The association between various smoking behaviors, cotinine biomarkers and skin autofluorescence, a marker for advanced glycation end product accumulation.

Robert P Van Waateringe,Bruce H R Wolffenbuttel,Helen L Lutgers,Jana V Van Vliet-Ostaptchouk,Karsten Suhre,Marjonneke J Mook-Kanamori,Dennis O Mook-Kanamori,Reindert Graaff,Mohammed M El-Din Selim,Sandra N Slagter,Melanie M Van Der Klauw,Ram Nagaraj

doi:10.1371/journal.pone.0179330

Abstract

BackgroundSkin autofluorescence, a biomarker for advanced glycation end products (AGEs) accumulation, has been shown to predict diabetes-related cardiovascular complications and is associated with several environmental and lifestyle factors. In the present study, we examined the association between various smoking behaviors and skin autofluorescence, as well as the association between several cotinine biomarkers and skin autofluorescence, using both epidemiological and metabolomics data.MethodsIn a cross-sectional study, we evaluated participants from the LifeLines Cohort Study and the Qatar Metabolomics Study on Diabetes (QMDiab). In the LifeLines Cohort Study smoking behavior and secondhand smoking were assessed in 8,905 individuals including 309 individuals (3.5%) with type 2 diabetes. In QMDiab, cotinine biomarkers were measured in saliva, plasma and urine in 364 individuals of whom 188 (51%) had type 2 diabetes. Skin autofluorescence was measured non-invasively in all participants using the AGE Reader.ResultsSkin autofluorescence levels increased with a higher number of hours being exposed to secondhand smoking. Skin autofluorescence levels of former smokers approached levels of never smokers after around 15 years of smoking cessation. Urinary cotinine N-oxide, a biomarker of nicotine exposure, was found to be positively associated with skin autofluorescence in the QMDiab study (p = 0.03).ConclusionsIn the present study, we have demonstrated that secondhand smoking is associated with higher skin autofluorescence levels whereas smoking cessation has a beneficial effect on skin autofluorescence. Finally, urinary cotinine N-oxide might be used as an alternative way for questionnaires to examine the effect of (environmental) tobacco smoking on skin autofluorescence.

Highlights

Advanced glycation end products (AGEs) are the final products of non-enzymatic glycation and oxidative reactions [1] and comprise a group of irreversibly modified proteins, lipids and nucleic acids [2]
Skin autofluorescence levels increased with a higher number of hours being exposed to secondhand smoking
We have demonstrated that secondhand smoking is associated with higher skin autofluorescence levels whereas smoking cessation has a beneficial effect on skin autofluorescence

Summary

Introduction

Advanced glycation end products (AGEs) are the final products of non-enzymatic glycation and oxidative reactions [1] and comprise a group of irreversibly modified proteins, lipids and nucleic acids [2]. AGE accumulation can be measured non-invasively in the skin with a device known as the AGE Reader (Diagnoptics Technologies, Groningen, The Netherlands) [7]. Previous studies have demonstrated that higher skin autofluorescence (SAF) is associated with, and a good predictor of the development of cardiovascular morbidity and mortality in patients with diabetes and (end-stage) renal failure [8,9,10]. Recent studies have shown that SAF levels are increased in patients with chronic obstructive pulmonary disease and peripheral artery disease, independent of diabetes status [11,12]. A biomarker for advanced glycation end products (AGEs) accumulation, has been shown to predict diabetes-related cardiovascular complications and is associated with several environmental and lifestyle factors. We examined the association between various smoking behaviors and skin autofluorescence, as well as the association between several cotinine biomarkers and skin autofluorescence, using both epidemiological and metabolomics data

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