Dietary Carbohydrate Intake and New-onset Diabetes: A Nationwide Cohort Study in China

Abstract Background: The association of carbohydrate intake with diabetes risk remains uncertain. We aimed to evaluate the prospective associations of the amount and types of carbohydrate intake with new-onset diabetes.Methods: A total of 16,260 non-diabetic participants from the China Health and Nutrition Survey (CHNS) were included. Dietary intake was collected by three consecutive 24-h dietary recalls combined with a household food inventory. Participants with self-reported diabetes, or fasting plasma glucose ≥7.0 mmol/L or glycated hemoglobin ≥6.5% during the follow-up were defined having new-onset diabetes. Results: During a median follow-up of 9 years (158,930 person-years), 1,100 participants developed diabetes. Overall, there was a U-shaped association between percent of energy from carbohydrate intake and new-onset diabetes, with minimal risk at 49-56% of energy from total carbohydrate intake (quartile 2) (P for nonlinearity <0.001). Moreover, there was an L-shaped association between high-quality carbohydrate intake and new-onset diabetes (P for nonlinearity <0.001), and a J-shaped association of low-quality carbohydrate intake with new-onset diabetes (P for nonlinearity <0.001). Furthermore, there was an inverse association between the plant-based low-carbohydrate scores for low-quality carbohydrate and new-onset diabetes. However, a reversed J-shaped association was found between the animal-based low-carbohydrate scores for low-quality carbohydrate and new-onset hypertension (P for nonlinearity <0.001). Conclusions: There was a U-shape association between percent of total carbohydrate intake and new-onset diabetes, with the lowest risk at 49-56% carbohydrate intake. Our findings provide some evidence for the intake of high-quality carbohydrate, and the substitution of plant-based products for low-quality carbohydrate for primary prevention of diabetes.

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Dietary Carbohydrate Intake and New-Onset Hypertension

Hypertension ◽

10.1161/hypertensionaha.120.16751 ◽

2021 ◽

Author(s):

Qinqin Li ◽

Chengzhang Liu ◽

Shaojie Zhang ◽

Rui Li ◽

Yuanyuan Zhang ◽

...

Keyword(s):

Blood Pressure ◽

Carbohydrate Intake ◽

Minimal Risk ◽

Inverse Association ◽

Nutrition Survey ◽

High Quality ◽

Increased Risk ◽

Low Carbohydrate ◽

New Onset

The association between carbohydrate intake and the risk of hypertension remains uncertain. We aimed to evaluate the prospective relations of the amount and type of carbohydrate intake with new-onset hypertension. A total of 12 177 adults who were free of hypertension at baseline from the China Health and Nutrition Survey were included. Dietary intake was measured by 3 consecutive 24-hour dietary recalls combined with a household food inventory. The study outcome was new-onset hypertension, defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg or diagnosed by physician or under antihypertensive treatment during the follow-up. A total of 4269 subjects developed hypertension during 95 157 person-years of follow-up. Overall, there was a U-shaped association between the percentage energy consumed from total carbohydrate (mean, 56.7%; SD, 10.7) and new-onset hypertension ( P for nonlinearity <0.001), with the lowest risk observed at 50% to 55% carbohydrate intake. The increased risks were mainly found in those with lower intake of high-quality carbohydrate (mean, 6.4%; SD, 5.6) or higher intake of low-quality carbohydrate (mean, 47.0%; SD, 13.0). Moreover, there was an inverse association between the plant-based low-carbohydrate scores for low-quality carbohydrate and new-onset hypertension. However, there was a U-shaped association between the animal-based low-carbohydrate scores for low-quality carbohydrate and new-onset hypertension ( P for nonlinearity <0.001). In summary, both high and low percentages of carbohydrate diets were associated with increased risk of new-onset hypertension, with minimal risk at 50% to 55% carbohydrate intake. Our findings support the intake of high-quality carbohydrate, and the substitution of plant-based products for low-quality carbohydrate for prevention of hypertension.

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Variety and quantity of dietary protein intake from different sources and risk of new-onset diabetes: a Nationwide Cohort Study in China

BMC Medicine ◽

10.1186/s12916-021-02199-8 ◽

2022 ◽

Vol 20 (1) ◽

Author(s):

Chun Zhou ◽

Chengzhang Liu ◽

Zhuxian Zhang ◽

Mengyi Liu ◽

Yuanyuan Zhang ◽

...

Keyword(s):

Food Sources ◽

Inverse Association ◽

Nutrition Survey ◽

Protein Sources ◽

Onset Diabetes ◽

Household Food Inventory ◽

Using Data ◽

Different Sources ◽

New Onset

Abstract Background The relation of the variety and quantity of different sources of dietary proteins intake and diabetes remains uncertain. We aimed to investigate the associations between the variety and quantity of proteins intake from eight major food sources and new-onset diabetes, using data from the China Health and Nutrition Survey (CHNS). Methods 16,260 participants without diabetes at baseline from CHNS were included. Dietary intake was measured by three consecutive 24-h dietary recalls combined with a household food inventory. The variety score of protein sources was defined as the number of protein sources consumed at the appropriate level, accounting for both types and quantity of proteins. New-onset diabetes was defined as self-reported physician-diagnosed diabetes or fasting glucose ≥7.0mmol/L or glycated hemoglobin ≥6.5% during the follow-up. Results During a median follow-up of 9.0 years, 1100 (6.8%) subjects developed diabetes. Overall, there were U-shaped associations of percentages energy from total protein, whole grain-derived and poultry-derived proteins with new-onset diabetes; J-shaped associations of unprocessed or processed red meat-derived proteins with new-onset diabetes; a reverse J-shaped association of the fish-derived protein with new-onset diabetes; L-shaped associations of egg-derived and legume-derived proteins with new-onset diabetes; and a reverse L-shaped association of the refined grain-derived protein with new-onset diabetes (all P values for nonlinearity<0.001). Moreover, a significantly lower risk of new-onset diabetes was found in those with a higher variety score of protein sources (per score increment; HR, 0.69; 95%CI, 0.65–0.72). Conclusions There was an inverse association between the variety of proteins with appropriate quantity from different food sources and new-onset diabetes.

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U-shaped Association Between Dietary Zinc Intake and New-onset Diabetes: A Nationwide Cohort Study in China

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgab636 ◽

2021 ◽

Author(s):

Panpan He ◽

Huan Li ◽

Mengyi Liu ◽

Zhuxian Zhang ◽

Yuanyuan Zhang ◽

...

Keyword(s):

Chinese Adults ◽

Dietary Zinc ◽

Nutrition Survey ◽

Zinc Intake ◽

Health And Nutrition ◽

Onset Diabetes ◽

Household Food Inventory ◽

Diagnosed Diabetes ◽

New Onset

Abstract Aims We aimed to investigate the relationship of dietary zinc intake with new-onset diabetes among Chinese adults. Materials and Methods A total of 16 257 participants who were free of diabetes at baseline from the China Health and Nutrition Survey were included. Dietary intake was measured by 3 consecutive 24-hour dietary recalls combined with a household food inventory. Participants with self-reported physician-diagnosed diabetes, or fasting glucose ≥ 7.0 mmol/L, or glycated hemoglobin ≥ 6.5% during the follow-up were defined as having new-onset diabetes. Results A total of 1097 participants developed new-onset diabetes during a median follow-up duration of 9.0 years. Overall, the association between dietary zinc intake and new-onset diabetes followed a U-shape (P for nonlinearity < 0.001). The risk of new-onset diabetes was significantly lower in participants with zinc intake < 9.1 mg/day (per mg/day: hazard ratio [HR], 0.73; 95% CI, 0.60-0.88), and higher in those with zinc intake ≥ 9.1 mg/day (per mg/day: HR, 1.10; 95% CI, 1.07-1.13). Consistently, when dietary zinc intake was assessed as deciles, compared with those in deciles 2-8 (8.9 -<12.2 mg/day), the risk of new-onset diabetes was higher for decile 1 (<8.9 mg/day: HR, 1.29; 95% CI, 1.04-1.62), and deciles 9 to 10 (≥12.2 mg/day: HR, 1.62; 95% CI, 1.38-1.90). Similar U-shaped relations were found for plant-derived or animal-derived zinc intake with new-onset diabetes (all P for nonlinearity < 0.001). Conclusions There was a U-shaped association between dietary zinc intake and new-onset diabetes in general Chinese adults, with an inflection point at about 9.1 mg/day.

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Associations of Carbohydrate Intake With New-Onset Hypertension Subtypes: Results From the China Health and Nutrition Survey (2000–2011)

Frontiers in Nutrition ◽

10.3389/fnut.2021.728774 ◽

2022 ◽

Vol 8 ◽

Author(s):

Su-Fen Qi ◽

Ya-Jing Cao ◽

Hui-Jun Wang ◽

Bing Zhang ◽

Jing Yan ◽

...

Keyword(s):

Blood Pressure ◽

Energy Intake ◽

Carbohydrate Intake ◽

Nutrition Survey ◽

Health And Nutrition ◽

Hazard Ratios ◽

Lactating Mothers ◽

Diastolic Hypertension ◽

New Onset

Background: The effects of carbohydrate intake on hypertension (HTN) subtypes are scarce. We examined the association of carbohydrate intake with new-onset HTN subtypes in Chinese adults.Methods: Chinese Health and Nutrition Survey (CHNS) 2000–2011, 22,418 individuals were recorded using a 24-h recall method over three consecutive days. We excluded those who were pregnant women, lactating mothers, age <18 years, baseline age, blood pressure, and energy intake deficiency, extreme energy intake (male > 6,000 kcal or < 800 kcal; female > 4,000 kcal or < 600 kcal), and pulse pressure difference (Systolic Blood Pressure [SBP] - Diastolic Blood Pressure [DBP]) <10 mm Hg, HTN at baseline and data from only one survey. The total number of subjects who participated in at least two surveys was 7,930. The main outcome was new-onset HTN subtypes over 6.9 person years of follow-up.Results: 2,521 participants were found to be HTN, which included 1,318 males (52.3%), 1,203 females (47.7%), 721 had systolic-diastolic hypertension (SDH, 28.6%), 655 had isolated systolic hypertension (ISH, 26.0%), and 993 had isolated diastolic hypertension (IDH, 39.4%). Compared with extreme quintiles of carbohydrate, multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI) for new-onset HTN, SDH, ISH and IDH associated with carbohydrate intake were 1.12 (0.97–1.30), 1.54 (1.18–2.00), 0.89 (0.67–1.19) and 1.15 (0.91–1.45), respectively. The HR of SDH compared with extreme quintiles of carbohydrates was 1.56 (95% CI, 1.08–2.25; Ptrend = 0.04) in men and 1.52 (95% CI, 1.02–2.26; Ptrend = 0.02) in women.Conclusion: Carbohydrates were related to a higher risk of SDH, which were not observed with HTN, ISH, and IDH.

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Inverse Association Between Riboflavin Intake and New-Onset Hypertension

Hypertension ◽

10.1161/hypertensionaha.120.16211 ◽

2020 ◽

Vol 76 (6) ◽

pp. 1709-1716

Author(s):

Mengyi Liu ◽

Chun Zhou ◽

Zhuxian Zhang ◽

Qinqin Li ◽

Panpan He ◽

...

Keyword(s):

Blood Pressure ◽

Hazard Ratio ◽

Dietary Sodium ◽

Inverse Association ◽

Nutrition Survey ◽

Health And Nutrition ◽

Household Food Inventory ◽

Prevention Of Hypertension ◽

New Onset

The prospective relation of dietary riboflavin intake with hypertension remains uncertain. We aimed to investigate the relationship of dietary riboflavin intake with new-onset hypertension and examine possible effect modifiers in general population. A total of 12 245 participants who were free of hypertension at baseline from China Health and Nutrition Survey were included. Dietary intake was measured by 3 consecutive 24-hour dietary recalls combined with a household food inventory. The study outcome was new-onset hypertension, defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg or diagnosed by physician or under antihypertensive treatment during the follow-up. A total of 4303 (35.1%) subjects developed hypertension during 95 573 person-years of follow-up. Overall, there was a nonlinear, inverse association between total, plant-based, or animal-based riboflavin intake and new-onset hypertension (all P for nonlinearity, <0.001). The risk of new-onset hypertension was increased only in participants with relatively lower riboflavin intake. Accordingly, a significantly lower risk of new-onset hypertension was found in participants in quartiles 2 to 4 of total riboflavin intake (hazard ratio, 0.74 [95% CI, 0.68–0.80]), plant-derived riboflavin intake (hazard ratio, 0.77 [95% CI, 0.71–0.84]), or animal-derived riboflavin intake (hazard ratio, 0.70 [95% CI, 0.65–0.77]), compared with those in quartile 1. In addition, the association between total riboflavin intake and new-onset hypertension was particularly evident in those with lower dietary sodium/potassium intake ratio ( P interaction, <0.001). In summary, there was an inverse association between riboflavin intake and new-onset hypertension in general Chinese adults. Our results emphasized the importance of maintaining relatively higher riboflavin intake levels for the prevention of hypertension.

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Abstract 658: New Onset Diabetes Does Not Pose Additional Risk - Analysis Of 15,111 Treated Hypertensive Patients With 40 Year Follow-up.

Hypertension ◽

10.1161/hyp.64.suppl_1.658 ◽

2014 ◽

Vol 64 (suppl_1) ◽

Author(s):

Stefanie Lip

Keyword(s):

Alkaline Phosphatase ◽

Hospital Admissions ◽

Cox Proportional Hazards ◽

Outcome Analysis ◽

Gamma Glutamyl Transpeptidase ◽

Hypertensive Patients ◽

Onset Diabetes ◽

Diabetes Status ◽

New Onset

Objective: It is unclear whether new onset diabetes (NOD) is a separate entity associated with excess risk in hypertensive patients. Methods: We studied 15111 hypertensive patients with up to 40 year follow-up at the Glasgow BP Clinic database. Diabetes status was defined based on hospital admissions for any diabetes related diagnosis or prescription of anti-diabetic drugs or diabetes monitoring materials. The date at first hospital encounter either for prescription or admission was considered as the onset of diabetes. NOD was classified into early and late (diagnosis <10yrs or >10years from first clinic visit). Cause-specific outcome analysis was performed using multivariate-adjusted Cox proportional hazards (Cox-PH) models. In order to address any potential competing risk introduced due to the long follow-up period, an additional composite end point of all-cause mortality+NOD was analysed. Results: There were 2521(17%) patients with DM, of whom 2061(14%) had NOD. The incidence rate of NOD was 9.2 per 1000 person-years. Prevalence of early NOD was 898 (6%) and late NOD 1163 (8%). The total time at risk was 239,952 person-years with a median survival time of 28.04 years (IQR: 16.24-39.95). There were 5225 deaths (52% from cardiovascular causes) during the follow-up period. Independent predictors of new-onset diabetes in order of decreasing significance were baseline glucose, BMI, age, alanine transaminase, alkaline phosphatase, gamma glutamyl transpeptidase and bilirubin. Of these age, glucose, BMI and alkaline phosphatase remained top predictors for the composite outcome of NOD+all-cause death. The mortality risk was the highest in those with prevalent DM (HR=1.5[95%CI=1.2;1.9]) and lowest in those with late NOD (0.79[0.68;0.92]). Early NOD and non-diabetic subjects had similar risks. Conclusions: Indices of liver function tests predict the risk of NOD and mortality in addition to BMI and baseline glucose. The risk posed by NOD is related to duration of diabetes primarily indicating the importance of efforts to delay onset of NOD.

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Associations of fat and carbohydrate intake with becoming overweight and obese: an 11-year longitudinal cohort study

British Journal Of Nutrition ◽

10.1017/s0007114520001579 ◽

2020 ◽

Vol 124 (7) ◽

pp. 715-728 ◽

Cited By ~ 1

Author(s):

Ya-Jing Cao ◽

Hui-Jun Wang ◽

Bing Zhang ◽

Su-Fen Qi ◽

Ying-Jun Mi ◽

...

Keyword(s):

Cox Model ◽

Overweight And Obesity ◽

Carbohydrate Intake ◽

Macronutrient Intake ◽

Dietary Carbohydrate ◽

Macronutrient Composition ◽

Total Fat ◽

The Relationship ◽

New Onset

AbstractThe effects of macronutrient intake on obesity are controversial. This research aims to investigate the associations between macronutrient intake and new-onset overweight/obesity. The relationship between the consumption of carbohydrate and total fat and obesity was assessed by the multivariable Cox model in this 11-year cohort, which included 6612 adults (3291 men and 3321 women) who were free of overweight and obesity at baseline. The dietary intake was recorded using a 24-h recall method for three consecutive days. Moreover, substitution models were developed to distinguish the effects of macronutrient composition alteration from energy intake modification. During 7·5 person years (interquartile range 4·3, 10·8) of follow-up, 1807 participants became overweight or obese. After adjusting for risk factors, the hazard ratio (HR) of overweight/obesity in extreme quintiles of fat was 1·48 (quintile 5 v. quintile 1, 95 % CI 1·16, 1·89; Ptrend = 0·02) in women. Additionally, replacing 5 % of energy from carbohydrate with equivalent energy from fat was associated with an estimated 4·3 % (HR 1·043, 95 % CI 1·007, 1·081) increase in overweight/obesity in women. Moreover, dietary carbohydrate was inversely associated with overweight/obesity (quintile 5 v. quintile 1, HR 0·70, 95 % CI 0·55, 0·89; Ptrend = 0·02) in women. Total fat was related to a higher risk of overweight/obesity, whereas high carbohydrate intake was related to a lower risk of overweight/obesity in women, which was not observed in men.

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Low-carbohydrate diets and prevalence, incidence and progression of coronary artery calcium in the Multi-Ethnic Study of Atherosclerosis (MESA)

British Journal Of Nutrition ◽

10.1017/s0007114518003513 ◽

2019 ◽

Vol 121 (4) ◽

pp. 461-468 ◽

Cited By ~ 2

Author(s):

Tian Hu ◽

David R. Jacobs ◽

Lydia A. Bazzano ◽

Alain G. Bertoni ◽

Lyn M. Steffen

Keyword(s):

Coronary Artery ◽

Robust Regression ◽

Epidemiological Studies ◽

Total Carbohydrate ◽

Baseline Measure ◽

Cross Sectional ◽

Ethnic Study ◽

Low Carbohydrate ◽

The Relationship

AbstractThe evidence linking low-carbohydrate diets (LCD) to CVD is controversial, and results from epidemiological studies are inconsistent. We aimed to assess the relationship between LCD patterns and coronary artery Ca (CAC) scores from computed tomography in the Multi-Ethnic Study of Atherosclerosis cohort. Our sample included 5614 men and women free of clinical CVD at baseline (2000–2002), who had a FFQ, a baseline measure and ≥1 measure of CAC during follow-up. We excluded those with implausible energy intake or daily physical activity. The overall, animal-based and plant-based LCD scores were calculated based on intakes of macronutrients. Relative risk regression and robust regression models were used to examine the cross-sectional and longitudinal relationship between LCD score quintile and CAC outcomes, after adjustment for multiple cardiovascular risk factors. The mean age of participants was 63 years. The median intakes of total carbohydrate, fat and protein were 53·7, 30·5 and 15·6 % energy/d, respectively. Among 2892 participants with zero CAC scores at baseline, 264 developed positive scores during 2·4-year follow-up (11–59 months). Among those with positive scores at baseline, the median increase in CAC was 47 units over the course of follow-up. The overall, the animal-based and the plant-based LCD scores were not associated with CAC prevalence, incidence and progression. In conclusion, diets low in carbohydrate and high in fat and/or protein, regardless of the sources of protein and fat, were not associated with higher levels of CAC, a validated predictor of cardiovascular events, in this large multi-ethnic cohort.

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Serum alkaline phosphatase levels and the risk of new-onset diabetes in hypertensive adults

Cardiovascular Diabetology ◽

10.1186/s12933-020-01161-x ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Yuanyuan Zhang ◽

Chun Zhou ◽

Jianping Li ◽

Yan Zhang ◽

Di Xie ◽

...

Keyword(s):

Alkaline Phosphatase ◽

Fasting Glucose ◽

Serum Alkaline Phosphatase ◽

Positive Association ◽

Trial Registration ◽

Clinical Trial Registration ◽

Onset Diabetes ◽

Increased Risk ◽

New Onset

Abstract Background The association between alkaline phosphatase (ALP) and incident diabetes remains uncertain. Our study aimed to investigate the prospective relation of serum ALP with the risk of new-onset diabetes, and explore possible effect modifiers, in hypertensive adults. Methods A total 14,393 hypertensive patients with available ALP measurements and without diabetes and liver disease at baseline were included from the China Stroke Primary Prevention Trial (CSPPT). The primary outcome was new-onset diabetes, defined as physician-diagnosed diabetes or use of glucose-lowering drugs during follow-up, or fasting glucose ≥ 7.0 mmol/L at the exit visit. The secondary study outcome was new-onset impaired fasting glucose (IFG), defined as FG < 6.1 mmol/L at baseline and ≥ 6.1 but < 7.0 mmol/L at the exit visit. Results Over a median of 4.5 years follow-up, 1549 (10.8%) participants developed diabetes. Overall, there was a positive relation of serum ALP and the risk of new-onset diabetes (per SD increment, adjusted OR, 1.07; 95% CI: 1.01, 1.14) and new-onset IFG (per SD increment, adjusted OR, 1.07; 95% CI: 1.02, 1.14). Moreover, a stronger positive association between baseline ALP (per SD increment) with new-onset diabetes was found in participants with total homocysteine (tHcy) < 10 μmol/L (adjusted OR, 1.24; 95% CI: 1.10, 1.40 vs. ≥ 10 μmol/L: adjusted OR, 1.03; 95% CI: 0.96, 1.10; P-interaction = 0.007) or FG ≥ 5.9 mmol/L (adjusted OR, 1.16; 95% CI: 1.07, 1.27 vs. < 5.9 mmol/L: adjusted OR, 1.00; 95% CI: 0.93, 1.08; P-interaction = 0.009) Conclusions In this non-diabetic, hypertensive population, higher serum ALP was significantly associated with the increased risk of new-onset diabetes, especially in those with lower tHcy or higher FG levels. Clinical Trial Registration-URL Trial registration: NCT00794885 (clinicaltrials.gov). Retrospectively registered November 20, 2008.

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Vitamin B12 and risk of diabetes: new insight from cross-sectional and longitudinal analyses of the China Stroke Primary Prevention Trial (CSPPT)

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001423 ◽

2020 ◽

Vol 8 (1) ◽

pp. e001423

Author(s):

Lishun Liu ◽

Xiao Huang ◽

Binyan Wang ◽

Yun Song ◽

Tengfei Lin ◽

...

Keyword(s):

Primary Prevention ◽

Positive Association ◽

Prevention Trial ◽

Vitamin B ◽

Longitudinal Analyses ◽

Primary Prevention Trial ◽

Cross Sectional ◽

Onset Diabetes ◽

New Onset

IntroductionPrevious studies in mostly Western populations have yielded conflicting findings on the association of vitamin B12 with diabetes risk, in part due to differences in study design and population characteristics. This study sought to examine the vitamin B12–diabetes association in Chinese adults with hypertension by both cross-sectional and longitudinal analyses.Research design and methodsThis report included a total of 16 699 participants from the China Stroke Primary Prevention Trial, with pertinent baseline and follow-up data. Diabetes mellitus was defined as either physician-diagnosed diabetes, use of glucose-lowering drugs, or fasting blood glucose (FBG) ≥7.0 mmol/L. New-onset diabetes was defined as any new case of onset diabetes during the follow-up period or FBG ≥7.0 mmol/L at the exit visit.ResultsAt baseline, there were 1872 (11.2%) patients with diabetes; less than 1.5% had clinical vitamin B12 deficiency (<148.0 pmol/L). Over a median follow-up period of 4.5 years, there were 1589 (10.7%) cases of new-onset diabetes. Cross-sectional analyses showed a positive association between baseline vitamin B12 levels and FBG levels (β=0.18, 95% CI 0.15 to 0.21) and diabetes (OR=1.16, 95% CI 1.10 to 1.21). However, longitudinal analyses showed no association between baseline vitamin B12 and new-onset diabetes or changes in FBG levels. Among a subset of the sample (n=4366) with both baseline and exit vitamin B12 measurements, we found a positive association between an increase in vitamin B12 and an increase in FBG.ConclusionsIn this large Chinese population of patients with hypertension mostly sufficient with vitamin B12, parallel cross-sectional and longitudinal analyses provided new insight into the conflicting findings of previous studies, and these results underscore the need for future studies to consider both baseline vitamin B12 and its longitudinal trajectory in order to better elucidate the role of vitamin B12 in the development of diabetes. Such findings would have important clinical and public health implications.

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