title: Low plasma level of atrial natriuretic peptide predicts development of diabetes: the prospective Malmo Diet and Cancer study.
abstract: BACKGROUND
  The cardiac natriuretic peptides are involved in blood pressure regulation, and large cross-sectional studies have shown lower plasma levels of N-terminal pro-natriuretic peptide levels [N-terminal atrial natriuretic peptide (N-ANP) and N-terminal brain natriuretic peptide (N-BNP)] in patients with insulin resistance, obesity, and diabetes.
  
  
  OBJECTIVE
  In this study, we prospectively tested whether plasma levels of mid-regional ANP (MR-ANP) and N-BNP predict new-onset diabetes and long-term glucose progression.
  
  
  METHODS
  MR-ANP and N-BNP were measured in 1828 nondiabetic individuals of the Malmö Diet and Cancer cohort (mean age 60 yr; 61% women) who subsequently underwent a follow-up exam including an oral glucose tolerance test after a median follow-up time of 16 yr. Logistic regression was used to adjust for covariates.
  
  
  RESULTS
  During follow-up, 301 subjects developed new-onset diabetes. After full multivariate adjustment, MR-ANP was significantly inversely associated with incident diabetes (OR = 0.85; 95% CI = 0.73-0.99; P = 0.034) but not N-BNP (OR = 0.92; 95% CI = 0.80-1.06; P = 0.262). In fully adjusted linear regression models, the progression of fasting glucose during follow-up was significantly inversely related to baseline levels of MR-ANP (P = 0.004) but not N-BNP (P = 0.129). Quartile analyses revealed that the overall association was mainly accounted for by excess risk of incident diabetes in subjects belonging to the lowest quartile of MR-ANP. After full adjustment, the odds ratio for incident diabetes in the bottom compared with the top quartile of MR-ANP was 1.65 (OR = 1.08-2.51, P = 0.019) and 1.43 (OR = 1.04-1.96, P = 0.027) compared with all other subjects.
  
  
  CONCLUSIONS
  Low plasma levels of MR-ANP predict development of future diabetes and glucose progression over time, suggesting a causal role of ANP deficiency in diabetes development.
authors: Departments of Clinical Sciences, Lund University, Skåne University Hospital, Ent 35, Floor 2, SE-205 02 Malmö, Sweden. martin.magnusson@med.lu.se
authors: Martin
authors: M
authors: Magnusson
authors: Amra
authors: A
authors: Jujic
authors: Bo
authors: B
authors: Hedblad
authors: Gunnar
authors: G
authors: Engström
authors: Margaretha
authors: M
authors: Persson
authors: Joachim
authors: J
authors: Struck
authors: Nils G
authors: NG
authors: Morgenthaler
authors: Peter
authors: P
authors: Nilsson
authors: Christopher
authors: C
authors: Newton-Cheh
authors: Thomas J
authors: TJ
authors: Wang
authors: Olle
authors: O
authors: Melander
mesh_terms: D009320:Atrial Natriuretic Factor / Q000032:analysis / Q000097:blood*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D003940:Diagnostic Techniques, Endocrine; D004032:Diet; D015536:Down-Regulation; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000453:epidemiology; D011379:Prognosis
chemical_list: D009320:Atrial Natriuretic Factor