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Published online February 19, 2008
Diabetes Care 31:958-963, 2008
DOI: 10.2337/dc07-2173
© 2008 by the American Diabetes Association
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Pathophysiology/Complications
Original Research

Circulating Surfactant Protein A (SP-A), a Marker of Lung Injury, Is Associated With Insulin Resistance

José Manuel Fernández-Real, MD, PHD1, Berta Chico1, Masanori Shiratori, MD, PHD2, Yusuke Nara, MD2, Hiroki Takahashi, PHD2 and Wifredo Ricart, MD1

1 Department of Diabetes, Endocrinology and Nutrition, Institut d'Investigació Biomédica de Girona and CIBER Fisiopatología de la Obesidad y Nutrición, Girona, Spain
2 Third Department of Internal Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan

Corresponding author: J.M. Fernández-Real, MD, PhD, Unit of Diabetes, Endocrinology and Nutrition, Hospital de Girona "Dr Josep Trueta," Ctra. França s/n, 17007 Girona, Spain. E-mail: uden.jmfernandezreal{at}htrueta.scs.es

OBJECTIVES—Impaired lung function and inflammation have both attracted interest as potentially novel risk factors for glucose intolerance, insulin resistance, and type 2 diabetes. We hypothesized that circulating levels of surfactant protein (SP)-A, which reflects interstitial lung injury, could be associated with altered glucose tolerance and insulin resistance.

RESEARCH DESIGN AND METHODS—Circulating SP-A concentration and metabolic variables (including insulin sensitivity by minimal model method, n = 89) were measured in 164 nonsmoking men.

RESULTS—Circulating SP-A concentration was significantly higher among patients with glucose intolerance and type 2 diabetes than in subjects with normal glucose tolerance, even after adjustment for BMI, age, and smoking status (ex/never). The most significant differences were found in overweight and obese subjects with altered glucose tolerance (n = 59) who showed significantly increased serum SP-A concentrations (by a mean of 24%) compared with obese subjects with normal glucose tolerance (n = 58) (log SP-A 1.54 ± 0.13 vs. 1.44 ± 0.13; P < 0.0001). Insulin sensitivity (P = 0.003) contributed independently to 22% of SP-A variance among all subjects. In subjects with altered glucose tolerance, insulin sensitivity (P = 0.01) and fasting triglycerides (P = 0.02) contributed to 37% of SP-A variance. Controlling for serum creatinine or C-reactive protein in these models did not significantly change the results.

CONCLUSIONS—Lung-derived SP-A protein was associated with altered glucose tolerance and insulin resistance in 164 nonsmoking men.

Abbreviations: SP, surfactant protein • WHR, waist-to-hip ratio


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