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Low fructosamine and mortality - A long term follow-up of 215,011 non-diabetic subjects in the Swedish AMORIS study
Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.ORCID iD: 0000-0002-6933-4637
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2016 (English)In: NMCD. Nutrition Metabolism and Cardiovascular Diseases, ISSN 0939-4753, E-ISSN 1590-3729, Vol. 26, no 12, 1120-1128 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND AIMS: Both high and low fasting glucose has been associated with an increased mortality among individuals without diabetes. This J-shaped association has also been shown for HbA1c in relation to all-cause mortality. High fructosamine is associated with increased mortality. In this study we aim to evaluate if low fructosamine is also associated with increased mortality in non-diabetic subjects.

METHODS AND RESULTS: We included 215,011 subjects from the AMORIS cohort undergoing occupational health screening or primary care in Stockholm, Sweden. Cause specific mortality was obtained from the Swedish Cause-of-Death Register by record linkage. Hazard ratios for the lowest decile of fructosamine were estimated by Cox regression for all-cause (n = 41,388 deaths) and cause-specific mortality during 25 years of follow-up. We observed gradually increased mortality with lower fructosamine in a large segment of the population. In the lowest decile of fructosamine the sex, age, social class and calendar adjusted hazard ratio was 1.20 (95% CI; 1.18-1.27) compared to deciles 2-9. This increased mortality was attenuated after adjustment for six other biomarkers (HR = 1.11 (95% CI; 1.07-1.15)). Haptoglobin, an indicator of chronic inflammation, made the greatest difference in the point estimate. In sensitivity analyses we found an association between low fructosamine and smoking and adjustment for smoking further attenuated the association between low fructosamine and mortality.

CONCLUSION: Low levels of fructosamine in individuals without diabetes were found to be associated with increased mortality. Smoking and chronic inflammation seem to at least partially explain this association but an independent contribution by low fructosamine cannot be excluded.

Place, publisher, year, edition, pages
2016. Vol. 26, no 12, 1120-1128 p.
Keyword [en]
Clinical tool; Content validity; Instrument development; Patient participation; Qualitative analysis
National Category
Clinical Medicine
Research subject
Health and Welfare
URN: urn:nbn:se:du-23276DOI: 10.1016/j.numecd.2016.08.006ISI: 000389518200009PubMedID: 27751668OAI: oai:DiVA.org:du-23276DiVA: diva2:1039787
Available from: 2016-10-25 Created: 2016-10-25 Last updated: 2017-01-23Bibliographically approved

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