Serum potassium is a predictor of incident diabetes in African Americans with normal aldosterone: The Jackson Heart Study

Ranee Chatterjee, Clemontina A. Davenport, Laura P. Svetkey, Bryan C. Batch, Pao Hwa Lin, Vasan S. Ramachandran, Ervin R. Fox, Jane Harman, Hsin Chieh Yeh, Elizabeth Selvin, Adolfo Correa, Kenneth Butler, David Edelman

Research output: Contribution to journalArticle

Abstract

Background: Low-normal potassium is a risk factor for diabetes and may account for some of the racial disparity in diabetes risk. Aldosterone affects serum potassium and is associated with insulin resistance. Objectives: We sought to confirm the association between potassium and incident diabetes in an African-American cohort, and to determine the effect of aldosterone on this association. Design: We studied participants from the Jackson Heart Study, an African-American adult cohort, who were without diabetes at baseline. With the use of logistic regression, we characterized the associations of serum, dietary, and urinary potassium with incident diabetes. In addition, we evaluated aldosterone as a potential effect modifier of these associations. Results: Of 2157 participants, 398 developed diabetes over 8 y. In a minimally adjusted model, serum potassium was a significant predictor of incident diabetes (OR: 0.83; 95% CI: 0.74, 0.92 per SD increment in serum potassium). In multivariable models, we found a significant interaction between serum potassium and aldosterone (P = 0.046). In stratified multivariable models, in those with normal aldosterone (,9 ng/dL, n = 1163), participants in the highest 2 potassium quartiles had significantly lower odds of incident diabetes than did those in the lowest potassium quartile [OR (95% CI): 0.61 (0.39, 0.97) and 0.54 (0.33, 0.90), respectively]. Among those with high-normal aldosterone ($9 ng/dL, n = 202), we found no significant association between serum potassium and incident diabetes. In these stratified models, serum aldosterone was not a significant predictor of incident diabetes. We found no statistically significant associations between dietary or urinary potassium and incident diabetes. Conclusions: In this African-American cohort, we found that aldosterone may modify the association between serum potassium and incident diabetes. In participants with normal aldosterone, highnormal serum potassium was associated with a lower risk of diabetes than was low-normal serum potassium. Additional studies are warranted to determine whether serum potassium is a modifiable risk factor that could be a target for diabetes prevention. This trial was registered at clinicaltrials.gov as NCT00415415.

Original languageEnglish (US)
Pages (from-to)442-449
Number of pages8
JournalAmerican Journal of Clinical Nutrition
Volume105
Issue number2
DOIs
StatePublished - Feb 1 2017

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Aldosterone
African Americans
Potassium
Serum
Dietary Potassium
Insulin Resistance
Logistic Models

Keywords

  • African Americans
  • Diabetes risk
  • Diabetes risk factor
  • Potassium
  • Racial disparity in diabetes risk

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

Chatterjee, R., Davenport, C. A., Svetkey, L. P., Batch, B. C., Lin, P. H., Ramachandran, V. S., ... Edelman, D. (2017). Serum potassium is a predictor of incident diabetes in African Americans with normal aldosterone: The Jackson Heart Study. American Journal of Clinical Nutrition, 105(2), 442-449. https://doi.org/10.3945/ajcn.116.143255

Serum potassium is a predictor of incident diabetes in African Americans with normal aldosterone : The Jackson Heart Study. / Chatterjee, Ranee; Davenport, Clemontina A.; Svetkey, Laura P.; Batch, Bryan C.; Lin, Pao Hwa; Ramachandran, Vasan S.; Fox, Ervin R.; Harman, Jane; Yeh, Hsin Chieh; Selvin, Elizabeth; Correa, Adolfo; Butler, Kenneth; Edelman, David.

In: American Journal of Clinical Nutrition, Vol. 105, No. 2, 01.02.2017, p. 442-449.

Research output: Contribution to journalArticle

Chatterjee, R, Davenport, CA, Svetkey, LP, Batch, BC, Lin, PH, Ramachandran, VS, Fox, ER, Harman, J, Yeh, HC, Selvin, E, Correa, A, Butler, K & Edelman, D 2017, 'Serum potassium is a predictor of incident diabetes in African Americans with normal aldosterone: The Jackson Heart Study', American Journal of Clinical Nutrition, vol. 105, no. 2, pp. 442-449. https://doi.org/10.3945/ajcn.116.143255
Chatterjee, Ranee ; Davenport, Clemontina A. ; Svetkey, Laura P. ; Batch, Bryan C. ; Lin, Pao Hwa ; Ramachandran, Vasan S. ; Fox, Ervin R. ; Harman, Jane ; Yeh, Hsin Chieh ; Selvin, Elizabeth ; Correa, Adolfo ; Butler, Kenneth ; Edelman, David. / Serum potassium is a predictor of incident diabetes in African Americans with normal aldosterone : The Jackson Heart Study. In: American Journal of Clinical Nutrition. 2017 ; Vol. 105, No. 2. pp. 442-449.
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abstract = "Background: Low-normal potassium is a risk factor for diabetes and may account for some of the racial disparity in diabetes risk. Aldosterone affects serum potassium and is associated with insulin resistance. Objectives: We sought to confirm the association between potassium and incident diabetes in an African-American cohort, and to determine the effect of aldosterone on this association. Design: We studied participants from the Jackson Heart Study, an African-American adult cohort, who were without diabetes at baseline. With the use of logistic regression, we characterized the associations of serum, dietary, and urinary potassium with incident diabetes. In addition, we evaluated aldosterone as a potential effect modifier of these associations. Results: Of 2157 participants, 398 developed diabetes over 8 y. In a minimally adjusted model, serum potassium was a significant predictor of incident diabetes (OR: 0.83; 95{\%} CI: 0.74, 0.92 per SD increment in serum potassium). In multivariable models, we found a significant interaction between serum potassium and aldosterone (P = 0.046). In stratified multivariable models, in those with normal aldosterone (,9 ng/dL, n = 1163), participants in the highest 2 potassium quartiles had significantly lower odds of incident diabetes than did those in the lowest potassium quartile [OR (95{\%} CI): 0.61 (0.39, 0.97) and 0.54 (0.33, 0.90), respectively]. Among those with high-normal aldosterone ($9 ng/dL, n = 202), we found no significant association between serum potassium and incident diabetes. In these stratified models, serum aldosterone was not a significant predictor of incident diabetes. We found no statistically significant associations between dietary or urinary potassium and incident diabetes. Conclusions: In this African-American cohort, we found that aldosterone may modify the association between serum potassium and incident diabetes. In participants with normal aldosterone, highnormal serum potassium was associated with a lower risk of diabetes than was low-normal serum potassium. Additional studies are warranted to determine whether serum potassium is a modifiable risk factor that could be a target for diabetes prevention. This trial was registered at clinicaltrials.gov as NCT00415415.",
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AU - Batch, Bryan C.

AU - Lin, Pao Hwa

AU - Ramachandran, Vasan S.

AU - Fox, Ervin R.

AU - Harman, Jane

AU - Yeh, Hsin Chieh

AU - Selvin, Elizabeth

AU - Correa, Adolfo

AU - Butler, Kenneth

AU - Edelman, David

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N2 - Background: Low-normal potassium is a risk factor for diabetes and may account for some of the racial disparity in diabetes risk. Aldosterone affects serum potassium and is associated with insulin resistance. Objectives: We sought to confirm the association between potassium and incident diabetes in an African-American cohort, and to determine the effect of aldosterone on this association. Design: We studied participants from the Jackson Heart Study, an African-American adult cohort, who were without diabetes at baseline. With the use of logistic regression, we characterized the associations of serum, dietary, and urinary potassium with incident diabetes. In addition, we evaluated aldosterone as a potential effect modifier of these associations. Results: Of 2157 participants, 398 developed diabetes over 8 y. In a minimally adjusted model, serum potassium was a significant predictor of incident diabetes (OR: 0.83; 95% CI: 0.74, 0.92 per SD increment in serum potassium). In multivariable models, we found a significant interaction between serum potassium and aldosterone (P = 0.046). In stratified multivariable models, in those with normal aldosterone (,9 ng/dL, n = 1163), participants in the highest 2 potassium quartiles had significantly lower odds of incident diabetes than did those in the lowest potassium quartile [OR (95% CI): 0.61 (0.39, 0.97) and 0.54 (0.33, 0.90), respectively]. Among those with high-normal aldosterone ($9 ng/dL, n = 202), we found no significant association between serum potassium and incident diabetes. In these stratified models, serum aldosterone was not a significant predictor of incident diabetes. We found no statistically significant associations between dietary or urinary potassium and incident diabetes. Conclusions: In this African-American cohort, we found that aldosterone may modify the association between serum potassium and incident diabetes. In participants with normal aldosterone, highnormal serum potassium was associated with a lower risk of diabetes than was low-normal serum potassium. Additional studies are warranted to determine whether serum potassium is a modifiable risk factor that could be a target for diabetes prevention. This trial was registered at clinicaltrials.gov as NCT00415415.

AB - Background: Low-normal potassium is a risk factor for diabetes and may account for some of the racial disparity in diabetes risk. Aldosterone affects serum potassium and is associated with insulin resistance. Objectives: We sought to confirm the association between potassium and incident diabetes in an African-American cohort, and to determine the effect of aldosterone on this association. Design: We studied participants from the Jackson Heart Study, an African-American adult cohort, who were without diabetes at baseline. With the use of logistic regression, we characterized the associations of serum, dietary, and urinary potassium with incident diabetes. In addition, we evaluated aldosterone as a potential effect modifier of these associations. Results: Of 2157 participants, 398 developed diabetes over 8 y. In a minimally adjusted model, serum potassium was a significant predictor of incident diabetes (OR: 0.83; 95% CI: 0.74, 0.92 per SD increment in serum potassium). In multivariable models, we found a significant interaction between serum potassium and aldosterone (P = 0.046). In stratified multivariable models, in those with normal aldosterone (,9 ng/dL, n = 1163), participants in the highest 2 potassium quartiles had significantly lower odds of incident diabetes than did those in the lowest potassium quartile [OR (95% CI): 0.61 (0.39, 0.97) and 0.54 (0.33, 0.90), respectively]. Among those with high-normal aldosterone ($9 ng/dL, n = 202), we found no significant association between serum potassium and incident diabetes. In these stratified models, serum aldosterone was not a significant predictor of incident diabetes. We found no statistically significant associations between dietary or urinary potassium and incident diabetes. Conclusions: In this African-American cohort, we found that aldosterone may modify the association between serum potassium and incident diabetes. In participants with normal aldosterone, highnormal serum potassium was associated with a lower risk of diabetes than was low-normal serum potassium. Additional studies are warranted to determine whether serum potassium is a modifiable risk factor that could be a target for diabetes prevention. This trial was registered at clinicaltrials.gov as NCT00415415.

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