Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
JAMA Cardiol. 2023 Oct 1;8(10):989-995. doi: 10.1001/jamacardio.2023.2758.
It is unclear to what extent insulin resistance is associated with N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the general population after accounting for body composition.
To characterize the association of insulin resistance with NT-proBNP independently of measures of body composition in US adults.
DESIGN, SETTING, AND PARTICIPANTS: In a cross-sectional design, data on participants aged 20 years or older were obtained from the 1999-2004 National Health and Nutrition Examination Survey with measures of NT-pro-BNP, body mass index (BMI), and dual energy x-ray absorptiometry (DEXA)-derived measures of body composition (fat and lean masses). Linear and logistic regression was used to characterize the associations of measures of body mass and composition (BMI, waist circumference, fat mass, and lean mass) with NT-proBNP, adjusting for cardiovascular risk factors. Linear regression was used to characterize the associations of homeostasis model assessment of insulin resistance [HOMA-IR] and NT-proBNP after adjusting for cardiovascular risk factors and body composition measures. The quantitative insulin sensitivity check index [QUICKI], triglyceride-glucose index [TyG index], insulin to glucose ratio [IGR], fasting insulin, and homeostasis model assessment of β-cell function (HOMA-β) were also examined. Data for this study were analyzed from August 10, 2022, to June 30, 2023.
Adjusted changes in NT-proBNP by insulin resistance levels.
A total of 4038 adults without diabetes or cardiovascular disease were included (mean [SD] age, 44 years; 51.2% female; and 74.3% White). In sex-specific analyses, insulin resistance measures were inversely associated with NT-pro-BNP. After adjustment including cardiovascular risk factors, BMI, waist circumference, and DEXA-derived fat mass and lean mass, the percent change in NT-proBNP associated with an SD increase in HOMA-IR was -16.84% (95% CI, -21.23% to -12.21%) in women and -19.04% (95% CI, -24.14 to -13.59) in men. Similar associations were observed for other indices of insulin resistance, including QUICKI (women: 17.27; 95% CI, 10.92-23.99 vs men: 22.17; 95% CI, 15.27 to 29.48), TyG index women: -11.47; 95% CI, -16.12 to -6.57 vs men: -15.81; 95% CI, -20.40 to -10.95), IGR women: -15.15; 95% CI, -19.35 to -10.74 vs men: -16.61; 95% CI, -21.63 to -11.26), and fasting insulin (women: -16.32; 95% CI, -20.63 to -11.78 vs men: -18.22; 95% CI, -23.30 to -12.79), as well as HOMA-β (women: -10.71; 95% CI, -14.71 to -6.52 vs men: -11.72; 95% CI, -16.35 to -6.85).
In a national sample of US adults, insulin resistance was inversely associated with NT-proBNP, even after rigorously accounting for multiple measures of fat mass and lean mass. These results suggest that the mechanisms linking NT-proBNP to insulin resistance are partially independent of excess adiposity and may be associated with hyperinsulinemia.
重要性：在考虑了身体成分后，胰岛素抵抗与 N 端脑利钠肽前体（NT-proBNP）在普通人群中的关联程度尚不清楚。
目的：在考虑了多种身体成分指标的情况下，在美国成年人中描述与胰岛素抵抗相关的 NT-proBNP。
设计、地点和参与者：在一项横断面设计中，我们从 1999-2004 年全国健康和营养调查中获取了年龄在 20 岁或以上的参与者的数据，测量了 NT-pro-BNP、体重指数（BMI）和双能 X 射线吸收法（DEXA）衍生的身体成分（脂肪和瘦体重）。我们使用线性和逻辑回归来描述身体质量和组成（BMI、腰围、脂肪量和瘦体重）与 NT-proBNP 的关联，调整了心血管危险因素。我们使用线性回归来描述在调整了心血管危险因素和身体成分指标后，稳态模型评估的胰岛素抵抗[HOMA-IR]与 NT-proBNP 的关联。还检查了定量胰岛素敏感性检查指数[QUICKI]、甘油三酯-葡萄糖指数[TyG 指数]、胰岛素与葡萄糖比[IGR]、空腹胰岛素和稳态模型评估的β细胞功能（HOMA-β）。这项研究的数据分析于 2022 年 8 月 10 日至 2023 年 6 月 30 日进行。
主要结果和措施：按胰岛素抵抗水平调整后的 NT-proBNP 变化。
结果：我们共纳入了 4038 名没有糖尿病或心血管疾病的成年人（平均[标准差]年龄 44 岁；51.2%为女性；74.3%为白人）。在性别特异性分析中，胰岛素抵抗指标与 NT-pro-BNP 呈负相关。在包括心血管危险因素、BMI、腰围和 DEXA 衍生的脂肪量和瘦体重在内的调整后，与 HOMA-IR 的一个标准差增加相关的 NT-proBNP 的百分比变化在女性中为-16.84%（95%CI，-21.23%至-12.21%），在男性中为-19.04%（95%CI，-24.14%至-13.59%）。其他胰岛素抵抗指标也观察到类似的关联，包括 QUICKI（女性：17.27；95%CI，10.92-23.99 vs 男性：22.17；95%CI，15.27 至 29.48）、TyG 指数（女性：-11.47；95%CI，-16.12 至-6.57 vs 男性：-15.81；95%CI，-20.40 至-10.95）、IGR（女性：-15.15；95%CI，-19.35 至-10.74 vs 男性：-16.61；95%CI，-21.63 至-11.26）和空腹胰岛素（女性：-16.32；95%CI，-20.63 至-11.78 vs 男性：-18.22；95%CI，-23.30 至-12.79），以及 HOMA-β（女性：-10.71；95%CI，-14.71 至-6.52 vs 男性：-11.72；95%CI，-16.35 至-6.85）。
结论和相关性：在一项美国成年人的全国性样本中，即使严格考虑了多种脂肪量和瘦体重指标，胰岛素抵抗也与 NT-proBNP 呈负相关。这些结果表明，将 NT-proBNP 与胰岛素抵抗联系起来的机制部分独立于多余的肥胖症，可能与高胰岛素血症有关。
