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窑Clinical Research窑
Retinopathy in non diabetics, diabetic retinopathy and oxidative stress: a new phenotype in Central Africa?
Walter Sisulu University, Faculty of Health Sciences, Walter Sisulu University, Private Bag X1, Mthatha 5117, South Africa 2 Department of Ophthalmology, University of Kinshasa, Kinshasa 11, DR Congo 3 Department of Chemistry and Chemical Technology, Walter Sisulu University, Private Bag X1, Mthatha 5117, South Africa 4 Department of Family Medicine, Umtata General Hospital, Walter Sisulu University, Private Bag X1, Mthatha 5117, South Africa 5 School of International Studies, Wendzou Medical College, Wenzhou 325005, Zhejiang Province, China 6 Department of Neuropsychiatry, University of Kinshasa, Kinshasa 11, DR Congo 7 Biostatistics Unit, Lomo Medical Center and Heart of Africa Center of Cardiology, Kinshasa, Kinshasa 11, DR Congo Correspondence to: Benjamin Longo-Mbenza. Walter Sisulu University, Faculty of Health Sciences, Private Bag X1, Mthatha 5117, Eastern Cape, South Africa. longombenza @gmail.com Received: 2013-08-29 Accepted: 2013-10-14 1
Abstract
· AIM:
To evaluate the rates of retinopathy without
diabetes and diabetic retinopathy (DR), associated with some markers of oxidative stress, antioxidants and cardiometabolic risk factors.
·METHODS: We determined the prevalence of DR in 150 type 2 diabetes mellitus
(T2DM) patients, that of
retinopathy in 50 non diabetics, the levels of body mass index (BMI), waist circumference (WC), blood pressure,
lipids, 8 -isoprostane, 8 -hydroxydeoxyguanosine (8 oHdG), gamma-glutamyl transferase (GGT), oxidized low density lipoprotein (LDL) (OxLDL), thiobarbituric acid
reacting substances(TBARS), reduced glutathione (GSH), superoxide dismutase
(SOD), uric acid, creatinine,
albumin, total antioxidant status (TAOS), zinc, selenium,
magnesium, vitamin C, vitamin D, vitamin E, glucose, apolipoprotein B (ApoB).
· RESULTS:
The prevalences of DR at 53y and Rtp at
62y were 44% ( =66) and 10% ( =5), respectively. The
highest levels of 8 -isoprostane, 8 -OHdG, TBARS, SOD,
and OxLDL were in DR. The lowest levels of vitamin D, vitamin C, TAOS, and vitamin E were in DR. In the casecontrol study discriminant analysis, the levels of vitamin C, vitamin D, ApoB, 8 -OHdG, creatinine, Zn, vitamin E, and WC distinguished significantly non-diabetics without DR (controls), T2DM patients without DR and T2DM patients with DR.
·CONCLUSION: Anticipation of DR onset is significantly associated with the exageration of oxidative stress biomarkers or decrease of antioxidants in African type 2 diabetics. Prevention of oxidative stress and abdominal obesity is needed. Supplementation in vitamin C, D, and E should be recommended as complement therapies of T2DM.
· KEYWORDS:
anticipation; apolipoprotein B; diabetic
retinopathy; oxidative stress; discriminant analysis; Africa DOI:10.3980/j.issn.2222-3959.2014.02.18 Longo-Mbenza B, Mvitu Muaka M, Masamba W, Muizila Kini L, Longo Phemba I, Kibokela Ndembe D, Tulomba Mona D. Retinopathy in non diabetics, diabetic retinopathy and oxidative stress: a new 2014;7(2):293-301 phenotype in Central Africa?
INTRODUCTION everal reports suggest that increased oxidative stress and impaired antioxidant defense are some contributory factors for initiation and progression of microvascular complications in diabetes mellitus (DM) [1-13]. Experimental and clinical studies suggest that oxidative stress including aging is increased in diabetic retinopathy (DR) presence because of processes that can damage proteins, lipids, polysaccharides and nucleic acids [1,3-10]. In rats with experimentally induced diabetes, the retinas display more extensive membrane lipid peroxidation and oxidative DNA damage which are the consequences of reactive oxygen species (ROS)-induced injury[11-13]. Moreover, "metabolic memory", phenomenon referred to the persistence of DR after glucose control has been reestablished [14]. The DR is a key marker of atherosclerosis, uncontrolled hypertension, metabolic syndrome (MS) including dyslipidemia, and insulin resistance (IR)[15-19]. [1] However, Yamagishi showed a significant association
S
293
Bantu phenotype of retinopathy
between increased oxidative stress, lower antioxidant system, control of diabetes, creatinine, triglycerides, aging and DM whereas the later factors were not associated with DR. In Democratic Republic of Congo (DRC), Central Africa, DR is one of the leading causes of visual disability (VD) among young adults with shorter DM duration (median 3-5y), demographic, epidemiologic and nutrition transitions as well as increasing risk of cardiometabolic diseases and ocular diabetic complications[14-16]. [20] [21] As reported by Ojaimi and Pang , retinopathy signs in people without DM and prediabetics are often observed among black Bantu people from the Western region of DRC (Mvitu Muaka, Unpublished data). The Los Angelos Latino Eye Study (LALES) published only one report of nondiabetic retinopathy in adult Latinos with a higher prevalence of non diabetic retinopathy in comparison to other population-based studies[22]. This study reported also a lack of association between hypertension and retinopathy in its population[21]. On clinical impression, a new retinopathy Bantu phenotype may point to the dynamics and diversity of oxidative stress and antioxidant defense in different compartments of the body. We hypothesize that isolated actions of genetics (apolipoprotein B=ApoB, African descent) and environment (Tobacco, obesity, insulin resistance), interactions of genetical and environmental factors, diabetic retinal hemodynamics, aging-related accelerating atherosclerosis and almost of markers of disturbance of balance between oxidative process and antioxidant defenses can distinguish infraclinical retinopathy in non diabetics, type 2 diabetics without DR, and type 2 diabetics with DR presence[23]. Therefore, the present findings might be important therapeutically in altering the course of DR by supplements of antioxidants such as vitamins, and preventing the risk factors and consequences of DR and oxidative stress[24]. The objectives of this study were to evaluate rates of retinopathy without diabetes, levels of some markers of oxidative stress, antioxidants, cardiometabolic risk of retinopathy in type 2 diabetes mellitus (T2DM) patients without DR, and T2DM patients with DR. We also investigated the discriminant function to separate the study groups. SUBJECTS AND METHODS This was a case-control study conducted in Kinshasa town, DRC, from July to September 2010. The cases of 150 T2DM patients were matched for age, sex, residence, and socioeconomic status (SES) to 50 apparently healthy and non diabetic people recruited from public places of each Kinshasa district (party lounges). Interviews, clinical examination and eye examination were performed at Saint Joseph Hospital Division of Ophthalmology in Kinshasa Limete, DRC. 294
T2DM was known by clinics and defined as a fasting serum glucose 逸126 mg/dL (逸7.0 mmol/L), and hemoglobin A1c (HbA1c) 逸6.5% according to the American Diabetes Association [25]. Sickle Cell disease, chloroquine side effects, children, young adults
窑Clinical Research窑
Retinopathy in non diabetics, diabetic retinopathy and oxidative stress: a new phenotype in Central Africa?
Walter Sisulu University, Faculty of Health Sciences, Walter Sisulu University, Private Bag X1, Mthatha 5117, South Africa 2 Department of Ophthalmology, University of Kinshasa, Kinshasa 11, DR Congo 3 Department of Chemistry and Chemical Technology, Walter Sisulu University, Private Bag X1, Mthatha 5117, South Africa 4 Department of Family Medicine, Umtata General Hospital, Walter Sisulu University, Private Bag X1, Mthatha 5117, South Africa 5 School of International Studies, Wendzou Medical College, Wenzhou 325005, Zhejiang Province, China 6 Department of Neuropsychiatry, University of Kinshasa, Kinshasa 11, DR Congo 7 Biostatistics Unit, Lomo Medical Center and Heart of Africa Center of Cardiology, Kinshasa, Kinshasa 11, DR Congo Correspondence to: Benjamin Longo-Mbenza. Walter Sisulu University, Faculty of Health Sciences, Private Bag X1, Mthatha 5117, Eastern Cape, South Africa. longombenza @gmail.com Received: 2013-08-29 Accepted: 2013-10-14 1
Abstract
· AIM:
To evaluate the rates of retinopathy without
diabetes and diabetic retinopathy (DR), associated with some markers of oxidative stress, antioxidants and cardiometabolic risk factors.
·METHODS: We determined the prevalence of DR in 150 type 2 diabetes mellitus
(T2DM) patients, that of
retinopathy in 50 non diabetics, the levels of body mass index (BMI), waist circumference (WC), blood pressure,
lipids, 8 -isoprostane, 8 -hydroxydeoxyguanosine (8 oHdG), gamma-glutamyl transferase (GGT), oxidized low density lipoprotein (LDL) (OxLDL), thiobarbituric acid
reacting substances(TBARS), reduced glutathione (GSH), superoxide dismutase
(SOD), uric acid, creatinine,
albumin, total antioxidant status (TAOS), zinc, selenium,
magnesium, vitamin C, vitamin D, vitamin E, glucose, apolipoprotein B (ApoB).
· RESULTS:
The prevalences of DR at 53y and Rtp at
62y were 44% ( =66) and 10% ( =5), respectively. The
highest levels of 8 -isoprostane, 8 -OHdG, TBARS, SOD,
and OxLDL were in DR. The lowest levels of vitamin D, vitamin C, TAOS, and vitamin E were in DR. In the casecontrol study discriminant analysis, the levels of vitamin C, vitamin D, ApoB, 8 -OHdG, creatinine, Zn, vitamin E, and WC distinguished significantly non-diabetics without DR (controls), T2DM patients without DR and T2DM patients with DR.
·CONCLUSION: Anticipation of DR onset is significantly associated with the exageration of oxidative stress biomarkers or decrease of antioxidants in African type 2 diabetics. Prevention of oxidative stress and abdominal obesity is needed. Supplementation in vitamin C, D, and E should be recommended as complement therapies of T2DM.
· KEYWORDS:
anticipation; apolipoprotein B; diabetic
retinopathy; oxidative stress; discriminant analysis; Africa DOI:10.3980/j.issn.2222-3959.2014.02.18 Longo-Mbenza B, Mvitu Muaka M, Masamba W, Muizila Kini L, Longo Phemba I, Kibokela Ndembe D, Tulomba Mona D. Retinopathy in non diabetics, diabetic retinopathy and oxidative stress: a new 2014;7(2):293-301 phenotype in Central Africa?
INTRODUCTION everal reports suggest that increased oxidative stress and impaired antioxidant defense are some contributory factors for initiation and progression of microvascular complications in diabetes mellitus (DM) [1-13]. Experimental and clinical studies suggest that oxidative stress including aging is increased in diabetic retinopathy (DR) presence because of processes that can damage proteins, lipids, polysaccharides and nucleic acids [1,3-10]. In rats with experimentally induced diabetes, the retinas display more extensive membrane lipid peroxidation and oxidative DNA damage which are the consequences of reactive oxygen species (ROS)-induced injury[11-13]. Moreover, "metabolic memory", phenomenon referred to the persistence of DR after glucose control has been reestablished [14]. The DR is a key marker of atherosclerosis, uncontrolled hypertension, metabolic syndrome (MS) including dyslipidemia, and insulin resistance (IR)[15-19]. [1] However, Yamagishi showed a significant association
S
293
Bantu phenotype of retinopathy
between increased oxidative stress, lower antioxidant system, control of diabetes, creatinine, triglycerides, aging and DM whereas the later factors were not associated with DR. In Democratic Republic of Congo (DRC), Central Africa, DR is one of the leading causes of visual disability (VD) among young adults with shorter DM duration (median 3-5y), demographic, epidemiologic and nutrition transitions as well as increasing risk of cardiometabolic diseases and ocular diabetic complications[14-16]. [20] [21] As reported by Ojaimi and Pang , retinopathy signs in people without DM and prediabetics are often observed among black Bantu people from the Western region of DRC (Mvitu Muaka, Unpublished data). The Los Angelos Latino Eye Study (LALES) published only one report of nondiabetic retinopathy in adult Latinos with a higher prevalence of non diabetic retinopathy in comparison to other population-based studies[22]. This study reported also a lack of association between hypertension and retinopathy in its population[21]. On clinical impression, a new retinopathy Bantu phenotype may point to the dynamics and diversity of oxidative stress and antioxidant defense in different compartments of the body. We hypothesize that isolated actions of genetics (apolipoprotein B=ApoB, African descent) and environment (Tobacco, obesity, insulin resistance), interactions of genetical and environmental factors, diabetic retinal hemodynamics, aging-related accelerating atherosclerosis and almost of markers of disturbance of balance between oxidative process and antioxidant defenses can distinguish infraclinical retinopathy in non diabetics, type 2 diabetics without DR, and type 2 diabetics with DR presence[23]. Therefore, the present findings might be important therapeutically in altering the course of DR by supplements of antioxidants such as vitamins, and preventing the risk factors and consequences of DR and oxidative stress[24]. The objectives of this study were to evaluate rates of retinopathy without diabetes, levels of some markers of oxidative stress, antioxidants, cardiometabolic risk of retinopathy in type 2 diabetes mellitus (T2DM) patients without DR, and T2DM patients with DR. We also investigated the discriminant function to separate the study groups. SUBJECTS AND METHODS This was a case-control study conducted in Kinshasa town, DRC, from July to September 2010. The cases of 150 T2DM patients were matched for age, sex, residence, and socioeconomic status (SES) to 50 apparently healthy and non diabetic people recruited from public places of each Kinshasa district (party lounges). Interviews, clinical examination and eye examination were performed at Saint Joseph Hospital Division of Ophthalmology in Kinshasa Limete, DRC. 294
T2DM was known by clinics and defined as a fasting serum glucose 逸126 mg/dL (逸7.0 mmol/L), and hemoglobin A1c (HbA1c) 逸6.5% according to the American Diabetes Association [25]. Sickle Cell disease, chloroquine side effects, children, young adults
