Association between the oxidative balance score and risk of microvascular complications in type 2 diabetes: A prospective UK biobank cohort study.

Association of ultraprocessed food consumption with risk of microvascular complications among individuals with type 2 diabetes in the UK Biobank: a prospective cohort study

Patients with type 2 diabetes (T2D) may disproportionately suffer the adverse cardiovascular effects of air pollution, but relevant evidence on microvascular outcome is lacking. We aimed to examine the association between air pollution exposure and the risk of microvascular complications among patients with T2D. This prospective study included 17 995 participants with T2D who were free of macro- and micro-vascular complications at baseline from the UK Biobank. Annual average concentrations of particulate matter (PM) with diameters <2.5 μm (PM2.5), <10 μm (PM10), nitrogen dioxide (NO2) and nitrogen oxides (NOx) were assessed using land use regression models. Cox proportional hazards regression was used to estimate the associations of air pollution exposure with incident diabetic microvascular complications. The joint effects of the air pollutant mixture were examined using quantile-based g-computation in a survival setting. In single-pollutant models, the adjusted hazard ratios (95% confidence intervals) for composite diabetic microvascular complications per interquartile range increase in PM2.5, PM10, NO2 and NOx were 1.09 (1.04-1.14), 1.06 (1.01-1.11), 1.07 (1.02-1.12) and 1.04 (1.00-1.08), respectively. Similar significant results were found for diabetic nephropathy and diabetic neuropathy, but not for diabetic retinopathy. The associations of certain air pollutants with composite microvascular complications and diabetic nephropathy were present even at concentrations below the World Health Organization limit values. Multi-pollutant analyses demonstrated that PM2.5 contributed most to the elevated risk associated with the air pollutant mixture. In addition, we found no interactions between air pollution and metabolic risk factor control on the risk of diabetic microvascular complications. Long-term individual and joint exposure to PM2.5, PM10, NO2 and NOx, even at low levels, was associated with an increased risk of diabetic microvascular complications, with PM2.5 potentially being the main contributor.

&lt;p&gt; &lt;/p&gt; &lt;p&gt;Objectives: Evidence is limited regarding the associations between vitamin D status and microvascular complications in individuals with type 2 diabetes (T2D), among whom vitamin D deficiency or insufficiency is particularly common. This study aimed to prospectively investigate the associations of serum 25-hydroxyvitamin D [25(OH)D] and vitamin D receptor (VDR) polymorphisms with the risk of diabetic microvascular complications.&lt;/p&gt; &lt;p&gt;Research Design and Methods: This analysis included 14,709 participants with T2D who were free of microvascular complications from the UK Biobank. Incidence of diabetic microvascular complications were ascertained via electronic health records. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). &lt;/p&gt; &lt;p&gt;Results: The median (interquartile range) of serum 25(OH)D concentration was 40.7 (27.5, 56.4) nmol/L. During a median of 11.2 years of follow-up, 1,370 people developed diabetic microvascular complications. Compared with participants with 25(OH)D &lt;25 nmol/L, individuals with 25(OH)D ≥75 nmol/L had a multivariable-adjusted HR (95% CI) of 0.65 (0.51, 0.84) for composite diabetic microvascular complications, 0.62 (0.40, 0.95) for diabetic retinopathy, 0.56 (0.40, 0.79) for diabetic nephropathy, and 0.48 (0.26, 0.89) for diabetic neuropathy. In addition, compared with participants with 25(OH)D &lt;25 nmol/L and minor allele homozygotes (TT of rs1544410 and GG of rs731236), the multivariable-adjusted HRs (95% CIs) of composite diabetic microvascular complications were 0.54 (0.38, 0.78) and 0.55 (0.38, 0.80) for participants with serum 25(OH)D ≥50 nmol/L and major allele homozygotes (CC and AA), respectively, although no significant interaction was observed.&lt;/p&gt; &lt;p&gt;Conclusions: Higher serum 25(OH)D concentrations were significantly associated with lower risk of diabetic microvascular complications, including diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy. Our findings suggest a potential beneficial role of maintaining adequate vitamin D status in the prevention of diabetic microvascular complications.&lt;/p&gt;

&lt;p&gt; &lt;/p&gt; &lt;p&gt;Objectives: Evidence is limited regarding the associations between vitamin D status and microvascular complications in individuals with type 2 diabetes (T2D), among whom vitamin D deficiency or insufficiency is particularly common. This study aimed to prospectively investigate the associations of serum 25-hydroxyvitamin D [25(OH)D] and vitamin D receptor (VDR) polymorphisms with the risk of diabetic microvascular complications.&lt;/p&gt; &lt;p&gt;Research Design and Methods: This analysis included 14,709 participants with T2D who were free of microvascular complications from the UK Biobank. Incidence of diabetic microvascular complications were ascertained via electronic health records. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). &lt;/p&gt; &lt;p&gt;Results: The median (interquartile range) of serum 25(OH)D concentration was 40.7 (27.5, 56.4) nmol/L. During a median of 11.2 years of follow-up, 1,370 people developed diabetic microvascular complications. Compared with participants with 25(OH)D &lt;25 nmol/L, individuals with 25(OH)D ≥75 nmol/L had a multivariable-adjusted HR (95% CI) of 0.65 (0.51, 0.84) for composite diabetic microvascular complications, 0.62 (0.40, 0.95) for diabetic retinopathy, 0.56 (0.40, 0.79) for diabetic nephropathy, and 0.48 (0.26, 0.89) for diabetic neuropathy. In addition, compared with participants with 25(OH)D &lt;25 nmol/L and minor allele homozygotes (TT of rs1544410 and GG of rs731236), the multivariable-adjusted HRs (95% CIs) of composite diabetic microvascular complications were 0.54 (0.38, 0.78) and 0.55 (0.38, 0.80) for participants with serum 25(OH)D ≥50 nmol/L and major allele homozygotes (CC and AA), respectively, although no significant interaction was observed.&lt;/p&gt; &lt;p&gt;Conclusions: Higher serum 25(OH)D concentrations were significantly associated with lower risk of diabetic microvascular complications, including diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy. Our findings suggest a potential beneficial role of maintaining adequate vitamin D status in the prevention of diabetic microvascular complications.&lt;/p&gt;

Evidence is limited regarding the associations between vitamin D status and microvascular complications in individuals with type 2 diabetes (T2D), among whom vitamin D deficiency or insufficiency is particularly common. In this study we aimed to prospectively investigate the associations of serum 25-hydroxyvitamin D [25(OH)D] and vitamin D receptor (VDR) polymorphisms with risk of diabetic microvascular complications. This analysis included 14,709 participants with T2D who were free of microvascular complications from the UK Biobank. Incidence of diabetic microvascular complications was ascertained via electronic health records. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs. Median serum 25(OH)D concentration was 40.7 nmol/L (interquartile range 27.5, 56.4). During a median of 11.2 years of follow-up, 1,370 people developed diabetic microvascular complications. Compared with participants with 25(OH)D <25 nmol/L, individuals with 25(OH)D ≥75 nmol/L had a multivariable-adjusted HR of 0.65 (95% CI 0.51, 0.84) for composite diabetic microvascular complications, 0.62 (0.40, 0.95) for diabetic retinopathy, 0.56 (0.40, 0.79) for diabetic nephropathy, and 0.48 (0.26, 0.89) for diabetic neuropathy. In addition, in comparisons with participants with 25(OH)D <25 nmol/L and minor allele homozygotes (TT of rs1544410 and GG of rs731236), the multivariable-adjusted HRs of composite diabetic microvascular complications were 0.54 (0.38, 0.78) and 0.55 (0.38, 0.80) for participants with serum 25(OH)D ≥50 nmol/L and major allele homozygotes (CC and AA), respectively, although no significant interaction was observed. Higher serum 25(OH)D concentrations were significantly associated with lower risk of diabetic microvascular complications, including diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy. Our findings suggest a potential beneficial role of maintaining adequate vitamin D status in the prevention of diabetic microvascular complications.

To investigate whether lower socioeconomic status (SES) was associated with an increased risk of diabetic microvascular complications and to analyze the potential mediating role of several modifiable factors. The study included 11 309 patients with type 2 diabetes at baseline from the UK Biobank cohort. SES was grouped based on income, education, and employment status by using latent class analysis. Microvascular complications of diabetes were identified through electronic health records. Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for microvascular complications across SES groups. Mediation analysis was applied to explore potential mediators in these associations. During a median follow-up of 12.2 years, 262, 764, and 1017 participants in the high, medium, and low SES groups were diagnosed with microvascular complications. Compared to participants with high SES, those with low SES had a HR of 1.75 (95% CI: 1.53, 2.01) for total microvascular complications, a HR of 2.11 (95% CI: 1.74, 2.55) for nephropathy, a HR of 1.40 (95% CI: 1.14, 1.72) for retinopathy, and a HR of 1.79 (95% CI: 1.32, 2.43) for neuropathy. Mediation analysis indicated that alcohol consumption, body mass index, triglycerides, high density lipoprotein cholesterol, and glycated hemoglobin mediated the association between SES and microvascular complications, with mediation percentages of 1.3%, 12.2%, 4.4%, 10.9%, and 10.8%, respectively. Lower SES may be associated with a higher risk of diabetic microvascular complications, and obesity-related indicators and glycated hemoglobin may play important mediating roles in the association.

BackgroundGlucosamine is a widely used supplement for treating osteoarthritis and joint pain. New evidence suggests a potential association between glucosamine and type 2 diabetes, inflammation and cardiometabolic risk. We aimed to prospectively evaluate the association of habitual glucosamine use with risk of diabetic microvascular complications based on data from the large-scale nationwide prospective UK Biobank cohort study.MethodsThis analysis included 21,171 participants with type 2 diabetes who were free of microvascular complications from the UK Biobank. Incidence of diabetic microvascular complications was ascertained via electronic health records. The Cox proportional hazards model was used to assess the relationship between glucosamine use and the risk of diabetic microvascular complications. Subgroup analyses and sensitivity analyses were performed to explore the potential effect modifications and the robustness of the main findings.ResultsAt baseline, 14.5% of the participants reported habitual use of glucosamine supplements. During a median follow-up of 12.3 years, 4399 people developed diabetic microvascular complications, including 2084 cases of incident diabetic nephropathy, 2401 incident diabetic retinopathy, and 831 incident diabetic neuropathy. Glucosamine use was significantly associated with lower risks of composite microvascular complications (hazard ratio (HR) 0.89, 95% CI: 0.81 to 0.97) and diabetic nephropathy (HR 0.87, 95% CI: 0.76 to 0.98) in fully adjusted models. However, there was no significant inverse association between glucosamine use and the risk of diabetic retinopathy (HR 0.94, 95% CI: 0.83 to 1.06) or diabetic neuropathy (HR 0.88, 95% CI: 0.71 to 1.08).ConclusionsHabitual use of glucosamine supplement was significantly associated with lower risks of composite microvascular complications and diabetic nephropathy but not retinopathy or neuropathy in individuals with type 2 diabetes.

Association of sleep patterns with microvascular complications in individuals with type 2 diabetes: A prospective cohort study.

This study aimed to investigate the association between adherence to the EAT-Lancet diet and the incidence of microvascular complications in type 2 diabetes (T2D). This prospective study included 7525 individuals with T2D who were free of diabetic microvascular complications (including diabetic retinopathy, neuropathy and nephropathy) at baseline from the UK Biobank cohort. Dietary data were collected via a web-based 24-hour dietary recall questionnaire. The EAT-Lancet diet index, ranging from 0 to 14 points, was constructed based on the EAT-Lancet reference diet. Cox proportional hazard models were used to examine the relationship between the EAT-Lancet diet index and the incidence of microvascular complications among individuals with T2D. During a mean follow-up of 12.58 years, 1217 participants developed diabetic microvascular complications. After adjusting for potential confounders, participants in the highest adherence group of the EAT-Lancet diet index had a significantly lower risk of developing microvascular complications (hazard ratio: 0.76, 95% CI: 0.64-0.88) compared to those in the lowest adherence group. Subtype analyses for incident diabetic retinopathy, neuropathy and nephropathy yielded consistent results. Additionally, each 1-point increase in the EAT-Lancet diet index was associated with an 8% lower risk of microvascular complications. These findings remained robust across several sensitivity analyses and nearly all subgroups. Our findings demonstrate a significant inverse association between adherence to the EAT-Lancet diet and the risk of microvascular complications in individuals with T2D.

AimsThere is a potential association between oxidative stress and the development of diabetic kidney disease (DKD). The Oxidative Balance Score (OBS), derived from dietary and lifestyle factors, acts as a comprehensive marker of oxidative stress. Research examining the relationship between OBS and DKD is scarce. This study aims to evaluate the association between OBS and the risk of DKD among U.S. adults.MethodsThis study enrolled 6,725 eligible participants from the U.S. population through the National Health and Nutrition Examination Survey (2005–2020). Patients with DKD were defined as those with diabetes who had a urinary albumin-to-creatinine ratio ≥ 30 mg/g and/or an estimated glomerular filtration rate < 60 mL/min/1.73 m². The OBS consists of 20 composite scores derived from dietary and lifestyle factors. To assess the potential relationship between OBS and DKD, weighted logistic regression and restricted cubic spline statistical approaches were employed.ResultsThe risk of DKD was inversely correlated with OBS, dietary OBS, and lifestyle OBS (p < 0.05). Compared to the lowest quartile of OBS, the adjusted odds ratios (OR) for OBS, lifestyle OBS and dietary OBS, and DKD in the highest quartile were 0.58 (95% CI: 0.48–0.70), 0.64 (95% CI: 0.51–0.81), and 0.57 (95% CI: 0.46–0.70), respectively. A substantial nonlinear relationship between lifestyle OBS and DKD was identified using the RCS curve (p for nonlinearity = 0.0081), which appeared as an inverted ‘L’ shape. Using the two-piecewise logistic regression model, a turning point in lifestyle OBS was identified at a score of 3 (p < 0.001).ConclusionsAmong the American population, OBS and DKD are significantly negatively correlated, suggesting that maintaining a higher OBS may reduce the risk of developing DKD.

&lt;p dir="ltr"&gt;The impact of the difference between cystatin C- and creatinine-based estimated glomerular filtration rate (eGFRdiff) on diabetic microvascular complications (DMCs) remains unknown. We aimed to investigate the associations of eGFRdiff with overall DMCs and subtypes including diabetic retinopathy (DR), diabetic kidney disease (DKD), and diabetic neuropathy (DN).&lt;/p&gt;&lt;p dir="ltr"&gt;Research Design and Methods &lt;/p&gt;&lt;p dir="ltr"&gt;This prospective cohort study included 25,825 participants with diabetes free of DMCs at baseline (2006 to 2010) from the UK Biobank. eGFRdiff was calculated using both absolute difference (eGFRabdiff) and the ratio (eGFRrediff) between cystatin C- and creatinine-based calculations. Incidence of DMCs was ascertained using electronic health records. Cox proportional hazards regression models were used to evaluate the associations of eGFRdiff with overall DMCs and subtypes. &lt;/p&gt;&lt;p dir="ltr"&gt;Results&lt;/p&gt;&lt;p dir="ltr"&gt;During a median follow-up of 13.6 years, 5,753 participants developed DMCs, including 2,752 cases of DR, 3,203 DKD, and 1,149 DN. Each standard-deviation decrease of eGFRabdiff was associated with a 28% higher risk of overall DMCs, 14% higher risk of DR, 56% higher risk of DKD, and 29% higher risk of DN. For each 10-percent decrease in eGFRrediff, the corresponding hazard ratios (95% confidence intervals) were 1.16 (1.14, 1.18) for overall DMCs, 1.08 (1.05, 1.11) for DR, 1.29 (1.26, 1.33) for DKD, and 1.17 (1.12, 1.22) for DN respectively. The magnitude of associations was not materially altered in all sensitivity analyses.&lt;/p&gt;&lt;p dir="ltr"&gt;Conclusions&lt;/p&gt;&lt;p dir="ltr"&gt;Large eGFRdiff was independently associated with risk of DMCs and its subtypes. Our findings suggested monitoring eGFRdiff among diabetes population have potentially beneficial for identification of high-risk patients. &lt;/p&gt;&lt;p&gt;&lt;br&gt;&lt;/p&gt;

&lt;p dir="ltr"&gt;The impact of the difference between cystatin C- and creatinine-based estimated glomerular filtration rate (eGFRdiff) on diabetic microvascular complications (DMCs) remains unknown. We aimed to investigate the associations of eGFRdiff with overall DMCs and subtypes including diabetic retinopathy (DR), diabetic kidney disease (DKD), and diabetic neuropathy (DN).&lt;/p&gt;&lt;p dir="ltr"&gt;Research Design and Methods &lt;/p&gt;&lt;p dir="ltr"&gt;This prospective cohort study included 25,825 participants with diabetes free of DMCs at baseline (2006 to 2010) from the UK Biobank. eGFRdiff was calculated using both absolute difference (eGFRabdiff) and the ratio (eGFRrediff) between cystatin C- and creatinine-based calculations. Incidence of DMCs was ascertained using electronic health records. Cox proportional hazards regression models were used to evaluate the associations of eGFRdiff with overall DMCs and subtypes. &lt;/p&gt;&lt;p dir="ltr"&gt;Results&lt;/p&gt;&lt;p dir="ltr"&gt;During a median follow-up of 13.6 years, 5,753 participants developed DMCs, including 2,752 cases of DR, 3,203 DKD, and 1,149 DN. Each standard-deviation decrease of eGFRabdiff was associated with a 28% higher risk of overall DMCs, 14% higher risk of DR, 56% higher risk of DKD, and 29% higher risk of DN. For each 10-percent decrease in eGFRrediff, the corresponding hazard ratios (95% confidence intervals) were 1.16 (1.14, 1.18) for overall DMCs, 1.08 (1.05, 1.11) for DR, 1.29 (1.26, 1.33) for DKD, and 1.17 (1.12, 1.22) for DN respectively. The magnitude of associations was not materially altered in all sensitivity analyses.&lt;/p&gt;&lt;p dir="ltr"&gt;Conclusions&lt;/p&gt;&lt;p dir="ltr"&gt;Large eGFRdiff was independently associated with risk of DMCs and its subtypes. Our findings suggested monitoring eGFRdiff among diabetes population have potentially beneficial for identification of high-risk patients. &lt;/p&gt;&lt;p&gt;&lt;br&gt;&lt;/p&gt;

BackgroundOxidative stress plays a crucial role in the onset and progression of diabetic kidney disease (DKD). The oxidative balance score (OBS) evaluates an individual’s dietary and lifestyle exposures related to oxidative stress. However, the association between the OBS and DKD remains unclear. This study aimed to investigate this association in patients with diabetes mellitus (DM).MethodsThis cross-sectional study included 1,882 participants, representing 19.5 million individuals with DM, from the National Health and Nutrition Examination Survey (NHANES) collected between 2011 and 2018. The OBS was calculated using 20 dietary and lifestyle factors. DKD was defined as impaired glomerular filtration rate (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m2), albuminuria (urinary albumin-to-creatinine ratio [ACR] ≥ 30 mg/g), or both in DM patients. The association between the OBS and DKD was examined using weighted logistic regression and subgroup analyses.ResultsThe OBS was negatively associated with DKD. The multivariable-adjusted odds ratio (OR) for DKD per unit increase in the OBS as a continuous variable was 0.92 (95%CI: 0.85–0.99). When analyzed as a categorical variable, participants in the highest OBS quartile had significantly lower odds of DKD (OR: 0.26, 95%CI: 0.07–0.98) than those in the lowest quartile (p < 0.05). Further analyses revealed that the dietary OBS, but not lifestyle OBS, was significantly associated with DKD. The OBS had significant correlations with DKD among male patients. Among dietary components, fiber, carotene, niacin, vitamin C, calcium, and magnesium were the most strongly associated with lower odds of DKD.ConclusionOur findings revealed a significant negative association between OBS levels and the presence of DKD in DM patients, suggesting that a higher antioxidant-rich diet score is associated with a lower likelihood of DKD. Future prospective studies are needed to confirm whether adopting such a lifestyle could serve as a strategy for DKD prevention.

Long-term exposure to ambient PM2.5 constituents and risk of microvascular complications among individuals with type 2 diabetes mellitus: a nationwide cohort study in UK.

Previous studies have linked famine exposure to the incidence of type 2 diabetes (T2D), yet its impact on diabetic microvascular complications (DMC) remains uncertain. This study aims to investigate the longitudinal association between early-life famine exposure and the risk of DMC in adult-hood among individuals with T2D. A retrospective cohort study was conducted among inpatients with T2D at Tianjin Medical University Chu Hsien-I Memorial Hospital from June 2014 to June 2022. The 2409 participants were divided into five famine exposure groups based on birth years: no exposure group (1962-1965), fetal period exposure group (1959-1961), early-childhood exposure group (1956-1958), mid-childhood exposure group (1953-1955), and late-childhood exposure group (1949-1952). Compared with those nonexposed, early-life famine exposure was associated with higher risks of incident overall DMC (HRtrend 1.134, 95% CI 1.052-1.223), diabetic retinopathy (DR) (HRtrend 1.193, 95% CI 1.100-1.293), and diabetic kidney disease (DKD) (HRtrend 1.262, 95% CI 1.117-1.425), but was not associated with diabetic neuropathy (p > 0.05). Notably, significant interactions were found between famine exposure and hypertension regarding the risk of DR, and between famine exposure and both and obesity patterns on the risk of DKD (all p for interaction < 0.05). Exposure to famine in early life was associated with increased risks of overall DMC, DR and DKD among patients with T2D. Specially, the association of DR was more pronounced in individuals with hypertension, while the association with DKD was stronger among those with hypertension or both general and abdominal obesity.