Associations between serum retinol and all-cause mortality among adults with prediabetes and diabetes: A cohort study

Abstract

We aimed to explore the associations between serum retinol and all-cause mortality among people with prediabetes and diabetes. The study included 2582 participants with prediabetes and 1654 with diabetes aged ≥40 years from the National Health and Nutrition Examination Survey 2001–2006. Serum retinol was collected from laboratory tests and categorized into five groups, including <50, 50–60, 60–70, 70–80, and ≥80 μg/dL. Deaths were obtained by linkage to National Death Index up to December 31, 2019. Cox proportional hazards models were used to estimate the associations between serum retinol and all-cause mortality. During the follow-up, 993 participants with prediabetes died and 874 participants with diabetes died. There were U-shaped associations between serum retinol and mortality among participants with prediabetes and diabetes, separately. Among participants with prediabetes, compared to serum retinol levels of 50–60 μg/dL, the hazard ratio (HR) (95% confidence interval [CI]) of mortality was 1.40 (95% CI 1.11 to 1.76) and 1.26 (95% CI 1.00 to 1.57) for serum retinol <50 or ≥80 μg/dL, respectively. Among participants with diabetes, compared to serum retinol levels of 50–60 μg/dL, the hazard ratio (HR) (95% confidence interval [CI]) of mortality was 1.25 (95% CI 0.96 to 1.62) and 1.21 (95% CI 0.91 to 1.62) for serum retinol <50 or ≥80 μg/dL, respectively. The U-shaped associations between serum retinol and mortality still existed among participants aged ≥60 years with prediabetes or diabetes but were not statistically significant among those aged 40–59 years with prediabetes or diabetes. In conclusion, both low and excessive serum retinol tended to be with higher mortality risk among people with abnormal blood glucose.