Predicting life span of type 2 diabetes patients through alkaline phosphatase and vitamin D: Results from NHANES 1999–2018,Atherosclerosis

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Predicting life span of type 2 diabetes patients through alkaline phosphatase and vitamin D: Results from NHANES 1999–2018
Atherosclerosis ( IF 4.9 ) Pub Date : 2023-10-05 , DOI: 10.1016/j.atherosclerosis.2023.117318
Fan Yang ₁ , Mingsi Wang ₂ , Jie Du ₃ , Yao Fu ₄ , Jingwen Deng ₃ , Jianjun Wu ₃ , Yao Zhang ₃ , Yilan Li ₃

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Disparities in serum biomarker levels related to mortality persist within the US diabetic population. We conducted a study to explore the impact of alkaline phosphatase (ALP) on all-cause mortality and cardiovascular disease (CVD) mortality in type 2 diabetes patients. We analyzed a nationally representative sample of individuals aged 20 years and above from the National Health and Nutrition Examination Survey (NHANES) conducted in the United States between 1999 and 2018. Baseline demographic information and biochemical markers, including blood glucose, γ-glutamyltranspeptidase, vitamin D and albumin, were collected. Participants were divided into four groups based on ALP levels and linked to the National Death Index to assess mortality. Follow-up continued until December 2019, and multiple mediation analyses were performed to assess the combined impact of different indicators on ALP differences in all-cause mortality and cardiovascular mortality risk. Our analysis included 6481 NHANES participants, categorized as follows: 1626 (21.9%) had ALP levels below 58 U/L, 1674 in the second quartile (58–72 U/L), 1569 in the third quartile (72–88.3 U/L), and 1612 in the fourth quartile (above 88.3U/L). Significantly higher all-cause mortality and cardiovascular mortality rates were observed among participants in the 4th ALP quartile compared to other levels. The all-cause mortality rate was 38.06 per 1000 person-years (95% CI 34.89–41.51), and the cardiovascular mortality rate was 10.67 (9.06–12.57). Mediation analysis indicated that Vitamin D and albumin played a mediating role in the association between all-cause mortality, cardiovascular mortality, and ALP levels, with mediation proportions ranging from 10.33% to 27.64%. Our study suggests that ALP levels have clinical value in predicting all-cause and CVD mortality risk in T2DM patients. The upregulation of Vitamin D and albumin might play a significant role in improving risk prediction and enable targeted interventions for reducing mortality risk in this population.

中文翻译：

通过碱性磷酸酶和维生素 D 预测 2 型糖尿病患者的寿命：NHANES 1999-2018 的结果

美国糖尿病人群中与死亡率相关的血清生物标志物水平仍然存在差异。我们进行了一项研究，探讨碱性磷酸酶 (ALP) 对 2 型糖尿病患者全因死亡率和心血管疾病 (CVD) 死亡率的影响。我们分析了 1999 年至 2018 年在美国进行的国家健康和营养检查调查 (NHANES) 中 20 岁及以上个体的全国代表性样本。基线人口统计信息和生化标志物，包括血糖、γ-谷氨酰转肽酶、维生素收集D和白蛋白。参与者根据 ALP 水平分为四组，并与国家死亡指数联系起来评估死亡率。随访持续至2019年12月，并进行多重中介分析，以评估不同指标对全因死亡率和心血管死亡风险中ALP差异的综合影响。我们的分析包括 6481 名 NHANES 参与者，分类如下：1626 名 (21.9%) 的 ALP 水平低于 58 U/L，1674 名处于第二四分位数 (58–72 U/L)，1569 名处于第三四分位数 (72–88.3 U/L)。 L），第四个四分位数为 1612（高于 88.3U/L）。与其他水平相比，第四个 ALP 四分位数的参与者的全因死亡率和心血管死亡率显着较高。全因死亡率为每1000人年38.06人（95% CI 34.89-41.51），心血管死亡率为10.67人（9.06-12.57）。中介分析表明，维生素D和白蛋白在全因死亡率、心血管死亡率和ALP水平之间的关联中起中介作用，中介比例范围为10.33%至27.64%。我们的研究表明，ALP 水平对于预测 T2DM 患者的全因死亡风险和 CVD 死亡风险具有临床价值。维生素 D 和白蛋白的上调可能在改善风险预测方面发挥重要作用，并能够采取有针对性的干预措施来降低该人群的死亡风险。

更新日期：2023-10-05

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