{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T16:13:39Z","timestamp":1792253619417,"version":"4.4.0"},"reference-count":31,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T00:00:00Z","timestamp":1750809600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T00:00:00Z","timestamp":1750809600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Metabolism Res"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Albuminuria is a recognized marker of endothelial dysfunction and early cardiovascular risk. The albumin\u2010to\u2010creatinine ratio (ACR) is widely used to estimate urinary albumin excretion, but in individuals with high fat\u2010free mass (FFM), such as those with obesity, elevated urinary creatinine may lead to underestimation of albuminuria. We aimed to investigate the concordance between ACR and 24\u2010h urinary albumin excretion (UAE) in adults with obesity and examine whether discrepancies affect the detection of vascular dysfunction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>140 individuals affected by severe obesity were enrolled. Albuminuria was assessed using both spot ACR and 24\u2010h UAE. A subgroup of 70 participants underwent vascular testing, including carotid\u2010femoral pulse wave velocity (cf\u2010PWV) and allometrically scaled flow\u2010mediated dilation (FMD). Multivariable linear models were used to evaluate associations between albuminuria markers and vascular parameters, adjusting for age, sex, blood pressure, and HbA1c.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      24h\u2010UAE\u00a0\u2265\u00a030\u00a0mg was more frequent in males (35%) than females (20%), while ACR\u00a0\u2265\u00a030\u00a0mg\/g showed no sex difference; 21 individuals (15%) exhibited elevated 24\u00a0h\u2010UAE (\u2265\u00a030\u00a0mg\/24\u00a0h) despite a normal ACR (&lt;\u00a030\u00a0mg\/g), a discordant pattern predominantly observed in males with high FFM and urinary creatinine levels. Interestingly, both ACR and UAE were independently associated with reduced FMD (st.\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u00a0=\u00a0\u22120.27 and \u22120.24;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.05). No sex\u2010based interactions were observed in the vascular models.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In individuals with obesity, ACR may underestimate albuminuria, especially in males. Despite this, both markers are associated with early endothelial dysfunction. UAE may provide added value in cardiovascular risk stratification where ACR underperforms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/dmrr.70064","type":"journal-article","created":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T07:34:53Z","timestamp":1750836893000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Albumin\u2010To\u2010Creatinine Ratio Underestimates True 24\u2010Hour Albuminuria in Obesity: Clinical Relevance for Vascular Risk Stratification"],"prefix":"10.1002","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1223-0167","authenticated-orcid":false,"given":"D.","family":"Moriconi","sequence":"first","affiliation":[{"name":"Department of Clinical and Experimental Medicine University of Pisa  Pisa Italy"},{"name":"Department of Information Engineering University of Pisa  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Nannipieri","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine University of Pisa  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Jadoon","sequence":"additional","affiliation":[{"name":"INSERM U970 Team 7 Paris Cardiovascular Research Centre\u2014PARCC Universit\u00e8 Paris\u2010Cit\u00e9  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Solini","sequence":"additional","affiliation":[{"name":"Department of Surgical Medical Molecular and Critical Area Pathology University of Pisa  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. M.","family":"Bruno","sequence":"additional","affiliation":[{"name":"INSERM U970 Team 7 Paris Cardiovascular Research Centre\u2014PARCC Universit\u00e8 Paris\u2010Cit\u00e9  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,6,25]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.124.071079"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2019.10.042"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12882\u2010016\u20100303\u2010x"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0000000000001674"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.orcp.2023.10.002"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2004090769"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2008030292"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwh326"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc22\u2010S011"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.09300911"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2013.05.010"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.xkme.2024.100804"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2020.10.026"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.03.009"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/978\u20103\u2010319\u201048382\u20105_15"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.numecd.2022.11.002"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.123.21618"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/eci.70026"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/37.3.478"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2008.698"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00394\u2010015\u20100923\u20100"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1159\/000481630"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1038\/ijo.2008.87"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1152\/physiol.00024.2014"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054\u2010024\u201005222\u20105"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.steroids.2023.109306"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2014.112"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9061611"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.18632\/aging.204331"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.3121\/cmr.2011.1021"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f324"}],"container-title":["Diabetes\/Metabolism 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