Urinary albumin levels in the normal range determine arterial wall thickness in adults with Type 2 diabetes: a FIELD substudy

Aim Cardiovascular disease (CVD) rates are substantially higher among patients with Type 2 diabetes than in the general population. The objective of this study was to identify the determinants of carotid intima media thickness (IMT) in patients with Type 2 diabetes. Methods We measured the thickness of the intima media layer of the carotid artery, a strong predictor of the risk of future vascular events, in 397 Type 2 diabetic patients drawn from the Fenofibrate Intervention and Event Lowering in Diabetes study, prior to treatment allocation. Results The mean IMT was 0.78 mm [interquartile range (IQR) 0.23 mm], and the maximum IMT was 1.17 mm (IQR 0.36 mm). By multivariate analysis, age, sex, duration of diabetes, triglycerides, and total cholesterol were independently correlated with IMT, as was urine albumin-creatinine ratio (ACR) (P < 0.001). The effect of ACR on IMT was further examined by tertile. Clinically significant differences in IMT were associated with ACR > 0.65 mg/mmol, approximately one-fifth the standard clinical threshold for microalbuminuria (P < 0.01). Long-term diabetes, independent of other parameters, was associated with a 50% increase in age-related thickening. Conclusions IMT in people with Type 2 diabetes is independently and continuously related to urine albumin levels and to the duration of diabetes. These results support previous data linking urine albumin measurements within the normal range with increased ischaemic cardiac mortality in the setting of Type 2 diabetes, and strongly suggest that urine albumin levels within this range should trigger a formal evaluation for CVD.

Analysis of plant microfossils in archaeological deposits from two remote archipelagos: The Marshall Islands, Eastern Micronesia, and the Pitcairn Group, Southeast Polynesia

Pollen and starch residue analyses were conducted on 24 sediment samples from archaeological sites on Maloelap and Ebon Atolls in the Marshall Islands, eastern Micronesia, and Henderson and Pitcairn Islands in the Pitcairn Group, Southeast Polynesia. The sampled islands, two of which are mystery islands (Henderson and Pitcairn), previously occupied and abandoned before European contact, comprise three types of Pacific islands: low coral atolls, raised atolls, and volcanic islands. Pollen, starch grains, calcium oxylate crystals, and xylem cells of introduced non-Colocasia Araceae (aroids) were identified in the Marshalls and Henderson (ca. 1,900 yr B.P. and 1,200 yr B.P. at the earliest, respectively). The data provide direct evidence of prehistoric horticulture in those islands and initial fossil pollen sequences from Pitcairn Island. Combined with previous studies, the data also indicate a horticultural system on Henderson comprising both field and tree crops, with seven different cultigens, including at least two species of the Araceae. Starch grains and xylem cells of Ipomoea sp., possibly introduced 1. batatas, were identified in Pitcairn Island deposits dated to the last few centuries before European contact in 1790.