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Sci Rep. 2017 Feb 6;7:41338. doi: 10.1038/srep41338.

Serum bilirubin levels and risk of type 2 diabetes: results from two independent cohorts in middle-aged and elderly Chinese.

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Department of Occupational and Environmental Health and State Key Laboratory of Environmental Health for Incubating, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Dongfeng Central Hospital, Dongfeng Motor Corporation and Hubei University of Medicine, Shiyan, Hubei, China.
Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA.
Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.
Duke-NUS Medical School, Singapore, Singapore.
Department of Nutrition and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.


Serum bilirubin is a potent endogenous antioxidant and has been identified as cardiovascular risk in cohort studies, while the relation to type 2 diabetes (T2D) in the elderly remains unclear. We investigated both cross-sectional and prospective associations between serum bilirubin levels and T2D risk in the Dongfeng-Tongji (DFTJ) cohort, and replicated the prospective findings in a nested case-control study (509 cases and 509 controls) within the Singapore Chinese Health Study (SCHS). In the cross-sectional analysis of DFTJ cohort (15,575 participants with 2,532 diabetes cases), serum bilirubin levels (total, direct and indirect) increased in new on-set diabetes and decreased with the diabetic duration. In the longitudinal analysis of DFTJ cohort (772 incident diabetes cases during 4.5 years of follow-up among 12,530 diabetes-free participants at baseline), positive association was found between direct bilirubin and T2D risk comparing extreme quartiles, similar results were observed in the nested case-control study within SCHS. Total and indirect bilirubin levels were not significantly associated with T2D in either cohort. In conclusion, our findings do not support the protective association between serum bilirubin levels and incident T2D in the middle-aged and elderly adults; instead, direct bilirubin levels were associated with increased risk of T2D.

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