Decreased risk of all-cause and heart-specific mortality is associated with low-fat or skimmed milk consumption compared with whole milk intake: A cohort study

Mitochondrial Metabolite Methylmalonic Acid, Subclinical Myocardial Injury, and its Incremental Predictive Value for Cardiovascular Mortality Risk

BACKGROUND AND AIMS

Methylmalonic acid (MMA) is involved in myocardial mitochondrial damage and energy metabolism disorders. We sought to investigate the association of MMA with subclinical myocardial injury and its incremental value in predicting cardiovascular mortality risk based on conventional risk factors and cardiac biomarkers.

METHODS

This study included 11,373 participants aged ≥18 years without prevalent cardiovascular disease (CVD). The cross-sectional associations of MMA with subclinical elevation of cardiac biomarkers (high-sensitivity cardiac troponin [hs-cTn] and N-terminal pro-B-type natriuretic peptide [NT-proBNP]), and their prospective associations with long-term mortality, were assessed. The predictive performance for 10-year cardiovascular mortality was estimated.

RESULTS

The association between MMA and elevated cardiac biomarkers was significant with a dose-response pattern. Compared with participants in the lowest quartile of MMA, the multivariable-adjusted rate ratios (95% CIs) in the highest quartile for elevated hs-cTnT and NT-proBNP were 2.35 (1.64-3.37) and 1.35 (1.12-1.62), respectively (each p trend <0.001). Strikingly, the cardiovascular mortality risk associated with elevated hs-cTnT or NT-proBNP was at least two-fold higher in adults with elevated MMA levels than in those with lower MMA levels. The adjusted hazard ratios (95% CIs) of elevated hs-cTnT for cardiovascular mortality were 1.58 (1.00-2.50) among individuals with MMA ≤125 nmol/L and 2.45 (1.94-3.11) among participants with MMA >125 nmol/L.

CONCLUSION

MMA accumulation is independently associated with subclinical myocardial injury before cardiovascular events occur. These findings support the additional value of mitochondria-related indicators to guide cardiac biomarker-based screening of populations at high risk for cardiovascular events.

Global disease burden analysis of Cardiometabolic disease attributable to second-hand smoke exposure from 1990 to 2040

Objective

Secondhand smoke (SHS) is a strong but comparatively controllable cardiometabolic risk factor. This study aims to assess the present and future burden of cardiometabolic diseases (CMDs) from SHS exposure.

Methods

Using the Global Burden of Disease (GBD) framework, we examined mortality and disability-adjusted life year (DALY) from CMDs attributable to SHS, by age, sex, and year, including cardiovascular disease [CVD, ischemic heart disease (IHD) and/or stroke], and/or Type 2 Diabetes Mellitus (T2DM) from 1990 to 2019. The predicted death number and age-standardized mortality rate (ASMR) from 2020 to 2040 were estimated by the Bayesian age-period cohort (BAPC) model.

Results

SHS exposure declined until 2016 but stabilized or increased thereafter. From 1990 to 2019, CMD-related deaths and DALYs due to SHS are continuously increasing, particularly in low-middle and middle Sociodemographic Index (SDI) regions. In 2019, a significant proportion of CMD-related deaths and DALYs among females under 65 were attributed to SHS exposure. In females aged 25-29, SHS contributed to 16.12 % and 13.30 % of IHD and T2DM deaths, respectively. Surprisingly, forecasts show that annual deaths from IHD, stroke, and T2DM related to SHS exposure are anticipated to rise over the next 20 years.

Conclusions

SHS exposure has stopped declining in recent years. CMD-related deaths from controlled SHS have increased and are predicted to rise substantially over the next 20 years. Reducing SHS exposure could have major benefits for cardiometabolic health worldwide, especially for women under 65 years in less developed regions.

Moderate full-fat and low-fat yoghurt consumption correlates with reduced mortality risk: a large-scale prospective analysis

Background

Yoghurt is a commonly consumed fermented food recommended by many guidelines. Yoghurt consumption can contribute to the intake of multiple nutrients and reduce the risk of several diseases. However, prospective evidence is limited on the associations between full/low-fat yoghurt consumption and mortality risk. In this prospective cohort study, we aimed to assess the dose-dependent associations between full/low-fat yoghurt intake and all-cause or cause-specific mortality.

Methods

We enrolled 186 168 participants from the UK Biobank who had joined the study between 2006 and 2010 and were followed up until 2022. We obtained data on self-reported intake of full/low-fat yoghurt and mortality from all causes and specific causes of death, including cancers and cardiovascular diseases (CVDs). We then used Cox proportional hazard models to calculate the hazard ratio (HR) and 95% confidence interval (CI) to evaluate the associations between full-fat and low-fat yoghurt intake and mortality. Lastly, we conducted subgroup and sensitivity analyses to examine the robustness of our findings.

Results

A total of 9402 deaths occurred during a mean follow-up of 13.4 years, including 1687 CVD-related and 5073 cancer-related deaths. Relative to non-consumers, the HRs (95% CIs) for all-cause mortality risk in participants consuming >0-50, 50-100, and >100 g of full-fat yoghurt a day were 0.82 (95% CI = 0.72, 0.93), 0.97 (95% CI = 0.86, 1.09), and 0.96 (95% CI = 0.84, 1.1) respectively. The corresponding HR estimates relative to non-consumers for participants consuming low-fat yoghurt were 0.88 (95% CI  = 0.81, 0.95), 0.91 (95% CI = 0.85, 0.98), and 0.95 (95% CI = 0.89, 1.01), respectively. Subgroup analysis indicated women who had moderate consumption of full-fat yoghurt had lower all-cause mortality risk, while men consuming low-fat yoghurt had lower all-cause mortality risk.

Conclusions

Moderate consumption of full-fat and low-fat yoghurt was correlated with decreased all-cause mortality. Future cohort studies are warranted to verify the potential of adopting yoghurt consumption as part of a healthy diet to reduce mortality.

Plant and Animal Fat Intake and Overall and Cardiovascular Disease Mortality

Importance

The impact of dietary fat intake on long-term human health has attracted substantial research interest, and the health effects of diverse dietary fats depend on available food sources. Yet there is a paucity of data elucidating the links between dietary fats from specific food sources and health.

Objective

To study associations of dietary plant and animal fat intake with overall mortality and cardiovascular disease (CVD) mortality.

Design, Setting, and Participants

This large prospective cohort study took place in the US from 1995 to 2019. The analysis of men and women was conducted in the National Institutes of Health-AARP Diet and Health Study. Data were analyzed from February 2021 to May 2024.

Exposures

Specific food sources of dietary fats and other dietary information were collected at baseline, using a validated food frequency questionnaire.

Main Outcomes and Measures

Hazard ratios (HRs) and 24-year adjusted absolute risk differences (ARDs) were estimated using multivariable-adjusted Cox proportional hazards regression.

Results

The analysis included 407 531 men and women (231 881 [56.9%] male; the mean [SD] age of the cohort was 61.2 [5.4] years). During 8 107 711 person-years of follow-up, 185 111 deaths were ascertained, including 58 526 CVD deaths. After multivariable adjustment (including adjustment for the relevant food sources), a greater intake of plant fat (HRs, 0.91 and 0.86; adjusted ARDs, -1.10% and -0.73%; P for trend < .001), particularly fat from grains (HRs, 0.92 and 0.86; adjusted ARDs, -0.98% and -0.71%; P for trend < .001) and vegetable oils (HRs, 0.88 and 0.85; adjusted ARDs, -1.40% and -0.71%; P for trend < .001), was associated with a lower risk for overall and CVD mortality, respectively, comparing the highest to the lowest quintile. In contrast, a higher intake of total animal fat (HRs, 1.16 and 1.14; adjusted ARDs, 0.78% and 0.32%; P for trend < .001), dairy fat (HRs, 1.09 and 1.07; adjusted ARDs, 0.86% and 0.24%; P for trend < .001), or egg fat (HRs, 1.13 and 1.16; adjusted ARDs, 1.40% and 0.82%; P for trend < .001) was associated with an increased risk for mortality for overall and CVD mortality, respectively, comparing the highest to the lowest quintile. Replacement of 5% energy from animal fat with 5% energy from plant fat, particularly fat from grains or vegetable oils, was associated with a lower risk for mortality: 4% to 24% reduction in overall mortality, and 5% to 30% reduction in CVD mortality.

Conclusions and Relevance

The findings from this prospective cohort study demonstrated consistent but small inverse associations between a higher intake of plant fat, particularly fat from grains and vegetable oils, and a lower risk for both overall and CVD mortality. A diet with a high intake of animal-based fat, including fat from dairy foods and eggs, was also shown to be associated with an elevated risk for both overall and CVD mortality.

Effect of chokeberry pomace as a feed additive for high-producing dairy goats on oxidative stress parameters and quality of milk

Introduction

Chokeberry pomace, rich in polyphenolic compounds, holds potential to be a valuable feed additive for enhancing the antioxidative capacity and overall quality of milk. This study explores the impact of dietary inclusion of chokeberry pomace on oxidative stress parameters and other milk quality parameters in high-producing dairy goats.

Material and Methods

Twenty-seven goats were allocated into three groups: a control group provided standard feed and two experimental groups provided feed supplemented with 15 g or 30 g of chokeberry pomace per kilogram. Milk samples were analysed for physicochemical traits, a range of enzyme activities and antioxidant properties.

Results

Supplementation with chokeberry pomace significantly reduced milk fat content, enhanced antioxidative properties and increased most of the quantified enzyme activities. Total polyphenol content and reduced glutathione levels were significantly higher in the supplemented groups, correlating with improved antioxidative potential of the milk.

Conclusion

Chokeberry pomace in goat diets enhances milk's antioxidative properties and upregulates its enzymatic activity profile, suggesting a potential strategy to improve the nutritional quality and health benefits of goat milk. The study underscores the utility of chokeberry pomace as a feed additive that might not only benefit animal health but also contribute to enhanced milk quality.

Full-fat dairy products and cardiometabolic health outcomes: Does the dairy-fat matrix matter?

Reducing dairy fat intake is a common dietary guideline to limit energy and saturated fatty acid intake for the promotion of cardiometabolic health. However, research utilizing a holistic, food-based approach to assess the consumption of the fat found in dairy, a broad and diverse food group, may provide new insight into these guidelines. Dairy fat is comprised of a diverse assembly of fatty acids, triacylglycerols, sterols, and phospholipids, all uniquely packaged in a milk fat globule. The physical structure of this milk fat globule and its membrane is modified through different processing methods, resulting in distinctive dairy-fat matrices across each dairy product. The objectives of this narrative review were to first define and compare the dairy-fat matrix in terms of its unique composition, physical structure, and fat content across common dairy products (cow's milk, yogurt, cheese, and butter). With this information, we examined observational studies and randomized controlled trials published within the last 10 years (2013-2023) to assess the individual effects of the dairy-fat matrix in milk, yogurt, cheese, and butter on cardiometabolic health and evaluate the implications for nutrition guidance. Searches conducted on Ovid MEDLINE and PubMed® utilizing search terms for cardiometabolic health, both broadly and regarding specific disease outcomes and risk factors, yielded 59 studies that were analyzed and included in this review. Importantly, this review stratifies by both dairy product and fat content. Though the results were heterogeneous, most studies reported no association between intake of these individual regular-fat dairy products and cardiometabolic outcome measures, thus, the current body of evidence suggests that regular-fat dairy product consumption may be incorporated within overall healthy eating patterns. Research suggests that there may be a beneficial effect of regular-fat milk and yogurt intake on outcome measures related to body weight and composition, and an effect of regular-fat cheese intake on outcome measures related to blood lipids, but more research is necessary to define the directionality of this relationship. Lastly, we identify methodological research gaps and propose future research directions to bolster the current evidence base available for ascertaining the role of dairy fat in a healthy diet.

Association between the recommended volume of leisure-time physical activity and erectile dysfunction: A cross-sectional analysis of the national health and nutrition examination survey, 2001-2004

Objective

Physical activity-related interventions alleviate the severity of erectile dysfunction (ED), but it is unknown whether the recommended volume of physical activity (PA) or a higher level of physical activity reduces the likelihood of ED in adult males. We aimed to evaluate the association between the recommended volume of PA and ED among US male adults.

Design

A nationally representative cross-sectional survey.

Setting

National Health and Nutrition Examination Survey 2001-2004.

Participants

A total of 2509 men aged ≥20 years were enrolled.

Primary and secondary outcome measures

ED and PA were assessed by a standardised self-report questionnaire. Weighted logistic regression analysis and spline fitting were used to assess the relationship between PA volume and the odds of ED.

Results

Among 2509 US adult males, the mean (standard error) age was 43.7 (0.46) years. A total of 61.1 % of men reached the recommended volume of aerobic PA. Compared with participants not meeting the PA guidelines, individuals who had recommended aerobic activities demonstrated a 34 % reduction in the odds of having ED (OR 0.66, 95 % CI 0.48-0.90; p = 0.011). Notably, according to the restricted cubic spline, we revealed a dose‒response pattern between PA volume and reduced odds of ED, even when exceeding the recommended PA levels. When compared to males with moderate-equivalent PA of less than 150 min/week, the odds of ED in those with moderate-equivalent PA levels of 150-300 min/week and >300 min/week decreased by 22 % and 39 %, respectively. Compared with participants who did not meet the PA guidelines, the multivariable-adjusted ORs (95 % CIs) of ED associated with adequate PA volumes were 0.37 (0.22-0.61) among non-smokers and 0.85 (0.57-1.25) among current smokers (p for interaction = 0.023).

Conclusions and Relevance

Our findings supported the benefit of meeting the guideline-recommended PA equivalents or higher volumes for ED prevention. However, PA-related benefit might be significantly diminished by smoking.

Association of a healthy beverage score with total mortality in the adult population of Spain: A nationwide cohort study

BACKGROUND

Despite the substantial evidence of the relationship between diet and mortality, the role of beverage consumption patterns is not well known. The aim of this study was to assess the association of the adherence to a Healthy Beverage Score (HBS) and all-cause mortality in a representative sample of the Spanish adult population.

METHODS AND FINDINGS

We conducted an observational cohort study using data from the Study on Nutrition and Cardiovascular Risk in Spain (ENRICA), which included 12,161 community-dwelling individuals aged ≥18 years recruited in 2008 to 2010 and followed until January 2022. At baseline, food consumption was collected using a validated diet history. The HBS consists of 7 items, each of which is scored from 1 to 4 (highest adherence). The HBS ranges from 7 to 28 points with a higher score representing a healthier pattern. Adherence was assigned as a higher consumption of low-fat milk, and coffee and tea, a lower consumption of whole-fat milk, no consumption of fruit juice, artificially sweetened beverages, or sugar-sweetened beverages, and no or moderate consumption of alcohol. Total mortality was ascertained by linkage to the Spanish National Death Index. Statistical analyses were performed with Cox models and adjusted for the main confounders, including sociodemographic, lifestyle, dietary variables, and morbidity. After a mean follow-up of 12.5 years (SD: 1.7; range: 0.5 to 12.9), a total of 967 deaths occurred. For all-cause mortality, the fully adjusted hazard ratio (HR) for the highest versus lowest sex-specific quartiles of HBS was 0.72 (95% confidence interval [0.57, 0.91], p linear-trend = 0.015), corresponding to an 8.3% reduction in the absolute risk of death. A linear relationship between the risk of death and the adherence to the HBS was observed using restricted cubic splines. The results were robust to sensitivity analyses. The main limitation was that repeated measurements on beverage consumption were not available and beverage consumption could have changed during follow-up.

CONCLUSIONS

In this study, we observed that higher adherence to the HBS was associated with lower total mortality. Adherence to a healthy beverage pattern could play a role in the prevention of premature mortality.

American Heart Association's new 'Life's Essential 8' score in association with cardiovascular disease: a national cross-sectional analysis

OBJECTIVE

The American Heart Association (AHA) has recently updated and enhanced the quantification of cardiovascular health by using the Life's Essential 8 (LE8) score. We intended to examine the correlation between cardiovascular health status, as measured by the new LE8 score, and cardiovascular disease (CVD) in US adults.

STUDY DESIGN

National cross-sectional study.

METHODS

A total of 24,730 individuals without pregnancy and with complete data from 2007 to 2018 enrolled in the study. The overall LE8 score was divided into low, moderate, and high groups. Multivariate logistic regressions were used to assess the odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between the LE8 score and the presence of CVD.

RESULTS

Overall, the high LE8 group had a younger age (20-59 years, 82.95%) and more females (60.09%) compared to the low LE8 group. Moderate and high LE8 correlated negatively with the presence of CVD (moderate, OR: 0.46, 95% CI: 0.39-0.54; high, OR: 0.26, 95% CI: 0.21-0.33). One standard deviation increment in the LE8 score correlated significantly with lower odds of CVD (OR: 0.64; 95% CI: 0.60-0.69). Further stratification analysis also detected a significant relationship between the new LE8 score and CVD, and the result was enhanced among the young and women (P-interaction<0.001).

CONCLUSIONS

Higher LE8 score correlated with lower odds of CVD, especially among the young and women.

Age-dependent interaction between Life's Essential 8 and chronic kidney disease: A national cross-sectional analysis

OBJECTIVE

Chronic kidney disease (CKD), an age-related condition, is closely associated with cardiovascular disease. We aimed to examine the age-dependent interaction between Life's Essential 8 (LE8), the updated measurement of cardiovascular health (CVH), and CKD in the United States.

METHODS

The cross-sectional study involved 25,529 participants from National Health and Nutrition Examination Survey in 2007-2018. Multivariate logistic regressions were used to estimate the age-dependent interaction between LE8 and CKD, and restricted cubic spline regressions were used to analyze the dose-response relationships between LE8 and CKD among adults and all age subgroups.

RESULTS

Overall, 2934 (9.3%), 17,278 (66.2%), and 5317 (24.5%) participants had low, moderate, and high CVH, separately. After adjusting for the potential covariates, LE8 was negatively associated with CKD [odds ratio (OR) for per 1 standard deviation (SD) increase and 95%CI, 0.71 (0.67, 0.75)], with a nonlinear dose-response relationship (P for nonlinearity = 0.001). The inversed association was stronger among participants aged 65 and older (0.65 (0.59, 0.71)) compared to youngers [20-39 years, 0.63 (0.59, 0.58), 40-64 years, 0.63 (0.59, 0.58)] (P for interaction = 0.002).

CONCLUSIONS

CVH, as measured by the LE8 score, was negatively associated with the presence of CKD in non-linear fashions, more pronounced in participants aged 65 and older compared to younger age groups.

Different types of milk consumption and the risk of dementia: Analysis from a large-scale cohort study

BACKGROUND & AIMS

Previous studies have investigated whether milk consumption has a role in preventing the development of cognitive impairment, but the results were inconsistent. Importantly, most of them have disregarded the role of different types of milk. This study aimed to examine the associations between different types of milk consumption and the risk of dementia.

METHODS

In this large-scale cohort study, participants without cognitive impairment at baseline were included from the UK Biobank. The type of milk mainly used was self-reported at baseline, including full-cream milk, skimmed-milk, soy milk, other milk, and no milk. The primary outcome was all-cause dementia. Secondary outcomes included Alzheimer's disease and vascular dementia.

RESULTS

Of the 307,271 participants included in the study (mean age 56.3 [SD 8.1] years), 3789 (1.2%) incident all-cause dementia cases were observed over a median follow-up of 12.3 years. After adjustment for potential confounders, only soy milk consumers had a statistically significantly lower risk of all-cause dementia compared with no milk consumers (hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.54 to 0.90). When compared with soy milk non-consumers consisting of full-cream milk, skimmed-milk, and other milk consumers, soy milk consumers still showed a lower risk of all-cause dementia (HR, 0.76; 95% CI, 0.63 to 0.92), and there was no significant interaction with genetic risk for dementia (P for interaction = 0.15). Soy milk consumers showed a lower risk of Alzheimer's disease (HR, 0.70; 95% CI, 0.51 to 0.94; P = 0.02), while the association was not significant for vascular dementia (HR, 0.72; 95% CI, 0.47 to 1.12; P = 0.14).

CONCLUSIONS

The main consumption of soy milk was associated with a lower risk of dementia, particularly non-vascular dementia. Additional studies are needed to investigate how this association varies with the dose or frequency of the consumption of soy milk and to examine the generalizability of these findings in different populations.

Dairy products and constituents: a review of their effects on obesity and related metabolic diseases

Obesity has become a global public health problem that seriously affects the quality of life. As an important part of human diet, dairy products contain a large number of nutrients that are essential for maintaining human health, such as proteins, peptides, lipids, vitamins, and minerals. A growing number of epidemiological investigations provide strong evidence on dairy interventions for weight loss in overweight/obese populations. Therefore, this paper outlines the relationship between the consumption of different dairy products and obesity and related metabolic diseases. In addition, we dive into the mechanisms related to the regulation of glucose and lipid metabolism by functional components in dairy products and the interaction with gut microbes. Lastly, the role of dairy products on obesity of children and adolescents is revisited. We conclude that whole dairy products exert more beneficial effect than single milk constituent on alleviating obesity and that dairy matrix has important implications for metabolic health.

Multimodal deep learning as a next challenge in nutrition research: tailoring fermented dairy products based on cytidine diphosphate-diacylglycerol synthase-mediated lipid metabolism

Deep learning is evolving in nutritional epidemiology to address challenges including precise nutrition and data-driven disease modeling. Fermented dairy products consumption as the implementation of specific dietary priority contributes to a lower risk of all-cause mortality, cardiovascular disease, and obesity. Various lipid types play different roles in cardiometabolic health and fermentation process changes the lipid profile in dairy products. Leveraging the power of multiple biological datasets can provide mechanistic insights into how proteins impact lipid pathways, and establish connections among fermentation-lipid biomarkers-protein. The recent leap of deep learning has been performed in food category recognition, agro-food freshness detection, and food flavor prediction and regulation. The proposed multimodal deep learning method includes four steps: (i) Forming data matrices based on data generated from different omics layers. (ii) Decomposing high-dimensional omics data according to self-attention mechanism. (iii) Constructing View Correlation Discovery Network to learn the cross-omics correlations and integrate different omics datasets. (iv) Depicting a biological network for lipid metabolism-centered quantitative multi-omics data analysis. Relying on the cytidine diphosphate-diacylglycerol synthase-mediated lipid metabolism regulates the glycerophospholipid composition of fermented dairy effectively. Innovative processing strategies including ohmic heating and pulsed electric field improve the sensory qualities and nutritional characteristics of the products.

Association of milk consumption with all-cause mortality and cardiovascular outcomes: a UK Biobank based large population cohort study

BACKGROUND

The association of milk consumption with mortality and cardiovascular disease (CVD) outcomes was unclear.

OBJECTIVE

The present study was performed to reveal the association of full cream, semi-skimmed, skimmed, soy, and other milk with all-cause mortality and CVD outcomes.

METHODS

A prospective cohort study was performed using data from the UK Biobank. This study recruited 450,507 participants without CVD at baseline between 2006 and 2010 from UK Biobank and followed them up through 2021. Cox proportional hazard models were adopted to calculate the hazard ratios (HRs) and 95% confidence interval (CI) to understand the correlation between milk consumption and clinical outcomes. Subgroup and sensitivity analyses were further conducted.

RESULTS

Among the participants, 435,486 (96.7%) were milk consumers. Multivariable model indicated that the adjusted HR of association between milk consumption and all-cause mortality was 0.84 (95% CI 0.79 to 0.91; P = 0.000) for semi-skimmed milk; 0.82 (0.76 to 0.88; P = 0.000) for skimmed milk and 0.83 (0.75 to 0.93; P = 0.001) for soy milk. Semi-skimmed, skimmed, and soy milk use were significantly related to lower risks of CVD mortality, CVD event, and stroke.

CONCLUSION

Compared with non-milk users, semi-skimmed milk, skimmed milk, and soy milk consumption were related to a lower risk of all-cause mortality and CVD outcomes. Among them, skim milk consumption was more beneficial for all-cause mortality, while soy milk consumption was more beneficial for CVD outcomes.

Association of Serum Homocysteine with Cardiovascular and All-Cause Mortality in Adults with Diabetes: A Prospective Cohort Study

Background

Homocysteine (Hcy) was implicated in oxidative stress and diabetes biologically. However, the clinical evidence on the link between Hcy level and diabetes is limited and controversial. This study is aimed at investigating the association of serum Hcy with all-cause and cardiovascular mortality in diabetic patients.

Methods

Serum Hcy was measured among 2,286 adults with type 2 diabetes in NHANES 1999-2006. Cox proportional hazard regression was used to estimate hazard ratios (HR) and 95% CIs for the association of Hcy with all-cause and cause-specific mortality.

Results

Over a median follow-up of 11.0 (interquartile range, 8.9-13.4) years, 952 of the 2286 patients with diabetes died, covering 269 (28.3%) cardiovascular deaths and 144 (15.2%) cancer deaths. Restricted cubic spline showed the linear relationship between Hcy and all-cause mortality risk. After multivariate adjustment, higher serum Hcy levels were independently associated with increased risk of all-cause and cardiovascular mortality. Compared with participants in the bottom tertile of Hcy, the multivariate-adjusted HRs and 95% CI for participants in the top quartile were 2.33 (1.64-3.30) for all-cause mortality (p_trend < 0.001), 2.24 (1.22-4.10) for CVD mortality (p_trend = 0.017), and 2.05 (0.90-4.69) for cancer mortality (p_trend = 0.096). The association with total mortality was especially stronger among patients with albuminuria. Serum Hcy significantly improved reclassification for 10-year mortality in diabetic patients (net reclassification index = 0.253 and integrated discrimination improvement = 0.011).

Conclusions

Serum Hcy was associated with risks of all-cause and cardiovascular mortality in diabetic adults. Our results suggested that Hcy was a promising biomarker in risk stratification among diabetic patients.