Malondialdehyde and Zinc May Relate to Severity of Microvascular Complications in Diabetes: A Preliminary Study on Older Adults with Type 2 Diabetes Mellitus in Northeast China

Figures & data

Table 1 Clinical Characteristics of Patients

Items		Without T2DM	Without DMC	With DMC
				1	2	3
	Age (years), median (range)	70.9(67.7,76.1)	69.5(64.0,75.8)	69.0(65.0,75.0)	72.0(66.8,78.0)	76.0(70.0,80.0)
Gender	Male, n (%)	44(42.3%)	17(42.5%)	30(40.5%)	28(44.4%)	6(40.0%)
	Female, n (%)	60(57.7%)	23(57.5%)	44(59.5%)	35(55.6%)	9(60.0%)
Smoking	Exist, n (%)	17(16.3%)	4(10.8%)	19(27.9%)	18(29.0%)	4(30.8%)
	No, n (%)	87(83.7%)	33(89.2%)	49(72.1%)	44(71.0%)	9(69.2%)
Drink alcohol	Exist, n (%)	2(1.9%)	4(10.8%)	8(11.4%)	12(19.4%)	3(20.0%)
	No, n (%)	102(98.1%)	33(89.2%)	62(88.6%)	50(80.6%)	12(80.0%)
Duration of disease	>10 years, n (%)	--	0(0.0%)	33(44.6%)	32(50.8%)	12(80.0%)
	5–10 years, n (%)	--	20(51.3%)	35(47.3%)	28(44.4%)	2(13.3%)
	<5 years, n (%)	--	19(48.7%)	6(8.1%)	3(4.8%)	1(6.7%)
BMI	≥25, n (%)	19(18.8%)	15(38.5%)	24(33.8%)	19(32.8%)	8(53.3%)
	23–25, n (%)	36(35.6%)	15(38.5%)	27(38.0%)	22(37.9%)	4(26.7%)
	<23, n (%)	46(45.6%)	9(23.1%)	20(28.2%)	17(29.3%)	3(20.0%)
FBG (mmol/L), median (range)		5.0(4.7,5.4)	6.2(5.5,7.3)	6.2(5.5,7.3)	7.5(6.3,8.9)	7.4(6.6,9.5)
TC (mmol/L), median (range)		4.5(3.8,5.3)	4.4(3.6,5.1)	4.4(3.6,5.1)	4.4(3.8,5.4)	4.7(4.1,5.8)
TG (mmol/L), median (range)		1.3(1.0,1.8)	1.5(1.0,2.3)	1.5(1.0,2.3)	1.6(1.1,2.1)	1.9(1.3,2.3)
HDL (mmol/L), median (range)		1.1(1.0,1.3)	1.1(0.9,1.3)	1.1(0.9,1.3)	1.1(0.9,1.2)	1.1(0.9,1.3)
LDL (mmol/L), mean ± SD		2.6±0.8	2.7±0.8	2.7±0.8	2.8±0.7	3.0±0.9
HbAlc (%), median (range)		5.6(5.3,5.9)	6.9(6.5,7.4)	6.9(6.5,7.4)	7.8(7.2,8.6)	8.1(7.0,9.5)
MDA (nmol/mL), median (range)		4.4(4.0,5.1)	4.7(4.4,5.5)	4.7(4.4,5.5)	6.4(5.9,6.8)	6.6(6.2,7.0)
NO (μmol/L), median (range)		29.6(27.0,34.5)	55.6(34.7,73.2)	55.6(34.7,73.2)	55.7(40.7,68.6)	70.5(52.3,85.0)
SOD (U/mL), median (range)		23.2(21.7,24.4)	22.8(20.8,23.6)	22.8(20.8,23.6)	21.4(20.4,23.4)	20.9(19.6,22.7)
T-AOC (U/mL), median (range)		15.4(13.1,17.6)	12.4(10.1,13.6)	12.4(10.1,13.6)	10.1(9.1,12.4)	9.9(8.9,11.1)
Iron (mmol/L), median (range)		13.8(10.4,17.9)	12.9(10.7,18.1)	12.9(10.7,18.1)	13.0(10.1,15.4)	13.3(10.4,16.1)
Magnesium (mmol/L), median (range)		0.9(0.8,1.0)	0.9(0.8,0.9)	0.9(0.8,0.9)	0.8(0.8,0.9)	0.8(0.8,0.9)
Zinc (mmol/L), median (range)		13.7(12.1,14.8)	12.5(11.4,13.5)	12.5(11.4,13.5)	11.3(10.5,12.7)	10.7(10.2,12.1)

Abbreviations: SD, Standard deviation; DMC, Diabetic microvascular complications; T2DM, Type 2 diabetes mellitus; FBG, Fasting blood glucose; TC, Total cholesterol; TG, Triglyceride; HDL, High-density lipoprotein cholesterol; LDL, Low-density lipoprotein cholesterol; HbA1c, Glycated hemoglobin; MDA, malondialdehyde; NO, nitric oxide; SOD, superoxide dismutase; T-AOC, total antioxidant capacity.

Table 2 Clinical Characteristics of Patients with and without T2DM

Items	Without T2DM	With T2DM	T/Z	P
FBG (mmol/L), median (range)	5.0(4.7,5.4)	7.3(6.0,8.8)	−10.452^†	<0.001*
TC (mmol/L), median (range)	4.5(3.8,5.3)	4.5(3.9,5.4)	−0.184^†	0.854
TG (mmol/L), median (range)	1.3(1.0,1.8)	1.7(1.1,2.2)	−3.484^†	<0.001*
HDL (mmol/L), median (range)	1.1(1.0,1.3)	1.1(0.9,1.2)	−1.181^†	0.238
LDL (mmol/L), mean ± SD	2.6±0.8	2.9±0.8	−2.597^‡	0.010*
HbAlc (%), median (range)	5.6(5.3,5.9)	7.7(6.9,8.8)	−13.663^†	<0.001*
MDA (nmol/mL), median (range)	4.4(4.0,5.1)	6.4(5.5,6.9)	−10.759^†	<0.001*
NO (μmol/L), median (range)	29.6(27.0,34.5)	62.9(42.5,77.0)	−10.503^†	<0.001*
SOD (U/mL), median (range)	23.2(21.7,24.4)	21.3(20.0,23.3)	−5.297^†	<0.001*
T-AOC (U/mL), median (range)	15.4(13.1,17.6)	10.1(9.1,12.0)	−11.960^†	<0.001*
Iron (mmol/L), median (range)	13.8(10.4,17.9)	13.0(10.4,15.8)	−1.490^†	0.136
Magnesium (mmol/L), median (range)	0.9(0.8,1.0)	0.8(0.8,0.9)	−5.429^†	<0.001*
Zinc (mmol/L), median (range)	13.7(12.1,14.8)	11.2(10.3,12.7)	−8.466^†	<0.001*

Notes: ^†t values, ^‡Z values, *Statistical significance.

Abbreviations: SD, Standard deviation; FBG, Fasting blood glucose; TC, Total cholesterol; TG, Triglyceride; HDL, High-density lipoprotein cholesterol; LDL, Low-density lipoprotein cholesterol; HbA1c, Glycated hemoglobin; MDA, malondialdehyde; NO, nitric oxide; SOD, superoxide dismutase; T-AOC, total antioxidant capacity.

Table 3 Clinical Characteristics of Patients with and without Diabetic Microvascular Complications

Items	Without DMC	With DMC			F/H	P
		1	2	3
FBG (mmol/L), median (range)	6.2(5.5,7.3)	7.5(6.3,8.9)	7.4(6.6,9.5)	8.8(5.0,10.9)	17.404^‡	<0.001*
TC (mmol/L), median (range)	4.4(3.6,5.1)	4.4(3.8,5.4)	4.7(4.1,5.8)	4.3(3.5,5.0)	4.816^‡	0.186
TG (mmol/L), median (range)	1.5(1.0,2.3)	1.6(1.1,2.1)	1.9(1.3,2.3)	1.8(1.0,2.4)	3.097^‡	0.377
HDL (mmol/L), median (range)	1.1(0.9,1.3)	1.1(0.9,1.2)	1.1(0.9,1.3)	1.0(0.9,1.2)	2.393^‡	0.495
LDL (mmol/L), mean ± SD	2.7±0.8	2.8±0.7	3.0±0.9	3.1±1.0	1.694^†	0.170
HbAlc (%), median (range)	6.9(6.5,7.4)	7.8(7.2,8.6)	8.1(7.0,9.5)	8.9(8.4,10.5)	31.847^‡	<0.001*
MDA (nmol/mL), median (range)	4.7(4.4,5.5)	6.4(5.9,6.8)	6.6(6.2,7.0)	7.1(6.4,7.7)	51.526^‡	<0.001*
NO (μmol/L), median (range)	55.6(34.7,73.2)	55.7(40.7,68.6)	70.5(52.3,85.0)	78.0(70.8,95.9)	22.819^‡	<0.001*
SOD (U/mL), median (range)	22.8(20.8,23.6)	21.4(20.4,23.4)	20.9(19.6,22.7)	19.9(19.1,20.7)	18.482^‡	<0.001*
T-AOC (U/mL), median (range)	12.4(10.1,13.6)	10.1(9.1,12.4)	9.9(8.9,11.1)	9.6(8.0,10.8)	22.842^‡	<0.001*
Iron (mmol/L) median (range)	12.9(10.7,18.1)	13.0(10.1,15.4)	13.3(10.4,16.1)	12.2(8.4,16.3)	1.829^‡	0.609
Magnesium (mmol/L), median (range)	0.9(0.8,0.9)	0.8(0.8,0.9)	0.8(0.8,0.9)	0.8(0.7,0.8)	11.688^‡	0.009*
Zinc (mmol/L), median (range)	12.5(11.4,13.5)	11.3(10.5,12.7)	10.7(10.2,12.1)	10.6(9.7,10.9)	21.54^‡	<0.001*

Notes: ^†F values, ^‡H values, *Statistical significance.

Abbreviations: SD, Standard deviation; DMC, Diabetic microvascular complications; FBG, Fasting blood glucose; TC, Total cholesterol; TG, Triglyceride; HDL, High-density lipoprotein cholesterol; LDL, Low-density lipoprotein cholesterol; HbA1c, Glycated hemoglobin; MDA, malondialdehyde; NO, nitric oxide; SOD, superoxide dismutase; T-AOC, total antioxidant capacity.

Figure 1 The association between trace elements and oxidative stress levels in elderly diabetic patients Matrix heatmap showed Spearman correlation coefficient values for all study parameters. Negative correlations are blue, positive correlations are red, and white indicates no association between variables. *P<0.05, **P<0.01.

Table 4 Logistic Regression Analysis of the Severity of Microvascular Complications in Elderly Diabetic Patients

Items		B	SE	Wald	P	OR	95% CI
							Lower	Upper
	Age (years)	0.061	0.023	6.795	0.009*	1.063	1.015	1.113
Gender	Male	0.041	0.267	0.023	0.878	1.042	0.617	1.756
	Female	Reference
Smoking	Exist	0.551	0.318	2.991	0.084	1.735	0.930	3.238
	No	Reference
Drink alcohol	Exist	0.563	0.384	2.147	0.143	1.756	0.827	3.728
	No	Reference
Duration of disease	>10 years	3.118	0.475	43.014	<0.001*	22.601	8.900	57.397
	5–10 years	1.872	0.444	17.767	<0.001*	6.501	2.724	15.534
	<5 years	Reference
BMI	≥25	−0.001	0.344	0.000	0.997	0.999	0.509	1.962
	23–25	−0.135	0.342	0.154	0.694	0.874	0.447	1.709
	<23	Reference
	FBG (mmol/L)	0.233	0.055	17.999	<0.001*	1.262	1.133	1.406
	TC (mmol/L)	0.201	0.115	3.048	0.081	1.223	0.975	1.533
	TG (mmol/L)	0.146	0.140	1.086	0.297	1.157	0.880	1.522
	HDL (mmol/L)	0.187	0.557	0.112	0.737	1.206	0.405	3.593
	LDL (mmol/L)	0.365	0.160	5.222	0.022*	1.441	1.053	1.972
	HbAlc (%)	0.519	0.101	26.451	<0.001*	1.680	1.379	2.046
	MDA (nmol/mL)	1.149	0.150	58.619	<0.001*	3.155	2.351	4.233
	NO(μmol/L)	0.024	0.006	17.574	<0.001*	1.024	1.013	1.036
	SOD(U/mL)	−0.215	0.059	13.109	<0.001*	0.807	0.718	0.907
	T-AOC(U/mL)	−0.244	0.058	17.763	<0.001*	0.783	0.700	0.878
	Iron(mmol/L)	−0.036	0.029	1.573	0.21	0.965	0.911	1.020
	Magnesium(mmol/L)	−2.966	1.868	2.520	0.112	0.052	0.001	2.006
	Zinc(mmol/L)	−0.315	0.076	17.180	<0.001*	0.730	0.629	0.847

Note: *Statistical significance.

Abbreviations: OR, Odds ratio; 95% CI, Confidence interval; FBG, Fasting blood glucose; TC, Total cholesterol; TG, Triglyceride; HDL, High-density lipoprotein cholesterol; LDL, Low-density lipoprotein cholesterol; HbA1c, Glycated hemoglobin; MDA, malondialdehyde; NO, nitric oxide; SOD, superoxide dismutase; T-AOC, total antioxidant capacity.

Table 5 Risk Factors for the Severity of Microvascular Complications in Elderly Diabetic Patients

Items		B	SE	Wald	P	OR	95% CI
							Lower	Upper
	Age (years)	0.021	0.027	0.595	0.441	1.021	0.969	1.077
	FBG (mmol/L)	0.235	0.091	6.690	0.010*	1.265	1.059	1.511
	LDL (mmol/L)	0.175	0.209	0.706	0.401	1.191	0.791	1.795
	HbAlc (%)	0.435	0.175	0.003	<0.001*	1.545	1.431	1.680
	MDA (nmol/mL)	1.095	0.231	22.428	<0.001*	2.989	1.900	4.702
	NO (μmol/L)	0.01	0.008	1.642	0.200	1.010	0.995	1.026
	SOD (U/mL)	−0.198	0.082	5.815	0.016*	0.820	0.698	0.964
	T-AOC (U/mL)	−0.086	0.082	1.099	0.295	0.918	0.780	1.078
	Zinc (mmol/L)	−0.386	0.154	6.323	0.012*	0.680	0.503	0.919
Duration of disease	>10 years	2.926	0.602	23.592	<0.001*	18.653	5.726	60.764
	5–10 years	1.713	0.576	8.857	0.003*	5.546	1.795	17.133
	<5 years	reference

Notes: *Statistical significance.

Abbreviations: OR, Odds ratio; 95% CI, Confidence interval; FBG, Fasting blood glucose; LDL, Low-density lipoprotein cholesterol; HbA1c, Glycated hemoglobin; MDA, malondialdehyde; NO, nitric oxide; SOD, superoxide dismutase; T-AOC, total antioxidant capacity.

Data Sharing Statement

The datasets generated and analysed during the current study are not publicly available but are available from the corresponding author on reasonable request.