6-Year trajectory of fasting plasma glucose (FPG) and mortality risk among individuals with normal FPG at baseline: a prospective cohort study

Wanlu Li; Chi Pang Wen; Wenyuan Li; Zhijun Ying; Sai Pan; Yizhan Li; Zecheng Zhu; Min Yang; Huakang Tu; Yi Guo; Zhenya Song; David Ta-Wei Chu; Xifeng Wu

doi:10.1186/s13098-023-01146-2

6-Year trajectory of fasting plasma glucose (FPG) and mortality risk among individuals with normal FPG at baseline: a prospective cohort study

Diabetol Metab Syndr. 2023 Aug 13;15(1):169. doi: 10.1186/s13098-023-01146-2.

Authors

Wanlu Li^#¹, Chi Pang Wen^#², Wenyuan Li¹, Zhijun Ying¹, Sai Pan¹, Yizhan Li¹, Zecheng Zhu¹, Min Yang^{1

3}, Huakang Tu¹, Yi Guo⁴, Zhenya Song^{4

5}, David Ta-Wei Chu⁶, Xifeng Wu^{7

8

9

10

11}

Affiliations

¹ Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
² National Institute for Data Science in Health and Medicine, Zhejiang University, 866 Yuhangtang Road, Hangzhou, 310058, Zhejiang, China.
³ Department of Nutrition and Food Hygiene School of Public Health, Zhejiang University School of Medicine, Hangzhou, China.
⁴ Department of Health Management Center and Department of General Medicine, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
⁵ The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, Zhejiang, China.
⁶ MJ Health Management Center, Taipei, Taiwan.
⁷ Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China. xifengw@zju.edu.cn.
⁸ National Institute for Data Science in Health and Medicine, Zhejiang University, 866 Yuhangtang Road, Hangzhou, 310058, Zhejiang, China. xifengw@zju.edu.cn.
⁹ The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, Zhejiang, China. xifengw@zju.edu.cn.
¹⁰ Cancer Center, Zhejiang University, Hangzhou, Zhejiang, China. xifengw@zju.edu.cn.
¹¹ School of Medicine and Health Science, George Washington University, Washington, DC, USA. xifengw@zju.edu.cn.

^# Contributed equally.

Abstract

Background: Higher fasting plasma glucose (FPG) levels were associated with an increased risk of all-cause mortality; however, the associations between long-term FPG trajectory groups and mortality were unclear, especially among individuals with a normal FPG level at the beginning. The aims of this study were to examine the associations of FPG trajectories with the risk of mortality and identify modifiable lifestyle factors related to these trajectories.

Methods: We enrolled 50,919 individuals aged ≥ 20 years old, who were free of diabetes at baseline, in the prospective MJ cohort. All participants completed at least four FPG measurements within 6 years after enrollment and were followed until December 2011. FPG trajectories were identified by group-based trajectory modeling. We used Cox proportional hazards models to examine the associations of FPG trajectories with mortality, adjusting for age, sex, marital status, education level, occupation, smoking, drinking, physical activity, body mass index, baseline FPG, hypertension, dyslipidemia, cardiovascular disease or stroke, and cancer. Associations between baseline lifestyle factors and FPG trajectories were evaluated using multinomial logistic regression.

Results: We identified three FPG trajectories as stable (n = 32,481), low-increasing (n = 17,164), and high-increasing (n = 1274). Compared to the stable group, both the low-increasing and high-increasing groups had higher risks of all-cause mortality (hazard ratio (HR) = 1.18 (95% CI 0.99-1.40) and 1.52 (95% CI 1.09-2.13), respectively), especially among those with hypertension. Compared to participants with 0 to 1 healthy lifestyle factor, those with 6 healthy lifestyle factors were more likely to be in the stable group (OR_{low-increasing} = 0.61, 95% CI 0.51-0.73; OR_{high-increasing} = 0.20, 95% CI 0.13-0.32).

Conclusions: Individuals with longitudinally increasing FPG had a higher risk of mortality even if they had a normal FPG at baseline. Adopting healthy lifestyles may prevent individuals from transitioning into increasing trajectories.

Keywords: Cohort analysis; Epidemiology; Fasting plasma glucose; Glucose homeostasis; Group-based trajectory model; Longitudinal change; Mortality.

Abstract

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