Homocysteine A Risk Factor For
Nephropathy & Retinopathy in Type 2
Increased homocysteine concentrations
are associated with an increased risk for incidence
of nephropathy and proliferative retinopathy.
The aim of this study was to examine the relation
between serum total homocysteine concentrations
and microvascular complications in Pima Indians
with Type 2 diabetes.
Homocysteine concentrations were measured in
frozen sera of 396 diabetic participants in a
longitudinal study who were 40 years of age or
older and who had attended one or more examinations
between 1982 and1985. Retinopathy was assessed
by fundoscopy and nephropathy by an albumin:creatinine
ratio greater than 300 mg/g. The incidence rate
ratio for a 5 µmol/l difference in homocysteine
was calculated using proportional hazard regression.
The incidence of each complication was assessed
in subjects without that complication at baseline
and with more than one follow-up examination:
229 for nephropathy, 212 for retinopathy and 266
for proliferative retinopathy. There were 101
incident cases of nephropathy, 113 of retinopathy
and 40 of proliferative retinopathy during a mean
follow-up of 8.6, 7.5 and 8.9 years, respectively.
Incidence of nephropathy was associated with homocysteine
concentrations: IRR=1.42 (95% CI, 1.09–1.84,
p=0.01); this remained statistically significant
controlled for age, sex and duration of diabetes
(p=0.03), but not when controlled for baseline
renal function (p=0.4). Homocysteine concentrations
were not associated with the incidence of any
retinopathy IRR=1.14 (95%CI 0.89–1.46, p=0.3)
but were associated with the incidence of proliferative
retinopathy IRR=1.62 (95% CI 1.16–2.28,
p=0.005); this association remained statistically
significant when controlled for baseline renal
function and diabetes duration (p=0.02).
In conclusion the results showed increased homocysteine
concentrations are associated with an increased
risk for incidence of nephropathy and proliferative
retinopathy; the relation with incidence of nephropathy
seems to be explained by an association with baseline
albuminuria status concentrations, whereas the
relation with incidence of proliferative retinopathy
does not.
Diabetologia (2003) 46: 766-772
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FACT:
In a national study, women lost more weight on
a lower-carb diet than on a lower-fat diet, even
when the calorie load was the same. The lower-carb
diet group lost more weight (18 pounds) and more
body fat (10.5 pounds) than the lower-fat diet
group (8.5 pounds and 4.4 pounds, respectively).
Journal of Clinical Endocrinology and Metabolism,
April 2003
