A cross-sectional study on the Nesfatin-1 serum levels of Vietnamese patients with pre-diabetes

Over the past few years, the number of diabetes patients in the world has increased rapidly, with many serious complications, making it one of the most pressing concerns in society. According to the International Diabetes Federation (IDF), there were 537 million people worldwide (aged 20–79) suffering from diabetes in 2021. This number is expected to rise to 783 million in 2045¹. Vietnam is among the top 10 countries with the highest increase rate of diabetes cases, at 5.5% per year. As reported by the Vietnamese Association of Diabetes and Endocrinology (VADE), there are currently 5 million Vietnamese people living with diabetes, accounting for 6% of the population. This number is predicted to increase to 7 or 8 million by 2025². Diabetes is estimated to be the cause of death for at least 80 people each day. The percentage of undiagnosed diabetes cases in Vietnam is nearly 62.6%³. If left undetected and untreated in the early stages, pre-diabetes can increase the risk of dangerous complications and severely affect the patient’s health.

In recent years, Nesfatin-1 has been identified as one of the cytokines associated with diabetes⁴,⁵. Peripheral Nesfatin-1 was linked to several clinical laboratory parameters that influenced nutrition and metabolism⁶. Therefore, determining the concentration of Nesfatin-1 serum is important for assessing the disease progression, predicting the damage to target organs, and evaluating the impact of treatment measures.

A cross-sectional study was carried out on 524 patients diagnosed with prediabetes and 205 healthy people serving as the control group. These participants were taken from periodic health check-up groups at general hospitals in northern Vietnam. Pre-diabetes was diagnosed for those with fasting blood glucose (FBG) ≥126 mg/dL, hemoglobin A1c (HbA1c) ≥6.5%, or with classic symptoms of hyperglycemia⁷. The concentration of Nesfatin-1 serum, anthropometry, and clinical parameters associated with the cardiovascular, hepatic, and renal organs were determined and analyzed.

Nesfatin-1 has the effects of suppressing appetite, reducing gastric motility, reducing cholesterol, triglycerides, and white adipose mass, as well as lowering lipid production and glucose in the blood. The Nesfatin-1 serum level of pre-diabetes patients was 1.5 times lower than in the control group (0.66 vs. 1.12 ng/mL) (Table 1). Blood glucose-related indices of pre-diabetes, such as HbA1c and FBG, were also higher than in the control group (6.41% and 7.76 mmol/L vs. 5.52% and 4.83 mmol/L). The parameters associated with cardiovascular disease in the pre-diabetes group were also significantly elevated, such as total cholesterol (6.02 mmol/L) and triglycerides (9.72 mmol/L). The data relating to cholesterol density, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) varied between study groups. Although they did not reach the warning or prudent level (HDL-C<1.0 mmol/L and LDL-C>3.3 mmol/L), they were still worse compared to the control group. Therefore, special monitoring and early treatment are essential.

Table 1
Demographic, anthropometric, and metabolic characteristics of pre-diabetes.

Group	Control	Patients
Numbers (male/ female)	205 (100/105)	524 (272/252)
Age (years)	52.02±17.89	52.21±18.18
Duration time (years)	–	1.98±0.73
Body mass index (kg/m2)	21.59±1.21	22.05±1.23
Waist hip ratio	0.90±0.11	0.86±0.10
Hemoglobin A1c (%)	5.40±0.65	6.41±1.35
Fasting blood glucose (mmol/L)	5.65±0.78	7.76±1.71
Total cholesterol (mmol/L)	4.84±1.01	6.02±1.11
Triglycerides (mmol/L)	1.71±0.77	2.72±1.59
High-density lipoprotein cholesterol (mmol/L)	1.41±0.38	1.30±0.47
Low-density lipoprotein cholesterol (mmol/L)	2.65±0.72	2.88±1.18
Alanine aminotransferase (Ul/L)	29.97±3.54	38.09±4.64
Aspartate aminotransferase (Ul/L)	26.77±2.81	37.34±6.36
Creatinine serum (umol/L)	88.92±9.42	108.12±12.87
Creatinine urine (umol/L)	107.89±8.83	118.01±7.24
Nesfatin-1 serum (ng/mL)	1.12±0.38	0.66±0.37

The results of liver and kidney tests showed that the condition of the liver was heading in a bad direction, as indicated by the alanine aminotransferase (ALT) and aspartate aminotransferase (AST) values (38.09 and 37.34 UI/L, respectively). Additionally, the creatinine serum and creatinine urine results for the pre-diabetes group were also not positive (108.12 and 118.01 μmol/L, respectively).

The study aimed to evaluate the correlation between Nesfatin-1 serum levels and the test parameters in pre-diabetes patients (Table 2). The results indicated that these values were lower in Vietnamese pre-diabetes patients compared to other Asian patients but higher than those in Europeans⁸–¹⁰. Furthermore, there was a positive correlation between the Nesfatin-1 serum levels and ALT, AST, and creatinine (r=0.113, p=0.009; r=0.133, p=0.002; and r=0.091, r=0.094, p<0.05). Conversely, a negative correlation was observed between Nesfatin-1 serum levels and body mass index (BMI), HbA1c, cholesterol, and triglycerides (p<0.05). Some previous studies have reported similar correlations but without statistically significant results (p>0.05)¹⁰–¹². The variability in sample size, patient selection, experimental methods, and ethnographic factors may explain these differing results.

Table 2
The correlation analysis results between Nesfatin-1 serum levels and diabetes.

Parameters	Pre-diabetes
	r	p-value
Age	-0.064	0.143
Body mass index	-0.105	0.015
Waist hip ratio	-0.037	0.394
Hemoglobin A1c	-0.108	0.014
Fasting blood glucose	0.040	0.365
Total cholesterol	-0.117	0.007
Triglycerides	-0.102	0.020
High-density lipoprotein cholesterol	0.094	0.031
Low-density lipoprotein cholesterol	-0.132	0.002
Alanine aminotransferase	0.113	0.009
Aspartate aminotransferase	0.133	0.002
Creatinine serum	0.091	0.037
Creatinine urine	0.094	0.032

This study represents the first published on Nesfatin-1 serum levels in Vietnamese pre-diabetes patients and reveals differences in concentration compared to other countries worldwide. The correlation between Nesfatin-1 serum concentration and clinical parameters associated with cardiovascular, liver, and kidney conditions was recorded for the first time in Vietnamese pre-diabetic patients, with statistically significant correlations observed between Nesfatin-1 serum levels and creatinine, aminotransferase, triglycerides, lipoprotein, cholesterol, hemoglobin A1c, and BMI.

• Funding: This work was supported by the Graduate University of Science and Technology, Vietnam Academy of Science and Technology (grant code: GUST.STS.ĐT2020-SH02).

REFERENCES

• ¹ International Diabetes Federation (IDF). International Diabetes Federation Atlas. 10th ed. Brussels; 2021. Available from: http://www.diabetesatlas.org
  » http://www.diabetesatlas.org
• ² Vietnamese Association of Diabetes and Endocrinology (VADE). Vietnamese Association of Diabetes and Endocrinology repost. 2020. Available from: https://vade.org.vn
  » https://vade.org.vn
• ³ Somvong V. The prevalence of pre-diabetes in outpatient department of Bach Mai Hospital. Vietnam J Diabetes Endocrinol. 2019;36:21-6. Available from: https://www.vjde.vn/journal/article/view/105
  » https://www.vjde.vn/journal/article/view/105
• ⁴ Su Y, Zhang J, Tang Y, Bi F, Liu JN. The novel function of nesfatin-1: anti-hyperglycemia. Biochem Biophys Res Commun. 2010;391(1):1039-42. https://doi.org/10.1016/j.bbrc.2009.12.014
  » https://doi.org/10.1016/j.bbrc.2009.12.014
• ⁵ Weibert E, Hofmann T, Stengel A. Role of nesfatin-1 in anxiety, depression and the response to stress. Psychoneuroendocrinology. 2019;100:58-66. https://doi.org/10.1016/j.psyneuen.2018.09.037
  » https://doi.org/10.1016/j.psyneuen.2018.09.037
• ⁶ World Health Organization (WHO). Definition and diagnosis of diabetes mellitus and intermediate hyperglycaemia: report of a WHO/IDF consultation. 2006. Available from: https://www.who.int/publications/i/item/definition-and-diagnosis-of-diabetes-mellitus-and-intermediate-hyperglycaemia
  » https://www.who.int/publications/i/item/definition-and-diagnosis-of-diabetes-mellitus-and-intermediate-hyperglycaemia
• ⁷ Cefalu WT, Berg EG, Saraco M, Petersen MP, Uelmen S, Robinson S. Diabetes advocacy: standards of medical care in diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S182-3. https://doi.org/10.2337/dc19-S016
  » https://doi.org/10.2337/dc19-S016
• ⁸ Ren L, Bao D, Wang L, Xu Q, Xu Y, Shi Z. Nucleobindin-2/nesfatin-1 enhances the cell proliferation, migration, invasion and epithelial-mesenchymal transition in gastric carcinoma. J Cell Mol Med. 2022;26(19):4986-94. https://doi.org/10.1111/jcmm.17522
  » https://doi.org/10.1111/jcmm.17522
• ⁹ Kravchun P, Kadykova O, Narizhnaya A, Tabachenko O, Shaparenko O. Association of circulating adiponectin, resistin, irisin, nesfatin-1, apelin-12 and obestatin levels with hypertension and obesity. Georgian Med News. 2020;(304-5):43-8. PMID: 32965248
• ¹⁰ Mirakhor Samani S, Ghasemi H, Rezaei Bookani K, Shokouhi B. Serum nesfatin-1 level in healthy subjects with weight-related abnormalities and newly diagnosed patients with type 2 diabetes mellitus; a case-control study. Acta Endocrinol (Buchar). 2019;5(1):69-73. https://doi.org/10.4183/aeb.2019.69
  » https://doi.org/10.4183/aeb.2019.69
• ¹¹ Matta RA, El-Hini SH, Salama AM, Moaness HM. Serum nesfatin-1 is a biomarker of pre-diabetes and interplays with cardiovascular risk factors. Egypt J Intern Med. 2022;34(1):15. Available from: https://ejim.springeropen.com/articles/10.1186/s43162-022-00106-y
  » https://ejim.springeropen.com/articles/10.1186/s43162-022-00106-y
• ¹² Alotibi MN, Alnoury AM, Alhozali AM. Serum nesfatin-1 and galanin concentrations in the adult with metabolic syndrome. Relationships to insulin resistance and obesity. Saudi Med J. 2019;40(1):19-25. https://doi.org/10.15537/smj.2019.1.22825
  » https://doi.org/10.15537/smj.2019.1.22825

Publication Dates

• Publication in this collection
  19 May 2023
• Date of issue
  2023

History

• Received
  08 Feb 2023
• Accepted
  12 Feb 2023