TABLE 2.
Hazard ratio (HR) (95% confidence intervals [CIs]) for all-cause and cause-specific mortality according to serum methylmalonic acid (MMA) concentrations among patients with diabetes in National Health and Nutrition Examination Survey (NHANES).
| Serum MMA concentrations, nmol/L |
||||||
| Causes of death | <120 | 120–175 | 175–250 | ≥250 | p-trend | Per one-unit increment innatural log-transformed MMA |
| All causes mortality | ||||||
| Number of deaths/total | 131/927 | 252/1,012 | 188/572 | 272/586 | ||
| Crude | 1.000 (ref.) | 1.927 (1.559–2.380) | 3.234 (2.586–4.045) | 5.609 (4.546–6.921) | 0.000 | 4.596 (3.891–5.428) |
| Model 1 | 1.000 (ref.) | 1.466 (1.183–1.816) | 2.005 (1.590–2.527) | 3.097 (2.477–3.873) | 0.000 | 2.977 (2.440–3.633) |
| Model 2 | 1.000 (ref.) | 1.287 (0.888–1.865) | 1.665 (1.082–2.561) | 2.119 (1.395–3.219) | 0.003 | 2.443 (1.472–4.053) |
| Model 3 | 1.000 (ref.) | 1.225 (0.839–1.789) | 1.713 (1.104–2.657) | 2.181 (1.421–3.347) | 0.002 | 2.683 (1.575–4.572) |
| CVD mortality | ||||||
| Number of deaths | 33 | 73 | 54 | 82 | ||
| Crude | 1.000 (ref.) | 1.933 (1.387–2.694 | 2.932 (2.050–4.194) | 5.116 (3.663–7.145) | 0.000 | 4.383 (3.335–5.760) |
| Model 1 | 1.000 (ref.) | 1.490 (1.065–2.086) | 1.851 (1.279–2.680) | 2.914 (2.042–4.157) | 0.000 | 2.902 (2.093–4.025) |
| Model 2 | 1.000 (ref.) | 2.470 (1.159–5.264) | 1.008 (0.359–2.827) | 2.736 (1.156–6.476) | 0.016 | 3.361 (1.663–6.796) |
| Model 3 | 1.000 (ref.) | 2.268 (1.053–4.883) | 0.991 (0.348–2.825) | 2.509 (1.044–6.027) | 0.038 | 2.062 (1.728–5.842) |
| Cancer mortality | ||||||
| Number of deaths | 26 | 45 | 26 | 34 | ||
| Crude | 1.000 (ref.) | 1.712 (1.056–2.776) | 2.167 (1.256–3.738) | 3.310 (1.978–5.538) | 0.000 | 3.322 (2.037–5.419) |
| Model 1 | 1.000 (ref.) | 1.394 (0.853–2.277) | 1.498 (0.852–2.634) | 2.057 (1.190–3.553) | 0.008 | 2.190 (1.226–3.910) |
| Model 2 | 1.000 (ref.) | 1.418 (0.564–3.564) | 1.968 (0.713–5.429) | 3.973 (1.532–10.301) | 0.017 | 4.755 (1.694–13.346) |
| Model 3 | 1.000(ref.) | 1.230 (0.472–3.205) | 2.000 (0.717–5.578) | 4.242 (1.537–11.712) | 0.015 | 4.515 (1.462–13.947) |
Model 1: adjusted for age (continuous), sex (male, or female), and race/ethnicity (non-Hispanic white, non-Hispanic black, Mexican American, or other).
Model 2: further adjusted (from Model 1) for BMI (<25.0, 25.0–30, or ≥30 kg/m2), education level (less than high school, high school or equivalent, or college or above), family income-poverty ratio (≤1.0, 1.0–3.0, or >3.0), Alcohol drinks (continuous), smoking status (never smoker, ever smoker, or current smoker), and Physical activity (vigorous activity, moderate activity, or Inactive).
Model 3: further adjusted (from Model 2) for Vitamin B12 (pmol/L, continuous), diabetes medication use (no insulin or pills, only diabetes pills, only insulin, or pills and insulin), Measurement of serum MMA (gas chromatography-mass spectrometry, standardized liquid chromatography-tandem mass spectrometry).