Urine albumin/creatinine ratio below 30mg/g is a predictor of incident hypertension and cardiovascular mortality

BackgroundMicroalbuminuria is associated with cardiovascular disease (CVD) mortality, but whether lower levels of urine albumin excretion similarly predict CVD is uncertain. We investigated associations between urine albumin:creatinine ratio (UACR) <30 mg/g, and incident hypertension, incident diabetes mellitus, and all?cause and CVD mortality, during a maximum of 11 years of follow?up.Methods and ResultsIndividuals (37 091) in a health screening program between 2002 and 2012 with baseline measurements of UACR were studied. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs for incident hypertension, incident diabetes mellitus, and mortality outcomes (lowest UACR quartile as reference) at follow?up. For linear risk trends, the quartile rank was used as a continuous variable in regression models. Nine?hundred sixty?three cases of incident hypertension, 511 cases of incident diabetes mellitus, and 349 deaths occurred during follow?up. In the fully adjusted models, there was a significant HR for the association between UACR and incident hypertension (highest UACR quartile HR 1.95 [95% CI 1.51, 2.53], P?value for trend across UACR quartiles P<0.001). In contrast, the association between UACR and incident diabetes mellitus was not significant (highest UACR quartile, HR 1.15 [95% CI 0.79, 1.66], P?value for trend P=0.20). For CVD mortality, with increasing UACR quartiles, there was a significant increase in HR across quartiles, P=0.029, (for all?cause mortality, P=0.078).ConclusionsLow levels of albuminuria, UACR below 30 mg/g, are associated with increased risk of incident hypertension and CVD mortality at follow?up, but are not associated with increased risk of incident diabetes mellitus

Depression and increased risk of nonalcoholic fatty liver disease in individuals with obesity

Aims: the longitudinal relationship between depression and the risk of nonalcoholic fatty liver disease (NAFLD) is uncertain. We examined: a) the association between depressive symptoms and incident hepatic steatosis (HS), both with and without liver fibrosis; and b) the influence of obesity on this association. Methods: cohort of 142,005 Korean adults with neither HS nor excessive alcohol consumption at baseline were followed for up to 8.9 years. The validated Center for Epidemiologic Studies-Depression score (CES-D) was assessed at baseline, and subjects were categorized as non-depressed (a CES-D <8, reference) or depression (CES-D ≥16). HS was diagnosed by ultrasonography. Liver fibrosis was assessed by the fibrosis-4 index (FIB-4). Parametric proportional hazards models were used to estimate the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). Results: during a median follow-up of 4.0 years, 27,810 people with incident HS and 134 with incident HS plus high FIB-4 were identified. Compared with the non-depressed category, the aHR (95% CIs) for incident HS was 1.24 (1.15-1.34) for CES-D ≥16 among obese individuals, and 1.00 (0.95-1.05) for CES-D ≥16 among non-obese individuals (P for interaction with obesity <0.001). The aHR (95% CIs) for developing HS plus high FIB-4 was 3.41 (1.33-8.74) for CES-D≥16 among obese individuals, and 1.22 (0.60-2.47) for CES-D≥16 among non-obese individuals (P for interaction =0.201). Conclusions: depression was associated with an increased risk of incident HS and HS plus high probability of advanced fibrosis, especially among obese individuals

Glycemic status, insulin resistance, and mortality from lung cancer among individuals with and without diabetes

Background: The effects of glycemic status and insulin resistance on lung cancer remain unclear. We investigated the associations between both glycemic status and insulin resistance, and lung cancer mortality, in a young and middle-aged population with and without diabetes. Methods: This cohort study involved individuals who participated in routine health examinations. Lung cancer mortality was identified using national death records. Cox-proportional hazards models were used to calculate hazard ratios (HRs) with 95% CIs for lung cancer mortality risk. Results: Among 666,888 individuals (mean age 39.9±10.9 years) followed for 8.3 years (interquartile range, 4.6–12.7), 602 lung cancer deaths occurred. Among individuals without diabetes, the multivariable-adjusted HRs (95% CI) for lung cancer mortality comparing hemoglobin A1c categories (5.7–5.9, 6.0–6.4, and ≥ 6.5% or 36–38, 39–46, and ≥ 48 mmol/mol, respectively) with the reference (&lt; 5.7% or &lt; 36 mmol/mol) were 1.39 (1.13–1.71), 1.72 (1.33–2.20), and 2.22 (1.56–3.17), respectively. Lung cancer mortality was associated with fasting blood glucose categories in a dose-response manner (P for trend = 0.001) and with previously diagnosed diabetes. Insulin resistance (HOMA-IR ≥ 2.5) in individuals without diabetes was also associated with lung cancer mortality (multivariable-adjusted HR, 1.41; 95% CI, 1.13–1.75). These associations remained after adjusting for changing status in glucose, hemoglobin A1c, insulin resistance, smoking status, and other confounders during follow-up as time-varying covariates. Conclusions: Glycemic status within both diabetes and prediabetes ranges and insulin resistance were independently associated with an increased risk of lung cancer mortality. Keywords Diabetes mellitus, Glycated hemoglobin A1c, Hyperglycemia, Insulin resistance, Lung cancer<br/

Akkermansia muciniphila-derived extracellular vesicles influence gut permeability through the regulation of tight junctions

The gut microbiota has an important role in the gut barrier, inflammation and metabolic functions. Studies have identified a close association between the intestinal barrier and metabolic diseases, including obesity and type 2 diabetes (T2D). Recently, Akkermansia muciniphila has been reported as a beneficial bacterium that reduces gut barrier disruption and insulin resistance. Here we evaluated the role of A. muciniphila-derived extracellular vesicles (AmEVs) in the regulation of gut permeability. We found that there are more AmEVs in the fecal samples of healthy controls compared with those of patients with T2D. In addition, AmEV administration enhanced tight junction function, reduced body weight gain and improved glucose tolerance in high-fat diet (HFD)-induced diabetic mice. To test the direct effect of AmEVs on human epithelial cells, cultured Caco-2 cells were treated with these vesicles. AmEVs decreased the gut permeability of lipopolysaccharide-treated Caco-2 cells, whereas Escherichia coli-derived EVs had no significant effect. Interestingly, the expression of occludin was increased by AmEV treatment. Overall, these results imply that AmEVs may act as a functional moiety for controlling gut permeability and that the regulation of intestinal barrier integrity can improve metabolic functions in HFD-fed mice.11Ysciescopuskc

Band gap opening by two-dimensional manifestation of Peierls instability in graphene

Using first-principles calculations of graphene having high-symmetry distortion or defects, we investigate band gap opening by chiral symmetry breaking, or intervalley mixing, in graphene and show an intuitive picture of understanding the gap opening in terms of local bonding and antibonding hybridizations. We identify that the gap opening by chiral symmetry breaking in honeycomb lattices is an ideal two-dimensional (2D) extension of the Peierls metal-insulator transition in 1D linear lattices. We show that the spontaneous Kekule distortion, a 2D version of the Peierls distortion, takes place in biaxially strained graphene, leading to structural failure. We also show that the gap opening in graphene antidots and armchair nanoribbons, which has been attributed usually to quantum confinement effects, can be understood with the chiral symmetry breaking