Clinical Research Unit, Department of Pediatrics, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN 46202, USA.
Nutrients. 2022 Jun 24;14(13):2629. doi: 10.3390/nu14132629.
Background: Nutritional, environmental, and metabolic status may play a role in affecting the progression and prognosis of type 2 diabetes. However, results in identifying prognostic biomarkers among diabetic patients have been inconsistent and inconclusive. We aimed to evaluate the associations of nutritional, environmental, and metabolic status with disease progression and prognosis among diabetic patients. Methods: In a nationally representative sample in the NHANES III (The Third National Health and Nutrition Examination Survey, 1988−1994), we analyzed available data on 44 biomarkers among 2113 diabetic patients aged 20 to 90 years (mean age: 58.2 years) with mortality data followed up through 2016. A panel of 44 biomarkers from blood and urine specimens available from NHANES III were included in this study and the main outcomes as well as the measures are mortalities from all-causes. We performed weighted logistic regression analyses after controlling potential confounders. To assess incremental prognostic values of promising biomarkers beyond traditional risk factors, we compared c-statistics of the adjusted models with and without biomarkers, separately. Results: In total, 1387 (65.2%) deaths were documented between 1988 and 2016. We observed an increased risk of all-cause mortality associated with higher levels of serum C-reactive protein (p for trend = 0.0004), thyroid stimulating hormone (p for trend = 0.04), lactate dehydrogenase (p for trend = 0.02), gamma glutamyl transferase (p for trend = 0.02), and plasma fibrinogen (p for trend = 0.03), and urine albumin (p for trend < 0.0001). In contrast, higher levels of serum sodium (p for trend = 0.005), alpha carotene (p for trend = 0.006), and albumin (p for trend = 0.005) were associated with a decreased risk of all-cause mortality. In addition, these significant associations were not modified by age, sex, or race. Inclusion of thyroid stimulating hormone (p = 0.03), fibrinogen (p = 0.01), and urine albumin (p < 0.0001), separately, modestly improved the discriminatory ability for predicting all-cause mortality among diabetic patients. Conclusions: Our nationwide study findings provide strong evidence that some nutritional, environmental, and metabolic biomarkers were significant predictors of all-cause mortality among diabetic patients and may have potential clinical value for improving stratification of mortality risk.
营养、环境和代谢状况可能在影响 2 型糖尿病的进展和预后方面发挥作用。然而，在确定糖尿病患者的预后生物标志物方面的结果一直不一致且没有定论。我们旨在评估营养、环境和代谢状况与糖尿病患者疾病进展和预后之间的关联。
在具有代表性的 NHANES III （第三次全国健康和营养检查调查，1988-1994 年）全国性样本中，我们分析了年龄在 20 至 90 岁之间（平均年龄：58.2 岁）的 2113 名糖尿病患者的可用数据，这些患者有死亡数据，随访至 2016 年。本研究纳入了来自 NHANES III 的血液和尿液样本中的 44 种生物标志物，主要结局和措施均为全因死亡率。在控制潜在混杂因素后，我们进行了加权逻辑回归分析。为了评估有前途的生物标志物在传统危险因素之外的额外预后价值，我们分别比较了有和没有生物标志物的调整模型的 c 统计量。
总共记录了 1988 年至 2016 年间 1387 例（65.2%）死亡。我们观察到，与较高水平的血清 C 反应蛋白（p 趋势= 0.0004）、促甲状腺激素（p 趋势= 0.04）、乳酸脱氢酶（p 趋势= 0.02）、γ-谷氨酰转移酶（p 趋势= 0.02）和血浆纤维蛋白原（p 趋势= 0.03）呈正相关，与尿液白蛋白（p 趋势<0.0001）呈正相关。相比之下，血清钠（p 趋势= 0.005）、α-胡萝卜素（p 趋势= 0.006）和白蛋白（p 趋势= 0.005）水平较高与全因死亡率降低相关。此外，这些显著关联不受年龄、性别或种族的影响。分别纳入促甲状腺激素（p=0.03）、纤维蛋白原（p=0.01）和尿液白蛋白（p<0.0001），可以适度提高对糖尿病患者全因死亡率的预测能力。
我们的全国性研究结果提供了强有力的证据，表明一些营养、环境和代谢生物标志物是糖尿病患者全因死亡率的重要预测指标，并且可能具有改善死亡率分层的潜在临床价值。
