Leptin concentrations are associated with higher proinsulin and insulin concentrations but a lower proinsulin/insulin ratio in non-diabetic subjects.

INTRODUCTION: Leptin (the product of the human OB gene) is increased in obese individuals, suggesting resistance to its effect. However, there is considerable variability in leptin levels at each level of body mass index (BMI), suggesting that genetic and environmental factors may regulate leptin concentrations. Previous data have suggested that leptin levels are associated with insulin resistance and in a few reports with impaired insulin secretion. We examined whether non-diabetic subjects, with elevated specific insulin and proinsulin levels, had increased leptin levels. METHODS: We used a radioimmunoassay (RIA) to measure serum leptin levels in 197 non-diabetic Mexican Americans and non-Hispanic whites from the San Antonio Heart Study. We also evaluated whether leptin levels were associated with impaired insulin secretion or increased beta cell stress, as evaluated by the fasting proinsulin/insulin ratio. (Higher fasting proinsulin/insulin ratios are thought to reflect impaired insulin secretion.) RESULTS: Leptin levels were significantly correlated with fasting specific insulin (r=0.55, P<0.001) and proinsulin (r=0.57, P<0.001) and inversely with the proinsulin/insulin ratio (r= -0.154, P=0.035) after adjustment for age, gender, ethnicity and 2 h glucose. These associations were similar in men and women and in Mexican Americans and in non-Hispanic whites. After further adjustment for BMI and waist-to-hip ratio (WHR), leptin levels remained significantly correlated with specific insulin (r=0.31, P<0.001) and proinsulin (r=0.24, P<0.001) although the magnitude of the associations were considerably attenuated. CONCLUSION: We conclude that specific insulin and proinsulin are positively related to leptin levels and that these associations are to some degree independent of obesity and body fat distribution. Thus, subjects with increased insulin levels may be relatively resistant to the effects of leptin. However, leptin levels are associated with a decrease in the fasting proinsulin/insulin ratio suggesting that leptin levels are not associated with an impairment in insulin secretion.

Leptin concentrations do not predict weight gain: the Mexico City Diabetes Study.

BACKGROUND: Leptin, a hormone which is produced by adipose tissue, has been shown to inhibit food intake and increase energy expenditure. In humans, leptin levels are correlated with body fat. In addition, leptin levels decline in subjects who lose weight. Yet few data exist on whether leptin levels predict weight change, except for a recent report suggesting that low leptin levels predict weight gain in very obese middle-aged Pima Indians. METHODS: We have examined the association between baseline leptin levels and subsequent weight gain over 3.25 y in 180 non-diabetic participants in the Mexico City Diabetes Study. RESULTS: At baseline, the correlation between leptin levels and body mass index (BMI) was 0.712 in men and 0.691 in women (both P < 0.001). Subjects were matched on age (+/- 2 y), gender and BMI (+/- 2 kg/m2) at baseline. Baseline BMI was 25.3 kg/m2 in men and 27.2 kg/m2 in women. Baseline leptin levels (ng/ml) did not predict weight gain in either men (weight gainers: 4.3; weight stable: 5.8; and weight losers: 5.2) or women (weight gainers: 17.4; weight stable: 17.7; and weight losers: 17.4). CONCLUSIONS: We conclude that baseline leptin levels did not predict weight change in moderately obese individuals.

Total immunoreactive proinsulin, immunoreactive insulin and specific insulin in relation to conversion to NIDDM: the Mexico City Diabetes Study.

Although insulin resistance and decreased insulin secretion are characteristic of established non-insulin-dependent diabetes mellitus (NIDDM), which of these metabolic abnormalities is the primary determinant of NIDDM is still controversial. A disproportionate increase in the proinsulin to insulin ratio has been proposed as a marker of compromised insulin secretion. We examined the association of fasting immunoreactive insulin (which cross-reacts with proinsulin), specific insulin (which does not cross-react with proinsulin), total immunoreactive proinsulin (or insulin precursors), and the fasting proinsulin/specific insulin ratio to the risk of developing NIDDM in the 3.25-year follow-up of the Mexico City Diabetes Study. These measurements were made in 85 subjects who subsequently converted to NIDDM (prediabetic subjects) and in 85 age and gender matched subjects who remained non-diabetic at follow-up (control subjects). Immunoreactive insulin, proinsulin and the proinsulin/specific insulin ratio were significantly higher in prediabetic than in control subjects. However, the relation between specific insulin and the development of NIDDM was weaker than for proinsulin or immunoreactive insulin. After further adjustment for obesity, body fat distribution and glucose tolerance status, proinsulin and the proinsulin/specific insulin ratio, but not specific or immunoreactive insulin, predicted conversion to NIDDM. A high proinsulin/specific insulin ratio predicted conversion to NIDDM both in subjects with normal and those with impaired glucose tolerance at baseline. We conclude that in prediabetic subjects increased proinsulin, a marker of islet cell distress or compromised insulin secretion, is associated with rapid conversion (within 3.25 years) to NIDDM even in obese populations.

Increased insulin resistance and insulin secretion in nondiabetic African-Americans and Hispanics compared with non-Hispanic whites. The Insulin Resistance Atherosclerosis Study.

The etiology of NIDDM is still controversial, with both insulin resistance and decreased insulin secretion postulated as potential important factors. African-Americans and Hispanics have a two- to threefold excess risk of developing NIDDM compared with non-Hispanic whites. Yet little is known concerning the prevalence of insulin resistance and secretion defects in minorities, especially in African-Americans in population-based studies. Fasting and 2-h post-glucose load glucose and insulin levels, insulin-mediated glucose disposal (insulin sensitivity index) (S(I)), glucose effectiveness (S(G)), and first-phase insulin response (acute insulin response [AIR]) were determined in nondiabetic African-Americans (n= 288), Hispanics (n= 363), and non-Hispanic whites (n= 435) as part of the Insulin Resistance Atherosclerosis Study. Subjects received a standard 2-h oral glucose tolerance test on the first day and an insulin-modified frequently sampled intravenous glucose tolerance test on the second day. African-Americans and Hispanics were more obese than non-Hispanic whites. Both African-Americans and Hispanics had higher fasting and 2-h insulin concentrations and AIR but lower S(I) than non-Hispanic whites. No ethnic difference was observed in S(G). After further adjustments for obesity, body fat distribution, and behavioral factors, African-Americans continued to have higher fasting and 2-h insulin levels and AIR, but lower S(I) than non-Hispanic whites. In contrast, after adjustment for these covariates, no significant ethnic differences in S(I) or fasting insulin levels were observed between Hispanics and non-Hispanic whites. Hispanics continued to have higher 2-h insulin levels and AIRs than those in non-Hispanic whites. In this report, the association between S(I) and upper body adiposity (waist-to-hip, ratio) was similar in each ethnic group. Both nondiabetic African-Americans and Hispanics have increased insulin resistance and higher AIR than nondiabetic non-Hispanic whites, suggesting that greater insulin resistance may be in large part responsible for the higher prevalence of NIDDM in these minority groups. However, in Hispanics. the greater insulin resistance may be due to greater adiposity and other behavioral factors.

Evaluation of two insulin assays in insulin resistance syndrome (syndrome X).

Recent data suggest that proinsulin is associated with cardiovascular risk factors in nondiabetic and diabetic subjects. Since most conventional insulin assays cross-react with proinsulin, it has been suggested that the associations of insulin concentrations with dyslipidemia and hypertension could actually reflect associations with proinsulin. We examined these associations by using both a conventional immunoreactive insulin assay and a specific Linco insulin assay that does not cross-react with proinsulin in 623 nondiabetic and in 180 non-insulin-dependent diabetic subjects who participated in the San Antonio Heart Study, a population-based study of diabetes and cardiovascular disease. Both the immunoreactive insulin assay and the specific Linco insulin assay were equally correlated with cardiovascular risk factors in nondiabetic subjects. Insulin concentrations were moderately correlated with high triglyceride and low high-density lipoprotein cholesterol levels and were weakly correlated with increased blood pressure. In diabetic subjects there were only weak associations between insulin and cardiovascular risk factors using either assay. We conclude that the association of insulin concentrations with cardiovascular risk factors is not a function of using insulin assays that cross-react with proinsulin and that for epidemiological studies of cardiovascular risk factors, conventional immunoreactive insulin assays are as good as the newer specific insulin assays.

Prevalence of hypertension in Mexico City and San Antonio, Texas.

BACKGROUND: Few data are available on the prevalence of hypertension in Mexico. METHODS AND RESULTS: We compared the prevalence of mild hypertension (systolic blood pressure > or = 140 mm Hg and/or diastolic blood pressure > or = 90 mm Hg and/or use of antihypertensive medications) in 1500 low-income Mexican Americans who participated in the San Antonio Heart Study and 2280 low-income Mexicans who participated in the Mexico City Diabetes Study. The crude prevalence of mild hypertension was 17.1% in Mexican men versus 24.4% in Mexican American men (P = .001) and 17.4% in Mexican women versus 22.0% in Mexican American women (P = .005). After adjustment for age, body mass index (BMI), waist-to-hip ratio (WHR), non-insulin dependent diabetes mellitus (NIDDM), educational attainment, and percent native American genetic admixture (Caucasian and native American), the odds ratio (Mexico City/San Antonio) was 0.55 (95% CI, 0.39, 0.77; P < .001) in men and 0.81 (CI, 0.54, 1.12; P = .201) in women. In a pooled model including both men and women, the odds ratio was 0.67 (95%, CI, 0.53, 0.84; P < .001). In the pooled model, city, age, female sex, NIDDM, BMI, WHR, and low educational attainment were significantly related to the prevalence of hypertension. CONCLUSIONS: The causes for these differences in hypertension prevalence are not known but may reflect a less modernized lifestyle in Mexico City, including greater physical activity, less obesity, and the consumption of a high-carbohydrate, low-fat diet.

Lack of association between sex hormones and Lp(a) concentrations in American and Finnish men.

Sex hormones may play a role in the determination of cardiovascular disease. Recently lipoprotein(a) (Lp[a]) has been recognized as a risk factor for coronary heart disease. Estrogens and anabolic steroids have been reported to alter Lp(a) levels, yet no data are available on the association between in vivo concentrations of sex hormones and Lp(a) concentrations. We examined the possible associations of sex hormone-binding globulin, total and free testosterone, estradiol, and dehydroepiandrosterone sulfate to Lp(a) concentrations in men in two population-based studies (San Antonio Heart Study [n = 178] and a Finnish study on the association between insulin resistance and atherosclerosis [n = 87]). In neither study were sex hormones significantly related to Lp(a) concentrations. In addition, Lp(a) was significantly related to apolipoprotein(a) molecular weight (which was measured in the Finnish study only). These results were unchanged when Lp(a) concentrations were adjusted for apolipoprotein(a) molecular weight (a strong correlate of Lp[a] concentrations). We conclude that in vivo concentrations of sex hormones are unlikely to be associated with Lp(a) concentrations in men.

LDL size and subclass pattern in a biethnic population.

Recently, the presence of small, dense low-density lipoprotein (LDL) has been recognized as a risk factor for coronary heart disease. There has been little work on correlates of LDL size in population-based studies and none in Mexican Americans. We examined the relationship of LDL size and pattern to anthropometric and metabolic variables in 466 Mexican Americans and non-Hispanic whites in the San Antonio Heart Study. LDL size in Angstrom units was significantly lower in Mexican Americans (255.8 +/- 0.6) than in non-Hispanic whites (257.9 +/- 0.7) (P = 0.041) after adjustment for gender and age. The percentage of subjects with pattern B tended to be higher in Mexican Americans than in non-Hispanic whites (40.0% versus 34.4%, respectively), although this difference did not reach statistical significance. In univariate analysis, LDL size was significantly associated with glucose (r = -.20), insulin (r = -.19), male gender (r = -.20), total cholesterol (r = -.22), high-density lipoprotein cholesterol (HDL-C) (r = .53), and triglyceride concentrations (r = -.63). In multivariate analyses, higher triglyceride, insulin, and glucose concentrations, lower HDL-C, and male gender were independent correlates of smaller, denser LDL. Correlates of LDL size were similar in Mexican Americans and non-Hispanic whites. Our results confirm previous reports that triglyceride and HDL-C concentrations are the most important variables associated with LDL size. The additional findings of independent effects of male gender, glucose, and insulin concentrations suggest that sex hormones and the insulin resistance syndrome may also play an important role.(ABSTRACT TRUNCATED AT 250 WORDS)

Is microalbuminuria part of the prediabetic state? The Mexico City Diabetes Study.

Microalbuminuria is associated with increased cardiovascular mortality in both diabetic and non-diabetic subjects. A number of studies have indicated that insulin resistance, increased blood pressure and dyslipidaemia precede the onset of clinical diabetes. We examined various correlates of microalbuminuria in 1,298 non-diabetic subjects who participated in the Mexico City Diabetes Study, a population-based study of diabetes and cardiovascular risk factors. Both parental history of diabetes and impaired glucose tolerance were significantly associated with microalbuminuria. These results were not explained by differences in age or blood pressure between subjects with or without a parental history of diabetes or impaired glucose tolerance. In addition, subjects with microalbuminuria had increased 2-h insulin and triglyceride concentrations, a higher prevalence of hypertension, and decreased high density lipoprotein cholesterol concentrations relative to subjects without microalbuminuria. These results that microalbuminuria may be a feature of the prediabetic state.