Abstract
BackgroundThis study aims to examine the cross-sectional association between serum total bilirubin (STB) and type 2 diabetes (T2D) risk in the general population, and whether obesity could moderate this association.MethodsWe used data from the 1999–2018 National Health and Nutrition Examination Surveys (NHANES), including a total of 38,641 US adult participants who were 18 years or older. The STB was classified as the low, moderate, and high groups according to tertiles.ResultsWe found that participants with lower STB had a significantly higher risk of T2D than those with moderate (OR = 0.81; 95% CI 0.74, 0.89; P < 0.001) and high (OR = 0.65; 95% CI 0.59, 0.73; P < 0.001) STB. Also, a significant interaction between body mass index (BMI) and STB on T2D was observed (P < 0.001). Stratified analysis showed that low STB was associated with a 20% and 27% decrease of T2D risk for moderate and high STB groups in obese patients, however, these effect estimates were smaller in the population with lower BMI (< 30 kg/m2). Similar associations of STB with glycohemoglobin and insulin resistance were observed.ConclusionThis study suggests that STB is associated with an elevated risk of T2D. More importantly, we reported for the first time that BMI may moderate the association between bilirubin and T2D.
Highlights
Type 2 diabetes (T2D) is a chronic disease that has become a serious issue in morbidity and health expenditures [1, 2]
In body mass index (BMI)-stratified analysis, we found that low serum total bilirubin (STB) was associated with a 20% and 27% decrease of type 2 diabetes (T2D) risk for moderate and high STB groups in obese patients (BMI ≥ 30), these effect estimates were smaller in the population with lower BMI (BMI < 30) (Table 3)
After adjusting for other covariates, the results showed that low STB was significantly associated with glycohemoglobin for moderate STB group (β = − 0.041; 95% confident interval (CI) − 0.059, − 0.024; P < 0.001) and high group (β = − 0.098; 95% CI − 0.115, − 0.080; P < 0.001)
Summary
Type 2 diabetes (T2D) is a chronic disease that has become a serious issue in morbidity and health expenditures [1, 2]. Risk factors for diabetes such as obesity, age, physical inactivity, dietary patterns have been well characterized and studied but the complex etiology of diabetes is still not fully understood [6]. In the context of the rapid rise of global costs of diabetic health care and management, it is imperative to identify novel risk factors of diabetes, which may help in the screening of high-risk populations and the introduction of early intervention strategies to prevent escalation of this chronic disease. This study aims to examine the cross-sectional association between serum total bilirubin (STB) and type 2 diabetes (T2D) risk in the general population, and whether obesity could moderate this association
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