He Xinyue, Shao Wei, Yu Senhai, Yu Jiazhou, Huang Changzhen, Ren Haiqing, Liu Chengguo, Xu Yuying, Zhu Yimin
Department of Epidemiology and Biostatistics and Department of Respiratory Diseases of Sir Run Run Show Hospital, Affiliated to School of Medicine, Zhejiang University, Hangzhou, 310058, Zhejiang, People's Republic of China.
Zhejiang Putuo Hospital, Zhoushan, Zhejiang, People's Republic of China.
Nutr Metab (Lond). 2023 Nov 1;20(1):47. doi: 10.1186/s12986-023-00763-y.
Whether and to what extent serum uric acid (SUA) mediates the association between combined lifestyle behaviors and type 2 diabetes mellitus (T2DM) remain unclear. This study aimed to investigate the role of SUA in the relationship between healthy lifestyle scores (HLS) and the incidence of T2DM.
This prospective study used data from Zhejiang Metabolic Syndrome cohort. A HLS (5-point scale including healthy waist circumference (WC), never smoking, high physical activity, healthy diet and moderate alcohol intake) was estimated in 13,919 participants, who had SUA at baseline examination in 2009-2014, and were followed-up to 2021-2022 to ascertain incident of T2DM. Cox proportional hazards models and mediation analysis were used to examine the associations between HLS, SUA and T2DM.
We included 13,919 participants aged 18 years or older without diabetes at baseline (mean age 54.6 [SD 13.9] years, 58.7% female). During a median follow-up of 9.94 years, 645 cases of T2DM occurred. Compared with participants with a poor HLS, those with 4-5 low-risk lifestyle factors showed a 60% reduction in the risk of developing T2DM (adjusted HR, 0.40; 95% CI: 0.28-0.57). Further, the population-attributable risk percent (95% CI) of T2DM for poor adherence to the overall healthy lifestyle (< 4 low-risk factors) was 43.24% (30.02%, 56.46%). The HLS was inversely associated with SUA level. With per score increased in HLS, the beta (95% CI) of SUA (log transformed) was - 0.03 (- 0.03, - 0.02), and the odds ratio (95% CI) of hyperuricemia was 0.82 (0.77, 0.86). The relationship between the HLS and risk of T2DM was mediated by SUA with a 13.06% mediation effect. There was no significant combined effect of HLS and SUA on risk of T2DM (P = 0.097).
The relationship between overall healthy lifestyle behaviors and T2DM was reconfirmed and the association appeared to be mediated by SUA. The mediation effect of baseline SUA was more pronounced among women who were below 60 years old.
血清尿酸（SUA）是否以及在何种程度上介导了综合生活方式行为与2型糖尿病（T2DM）之间的关联尚不清楚。本研究旨在探讨SUA在健康生活方式评分（HLS）与T2DM发病率之间关系中的作用。
这项前瞻性研究使用了来自浙江代谢综合征队列的数据。对13919名参与者进行了HLS评估（5分制，包括健康腰围（WC）、从不吸烟、高体力活动、健康饮食和适度饮酒），这些参与者在2009 - 2014年的基线检查中有SUA数据，并随访至2021 - 2022年以确定T2DM的发病情况。采用Cox比例风险模型和中介分析来检验HLS、SUA与T2DM之间的关联。
我们纳入了13919名年龄在18岁及以上、基线时无糖尿病的参与者（平均年龄54.6[标准差13.9]岁，58.7%为女性）。在中位随访9.94年期间，发生了645例T2DM病例。与HLS较差的参与者相比，具有4 - 5个低风险生活方式因素的参与者患T2DM的风险降低了60%（调整后HR，0.40；95%CI：0.28 - 0.57）。此外，总体健康生活方式依从性差（<4个低风险因素）导致T2DM的人群归因风险百分比（95%CI）为43.24%（30.02%，56.46%）。HLS与SUA水平呈负相关。HLS每增加一分，SUA（对数转换）的β（95%CI）为- 0.03（- 0.03，- 0.02），高尿酸血症的优势比（95%CI）为0.82（0.77，0.86）。HLS与T2DM风险之间的关系由SUA介导，中介效应为13.06%。HLS和SUA对T2DM风险没有显著的联合效应（P = 0.097）。
再次证实了总体健康生活方式行为与T2DM之间的关系，且这种关联似乎由SUA介导。基线SUA的中介效应在60岁以下女性中更为明显。
