course of the disease, HLA-B27 status, and vitamin D and C-reactive protein (CRP) levels of 98 axSpA patients. Lumbar spine and femoral BMD were assessed by dual-energy X-ray (DXA), and SIJ grade was determined by CT. RESULTS: The axSpA patients (71 men, 27 women) with a mean age of 31.9 years (range 18-57 years) and body mass index 21.8 kg/m2 (range 15.6-30.6 kg/m2), with disease duration 4.5 years (range 0.3-30 years) were included. A longer disease course, higher CRP level, and lower femoral and lumbar spine BMD were independently related to a higher CT grade. Older age, longer disease course, elevated CRP, and high SIJ CT grade were independently related to lower BMD (femur and/or lumbar spine L1-L4 T scores ≤ -1). Older age, elevated CRP, low vitamin D levels, and high CT grade were independently associated with low femur and lumbar spine BMD. However, a longer disease course was independently related to low femur BMD, but not low lumbar spine BMD. CONCLUSIONS: Thus, inflammation and low femoral and lumbar spine BMD were strongly correlated with a high SIJ CT grade, and inflammation, low vitamin D levels, and a longer disease course within a certain time range influenced bone loss in axSpA.