Adult height and glucose tolerance: a re-appraisal of the importance of body mass index.

AIM: To study both the association between adult height and glucose regulation based on findings from a 75-g oral glucose tolerance test, and the combined effect of height and adiposity on glucose values. METHODS: We conducted a population-based, cross-sectional study among apparently healthy people with high cardiovascular risk living in south-western Finland. The study included 2659 participants aged 45-70 years, who had at least one cardiovascular risk factor but no previously diagnosed diabetes or manifested cardiovascular disease. An oral glucose tolerance test was performed in all participants. Height and weight were measured and BMI was calculated. The participants were divided into five height groups based on normal distribution. For further analysis of the association between height and glucose concentrations the participants were divided into four BMI groups (<25.0 kg/m2 ; 25-29.9 kg/m2 ; 30-34.9 kg/m2 ; ≥35 kg/m2 ). Data were analysed using age-adjusted linear regression models. RESULTS: Height was inversely associated with 2-h plasma glucose, but not with fasting plasma glucose concentration. No gender difference was observed. The 2-h plasma glucose values increased with an increase in BMI, so that height was inversely associated with 2-h plasma glucose in the three lowest BMI groups, but not in the highest BMI group (P=0.33). CONCLUSIONS: Taller people had lower 2-h plasma glucose concentrations than shorter people, up to a BMI of 35 kg/m2 . Adjustment for height and BMI is needed for accurate interpretation of oral glucose tolerance tests.

How to assess kidney function in outpatient clinics.

BACKGROUND: In 2002, a new definition and classification of chronic kidney disease was published, and glomerular filtration rate < 60 ml/min/1.73 m(2) for 3 months or more was adapted to define chronic kidney disease irrespective of other signs of kidney damage. AIMS: To discuss different ways to assess kidney function in outpatient clinics and especially in primary care. METHODS: The PubMed database was searched for relevant articles. RESULTS: The estimated glomerular filtration rate equations which take into account plasma creatinine, age, sex, race and body size have been developed to identify patients with chronic kidney disease formerly overlooked if the renal function had been assessed by plasma creatinine alone. Cystatin C-based equations have also been developed to enhance accuracy for individuals with whom creatinine-based estimates for kidney function are acknowledged to be less accurate. DISCUSSION: The characteristics of the patients to whom the diagnostic test is applied can influence the sensitivity of the test. Thus, there is nowadays controversy over the best method to assess kidney function in general population. CONCLUSION: In the overwhelming majority of patients currently treated in primary care, the CKD-EPI creatinine equation is suitable for estimating renal function. The CKD-EPIcr-cys equation would provide further reliability in individuals with a CKD-EPI creatinine eGFR of 45-59 ml/min/1.73 m(2) , but the cost of serum cystatin C analysis limits its use in everyday general practice.

Patients with resistant hypertension have more peripheral arterial disease than other uncontrolled hypertensives.

The aim of this study was to investigate whether resistant hypertension differs from uncontrolled and controlled hypertension in terms of target organ damage. Hypertensive subjects with antihypertensive medication (n=385) were identified in a population survey conducted in southwestern Finland. None of the study subjects had previously diagnosed cardiovascular or renal disease or diabetes. Ankle-brachial index, estimated glomerular filtration rate, electrocardiogram-determined left ventricular hypertrophy and cardiometabolic risk factors were assessed. The prevalence of peripheral arterial disease among subjects with resistant, uncontrolled and controlled hypertension was 6/37 (16%), 22/275 (8%) and 0/73 (0%), respectively (P=0.006). There were no differences in the prevalence of renal insufficiency, left ventricular hypertrophy or metabolic parameters between the groups. Resistant hypertension affects vasculature more than uncontrolled hypertension, and thus it can be regarded as a marker of more severe disease.