You are here

  • Home
  • Online First
  • Total bilirubin modified the association between diabetes and stroke: a cross-sectional study from NHANES 2011–2016

Article Text

Article menu
Download PDFPDF
Cerebrovascular disease
Original research
Total bilirubin modified the association between diabetes and stroke: a cross-sectional study from NHANES 2011–2016
  1. Zhang Xia1,2,3,
  2. Guozheng Xu1,3,
  3. Mingyang Zhao1,3,
  4. Yuhao Li1,3,
  5. Peiyu Ye1,4,
  6. Yijian Liu1,3,
  7. Herbert Y Gaisano5,
  8. Yan He1,3
  1. 1Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
  2. 2Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  3. 3Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
  4. 4Center for Non-communicable Disease Management, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
  5. 5Department of Medicine and Physiology, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Prof Yan He; yanhe12201220{at}163.com

Abstract

Background Total bilirubin (TBIL) has antioxidant and anti-inflammatory properties. This study aimed to determine whether elevated TBIL could modify the association between diabetes and stroke.

Method Data were obtained from the National Health and Nutrition Examination Survey 2011–2016. TBIL was stratified by median (10.3 µmol/L). The association between diabetes and stroke was quantified using multivariable logistic regression models. The cut-off concentration for the presence of TBIL modification effects was identified by Johnson-Neyman analyses. Mediation analyses were performed to determine the influence of TBIL on mediating factors that mediate the relationship between diabetes and stroke.

Results This cross-sectional study included 16 130 participants, with the mean age of 46.8±0.4 years and 48.5% of men. Diabetes was associated with the presence of stroke at TBIL <10.3 µmol/L (OR=2.19, 95% CI 1.58 to 3.05) but not at TBIL ≥10.3 µmol/L (OR=1.27, 95% CI 0.85 to 1.88) after adjustment for confounders. Above associations were significantly different between the two TBIL concentrations (P for interaction=0.03). Moreover, the modification effect of TBIL specifically occurred in men (P for interaction=0.02) rather than in women (P for interaction=0.08). The cut-off concentration for the presence of TBIL modification effects was 17.05 µmol/L. Additionally, the TBIL of ≥10.3 µmol/L inhibited mediating effects of hypersensitive C reactive protein (mediating effect=0.03, 95% CI −0.15 to 0.22, P=0.72) and systemic immune-inflammation index (mediating effect=0.01, 95% CI −0.01 to 0.04, P=0.29) as compared with the TBIL of <10.3 µmol/L.

Conclusions Elevated TBIL modified the association between diabetes and stroke through inhibiting mediating effects of inflammatory factors.

  • STROKE
  • DIABETES MELLITUS

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request to the corresponding author.

https://doi.org/10.1136/jnnp-2024-334408

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    Data are available upon reasonable request. Data are available upon reasonable request to the corresponding author.

    View Full Text

    Footnotes

    • ZX and GX contributed equally.

    • Contributors GX, YH and ZX conceived and designed the work. GX contributed to data acquisition. GX, ZX and YH contributed to methodology and data analyses. All authors contributed to data interpretation. GX and ZX wrote the first draft of the manuscript. YH, MZ, YHL, PY, YJL and HYG contributed to the revision of the manuscript. YH is the guarantor of this work, has full access to all the data in the study and takes responsibility for the integrity of the data. All authors read and approved the final manuscript.

    • Funding This study was supported by the grant from the National Natural Science Foundation of China (82073648). The funder had no role in study design, data collection, analysis, decision to publish or preparation of the manuscript.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.