Accelerated biological aging mediates the associations of stress hyperglycemia ratio (SHR) with mortality in type 2 diabetes and obesity (diabesity)
Authors' conclusion
Both SHR and accelerated biological aging independently predict higher all-cause, CVD, and cancer mortality in patients with type 2 diabetes and obesity. Furthermore, KDMAgeAccel could significantly mediates these associations, while PhenoAgeAccel could potentially suppress the direct effect of SHR on all-cause and CVD mortality, and exacerbate SHR's direct effect on cancer mortality. Interventions targeting both stress hyperglycemia and aging-related pathways may reduce mortality risks in patients with type 2 diabetes and obesity.
Study context
- Population
- Individuals with T2D and obesity (diabesity), NHANES
- Participants
- 4,253 individuals
- Exposure
- Highest vs reference SHR tertile
- Outcome
- All-cause, CVD and cancer mortality
- Follow-up
- Median 110.00 months (IQR 40.00-152.00 months)
Methodological detailsNHANES, mortality linkage to National Death Index, mediation analysis
- NHANES
- Mortality linkage to National Death Index
- Mediation analysis
Main finding
As reported in the abstract
AHR, all-cause mortality
1.32
all P < 0.001
Highest SHR tertile
AHR, cardiovascular disease (CVD) mortality
1.38
all P < 0.001
Highest SHR tertile
AHR, cancer mortality
1.61
all P < 0.001
Highest SHR tertile
- All-cause deaths
- 1139 (26.78%)
- CVD deaths
- 318 (7.48%)
- Cancer deaths
- 215 (5.06%)
Observational data: associations, not effects.
Further findings
Survival by SHR (Kaplan-Meier)
- Higher SHR associated with reduced survival
- P < 0.001
Dose-response (restricted cubic spline (RCS))
- U-shaped relationships for all-cause and CVD mortality; linear positive for cancer mortality
SHR and biological aging
- β, SHR with KDMAgeAccel
- 5.00
- β, SHR with PhenoAgeAccel
- 1.15
- Both P < 0.01
Mediation by KDMAgeAccel
- Proportion mediated, all-cause mortality
- 10.31%
- Proportion mediated, CVD mortality
- 12.81%
- Proportion mediated, cancer mortality
- 3.65%
- PhenoAgeAccel suppressed SHR's effect on all-cause and CVD mortality and exacerbated its effect on cancer mortality
- All P < 0.05
- Consistent across subgroup and sensitivity analyses
Original publication
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