Department of Nutrition and Food Hygiene, The National Key Discipline, School of Public Health, Harbin Medical University, Harbin 150081, P. R. China.
Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin 150081, China.
J Clin Endocrinol Metab. 2023 May 17;108(6):1318-1329. doi: 10.1210/clinem/dgac741.
The hyperglycemia condition disrupts metabolism of nitrate/nitrite and nitric oxide, and dietary nitrate intake can restore nitric oxide homeostasis.
This study aims to examine whether urinary nitrate is associated with diabetes complications and long-term survival among people with hyperglycemia.
A total of 6208 people with hyperglycemia who participated in the National Health and Nutrition Examination Survey from 2005 to 2014 were enrolled. Diabetes complications included congestive heart failure, coronary heart disease, angina, stroke, myocardial infarction, diabetic retinopathy, and nephropathy. Mortality was obtained from the National Death Index until 2015. Urinary nitrate was measured by ion chromatography coupled with electrospray tandem mass spectrometry, which was log-transformed and categorized into tertiles. Logistic regression models and Cox proportional hazards models were respectively performed to assess the association of urinary nitrate with the risk of diabetes complications and disease-specific mortalities.
After adjustment for potential confounders, including urinary perchlorate and thiocyanate, compared with the participants in the lowest tertile of nitrate, the participants in the highest tertile had lower risks of congestive heart failure (odds ratio [OR] 0.41; 95% CI, 0.27-0.60) and diabetic nephropathy (OR 0.50; 95% CI, 0.41-0.62). Meanwhile, during a total follow-up period of 41 463 person-years, the participants in the highest tertile had lower mortality risk of all-cause (hazard ratio [HR] 0.78; 95% CI, 0.62-0.97), cardiovascular disease (CVD) (HR 0.56; 95% CI, 0.37-0.84), and diabetes (HR 0.47; 95% CI, 0.24-0.90), which showed dose-dependent linear relationships (P for nonlinearity > 0.05). Moreover, no association between nitrate and cancer mortality was observed (HR 1.13; 95% CI, 0.71-1.80).
Higher urinary nitrate is associated with lower risk of congestive heart failure and diabetic nephropathy, and lower risk of all-cause, CVD, and diabetes mortalities. These findings indicate that inorganic nitrate supplementation can be considered as a supplementary treatment for people with hyperglycemia.
高血糖状态会破坏硝酸盐/亚硝酸盐和一氧化氮的代谢，而膳食硝酸盐的摄入可以恢复一氧化氮的体内平衡。
本研究旨在探讨尿硝酸盐是否与高血糖人群的糖尿病并发症和长期生存相关。
共纳入 2005 年至 2014 年参加全国健康和营养调查的 6208 名高血糖患者。糖尿病并发症包括充血性心力衰竭、冠心病、心绞痛、中风、心肌梗死、糖尿病视网膜病变和肾病。死亡率通过国家死亡索引获得，截至 2015 年。尿硝酸盐通过离子色谱-电喷雾串联质谱法测定，经对数转换并分为三分位。分别采用 logistic 回归模型和 Cox 比例风险模型评估尿硝酸盐与糖尿病并发症风险和特定疾病死亡率的关系。
在调整了潜在混杂因素（包括尿高氯酸盐和硫氰酸盐）后，与硝酸盐最低三分位组相比，硝酸盐最高三分位组充血性心力衰竭（比值比 [OR] 0.41；95%置信区间 [CI] 0.27-0.60）和糖尿病肾病（OR 0.50；95%CI 0.41-0.62）的风险较低。同时，在总计 41463 人年的随访期间，硝酸盐最高三分位组的全因（风险比 [HR] 0.78；95%CI 0.62-0.97）、心血管疾病（CVD）（HR 0.56；95%CI 0.37-0.84）和糖尿病（HR 0.47；95%CI 0.24-0.90）死亡率风险较低，且呈剂量依赖性线性关系（非线性 P 值>0.05）。此外，硝酸盐与癌症死亡率之间无关联（HR 1.13；95%CI 0.71-1.80）。
较高的尿硝酸盐与充血性心力衰竭和糖尿病肾病风险降低以及全因、CVD 和糖尿病死亡率降低相关。这些发现表明，无机硝酸盐补充剂可被视为高血糖人群的一种辅助治疗方法。
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