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Low fructosamine and mortality - A long term follow-up of 215,011 non-diabetic subjects in the Swedish AMORIS study
Karolinska Inst, Inst Environm Med, Epidemiol Unit, Stockholm, Sweden..
Karolinska Inst, Div Family Med, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden..
Karolinska Univ Hosp, Dept Emergency Med, Huddinge, Sweden.;Karolinska Inst, Dept Internal Med, Solna, Sweden..
Univ Uppsala Hosp, Dept Med Sci, Uppsala, Sweden.;Dalarna Univ, Sch Hlth & Social Studies, Falun, Sweden..
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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]
Fructosamine, Glucose, Inflammation, Smoking, Cardiovascular, Cancer, Mortality
National Category
Cancer and Oncology
URN: urn:nbn:se:uu:diva-312063DOI: 10.1016/j.numecd.2016.08.006ISI: 000389518200009PubMedID: 27751668OAI: oai:DiVA.org:uu-312063DiVA: diva2:1062166
Available from: 2017-01-04 Created: 2017-01-04 Last updated: 2017-01-04Bibliographically approved

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Ärnlöv, Johan
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